The SAGE encyclopedia of psychology and gender (4 Volume Set) [1-4] 9781483384283

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The SAGE Encyclopedia of

Psychology and Gender

Editorial Board Editor Kevin L. Nadal John Jay College of Criminal Justice and The Graduate Center at City University of New York

Associate Editors Silvia L. Mazzula John Jay College of Criminal Justice and The Graduate Center at City University of New York David P. Rivera Queens College, City University of New York

Editorial Board lore m. dickey Louisiana Tech University Michelle Fine The Graduate Center at City University of New York Michi Fu Alliant International University Los Angeles Beverly A. Greene St. John’s University Jioni A. Lewis University of Tennessee, Knoxville Gina C. Torino SUNY Empire State College

The SAGE Encyclopedia of

Psychology and Gender 1

Edited by Kevin L. Nadal

John Jay College of Criminal Justice and The Graduate Center at City University of New York

FOR INFORMATION:

Copyright © 2017 by SAGE Publications, Inc.

SAGE Publications, Inc. 2455 Teller Road Thousand Oaks, California 91320 E-mail: [email protected] SAGE Publications Ltd.

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Names: Nadal, Kevin L., editor.

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Title: The SAGE encyclopedia of psychology and gender / edited by Kevin L. Nadal, John Jay College of Criminal Justice.

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Other titles: Encyclopedia of psychology and gender

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Description: First Edition. | Thousand Oaks : SAGE Publications, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2017014081 | ISBN 9781483384283 (hardcover : alk. paper) Subjects: LCSH: Gender identity. | Developmental psychobiology. Classification: LCC BF692.2 .S234 2017 | DDC 155.3/3—dc23 LC record available at https://lccn.loc.gov/2017014081

Acquisitions Editor: Maureen Adams Editorial Assistant: Jordan Enobakhare Developmental Editor: Carole Maurer Reference Systems Manager: Leticia Gutierrez Production Editor: Tracy Buyan Copy Editors: QuADS Prepress (P) Ltd. Typesetter: Hurix Systems Pvt. Ltd.

This book is printed on acid-free paper.

Proofreaders: Lawrence Baker, Sarah Duffy, Annette Van Deusen Indexer: Maria Sosnowski Cover Designer: Candice Harman Marketing Manager: Kate Brummitt Cover images: A  dam Hester/Getty Images Thinkstock.com/Design Pics ©iStockphoto.com/SolStock Roy Rochlin/Getty Images

17  18  19  20  21  10  9  8  7  6  5  4  3  2  1

Contents Volume 1 List of Entries   vii Reader’s Guide   xv About the Editors   xxiii Contributors   xxv Introduction  xli Entries A 1 C 275 B 121 D 423

Volume 2 List of Entries   vii Entries E 479 H 817 F 537 I 913 G 589

Volume 3 List of Entries   vii Entries J 997 O 1247 K 1009 P 1253 L 1017 Q 1383 M 1091 R 1389 N 1221

Volume 4 List of Entries   vii Entries S 1433 V 1749 T 1657 W 1771 Appendix A: Chronology   1857 Appendix B: Resource Guide   1865 Index  1869

List of Entries Ability Status and Gender Ability Status and Sexual Orientation Abortion Abstinence Abstinence in Adolescence Abstinence-Only Education Acceptance and Commitment Therapy Acquaintance Rape Adlerian Theories of Gender Development Adolescence and Gender: Overview Affirmative Action Ageism Agender. See Genderqueer Aging and Gender: Overview Aging and Mental Health Agoraphobia and Gender Alcoholism and Gender Alexithymia Allies Ambivalent Sexism Androcentrism Androgyny Anorexia and Gender Anti-Feminist Backlash Antisocial Personality Disorder and Gender Anti-Trans Bias in the DSM Anxiety Disorders and Gender Arab Americans and Gender Arab Americans and Sexual Orientation Arab Americans and Transgender Identity Asexuality Asian Americans and Gender Asian Americans and Sexual Orientation Asian Americans and Transgender Identity Assisted Reproduction and Alternative Families Assisted Suicide, Euthanasia, and Gender Attraction Avoidant Personality Disorder and Gender

Behavioral Approaches and Gender Behavioral Disorders and Gender Behavioral Theories of Gender Development Bem Sex Role Inventory Benevolent Sexism Biculturalism and Gender Biculturalism and Sexual Orientation Biculturalism and Transgender Identity Bi-Gender Biological Sex and Cognitive Development Biological Sex and Health Outcomes Biological Sex and Language and Communication Biological Sex and Mental Health Outcomes Biological Sex and Social Development Biological Sex and the Brain Biological Sex Differences: Overview Biological Theories of Gender Development Biopsychology Biphobia Bipolar Disorder and Gender Bisexual Identity Development Bisexuality Black Americans and Gender Black Americans and Sexual Orientation Black Americans and Transgender Identity Body Dysmorphic Disorder and Gender Body Image Body Image and Adolescence Body Image and Aging Body Image Issues and Men Body Image Issues and Women Body Modification Body Objectification Borderline Personality Disorder and Gender Brain Lateralization Breastfeeding Buddhism and Gender Buddhism and Sexual Orientation Bulimia and Gender vii

viii   List of Entries

Bullying, Gender-Based Bullying in Adolescence Bullying in Childhood Butch Bystanders Campus Rape Career Choice and Gender Career Choice and Sexual Orientation Caretakers, Experiences of Child Adoption and Gender Child Neglect Child Play Childhood and Gender: Overview Children With LGBTQ Parents Children With Transgender Parents Children’s Cognitive Development Children’s Moral Development Children’s Social-Emotional Development Christianity and Gender Christianity and Sexual Orientation Cisgender Cissexism Cognitive Approaches and Gender Cognitive Disorders in Men Cognitive Disorders in Women Cognitive Theories of Gender Development Colonialism and Gender Coming Out Processes for LGBTQ Youth Coming Out Processes for Transgender People Community and Aging Competition and Gender Comprehensive Sexuality Education Congenital Adrenal Hyperplasia Consciousness-Raising Groups Contraception Conversion Therapy. See Sexual Orientation Change Efforts Couples Therapy With Heterosexual Couples Couples Therapy With Same-Sex Couples Criminal Justice System and Gender Criminal Justice System and Sexual Orientation Criminal Justice System and Transgender People Criminalization of Gender Nonconformity Criminalization of Men of Color Criminalization of Transgender People Critical Race Feminism Cross-Cultural Differences in Gender Cross-Cultural Models or Approaches to Gender Cultural Competence

Cultural Gender Role Norms Cyberbullying Cycles of Abuse Date Rape Delusional Disorder and Gender Demasculation. See Masculinity Threats Dependent Personality Disorder and Gender Depression and Gender Depression and Men Depression and Women Developmental and Biological Processes: Overview Dialectical Behavior Therapy and Gender Disability and Adolescence Disability and Aging Disability and Childhood Discursive Approaches Dissociative Disorders and Gender Division of Domestic Labor Doing Gender Domestic Care Industry and Women Dual Diagnosis and Gender Dual Minority Status Eating Disorders and Gender Ecofeminism Education and Gender: Overview Egg Donation Emasculation. See Masculinity Threats Emotional Abuse Emotions in Adolescence and Gender End-of-Life and Existential Issues Equal Employment Opportunity Equal Pay for Equal Work Equality Feminism Estrogen Ethics in Gender Research Ethics in Psychotherapy and Gender Ethics of Self-Care for Psychologists Evolutionary Sex Differences Exhibitionism and Gender Existential Approaches and Gender Existential Theories of Gender Development Exoticization of LGBTQ People of Color Exoticization of Women of Color Family Relationships in Adolescence Fat Shaming Fatherhood

List of Entries   ix

Female Sex Offenders Femininity Feminism: Overview Feminism and Men Feminist Identity Development Model Feminist Psychology Feminist Therapy Femme Fetal Programming of Gender Fetal Sex Selection Fetishism and Gender First-Wave Feminism Fraternities Friendships in Adolescence Frotteurism and Gender Gambling and Gender Gay Male Identity Development Gay Men Gay Men and Dating Gay Men and Feminism Gay Men and Gender Roles Gay Men and Health Gay Men and Romantic Relationships Gender Affirming Medical Treatments Gender and Society: Overview Gender Balance in Education Gender Bias in Education Gender Bias in Hiring Practices Gender Bias in Research Gender Bias in the DSM Gender Conformity Gender Development, Theories of Gender Discrimination Gender Dynamics in Clinical Supervision Gender Dynamics in Clinical Training Gender Dynamics in Group Therapy Gender Dynamics in Psychotherapy Gender Dysphoria Gender Equality Gender Expression Gender Fluidity Gender Identity Gender Identity and Adolescence Gender Identity and Childhood Gender Identity Disorder, History of Gender Marginality in Adolescence Gender Microinequities Gender Nonconforming Behaviors

Gender Nonconforming People Gender Nonconformity and Transgender Issues: Overview Gender Norms and Adolescence Gender Presentation and Childhood. See Gender Variant Role Expression in Childhood Gender Pronouns Gender Reaffirming Surgeries Gender Role Behavior Gender Role Conflict Gender Role Socialization Gender Role Strain Paradigm Gender Role Stress Gender Roles: Overview Gender Segregation Gender Self-Socialization Gender Self-Socialization Model Gender Socialization in Adolescence Gender Socialization in Aging Gender Socialization in Childhood Gender Socialization in Men Gender Socialization in Women Gender Stereotypes Gender Studies in Higher Education Gender Studies in K–12 Education Gender Tracking in Education Gender Variant Role Expression in Childhood Gender Versus Sex Gender-Based Violence Gender-Based Violence in Athletics Gender-Based Violence in the Media Gender-Biased Language in Research Gendered Behavior Gendered Behaviors in Adolescence Gendered Organizations Gendered Stereotyped Behaviors in Childhood Gendered Stereotyped Behaviors in Men Gendered Stereotyped Behaviors in Women Genderqueer Gilligan’s Moral Development Theory Glass Ceiling. See Women and Leadership; Women in Corporate Positions, Experiences of; Workplace Sexual Harassment Government and Gender Grieving and Gender Hate Crimes Toward LGBTQ People Health at Every Size Health Issues and Gender: Overview Hegemonic Masculinity

x   List of Entries

Help-Seeking Behaviors and Men Help-Seeking Behaviors and Women Heteronormative Bias in Research Heteronormativity Heterosexism Heterosexist Bias in the DSM Heterosexual Male Identity Development Heterosexual Male Relationships Heterosexual Men and Dating Heterosexual Men and Feminism Heterosexual Privilege Heterosexual Romantic Relationships Heterosexual Women and Dating Heterosexuality Histrionic Personality Disorder and Gender HIV/AIDS Homophobia Homosexuality Hormone Therapy for Cisgender Men and Women Hormone Therapy for Transgender People Hostile Sexism Hostile Work Environment. See Women’s Issues: Overview; Workplace Sexual Harassment Human Rights Humanistic Approaches and Gender Humanistic Theories of Gender Development Hypochondriasis and Gender Hysterectomy Identity Construction Identity Development and Aging Identity Formation in Adolescence Identity Formation in Childhood Immigration and Gender Immigration and Sexualities Immigration and Transgender Identity Impostor Syndrome In Vitro Fertilization Inferiority Complex Infertility Institutional Sexism Intermittent Explosive Disorder and Gender Internalized Heterosexism Internalized Sexism Internalized Transphobia International Perspectives on Women’s Mental Health Interpersonal Therapies and Gender

Intersectional Identities Intersectional Theories Intersex Intimacy Intimate Partner Violence Intimate Partner Violence in Same-Sex Couples Islam and Gender Islam and Sexual Orientation Isolation and Aging Judaism and Gender Judaism and Sexual Orientation Juvenile Justice System and Gender Kinsey Reports Kinsey Scale, The Kohlberg’s Stages of Moral Development Labor Movement and Women Late Adulthood and Gender Latina/o Americans and Gender Latina/o Americans and Sexual Orientation Latina/o Americans and Transgender Identity Legal System and Gender Lesbian, Gay, and Bisexual Children Lesbian, Gay, and Bisexual Experiences of Aging Lesbian Identity Development Lesbians Lesbians and Dating Lesbians and Gender Roles Lesbians and Health Lesbians and Romantic Relationships LGBQ Older Adults and Health LGBTQ Athletes, Experiences of LGBTQ Community, Experiences of Transgender People in LGBTQ Community, Gender Dynamics in LGBTQ People of Color and Discrimination LGBTQQ-Affirmative Psychotherapy Long-Term Care Low Testosterone Machismo Male Privilege Mania and Gender Marianismo Marriage Marriage Equality Masculinities Masculinity Gender Norms

List of Entries   xi

Masculinity Ideology and Norms Masculinity in Adolescence Masculinity Threats Masturbation Matriarchy Measuring Gender Measuring Gender Identity Measuring Gender Roles Measuring Sexual Orientation Media and Gender Men and Aging Menopause Men’s Friendships Men’s Group Therapy Men’s Health Men’s Issues: Overview Men’s Studies Menstruation Mental Health and Gender: Overview Mental Health Stigma and Gender Microaggressions Middle Adulthood and Gender Military and Gender Military Sexual Trauma Minority Stress Misogyny Motherhood Multiculturalism and Gender: Overview Multiracial People and Gender Multiracial People and Sexual Orientation Multiracial People and Transgender Identity Narcissistic Personality Disorder and Gender Native Americans and Gender Native Americans and Sexual Orientation. See Two-Spirited People Native Americans and Transgender Identity Nature Versus Nurture Neofeminism Neurofeminism Neurosexism Nonbinary Gender. See Gender Nonconforming People Obsessive-Compulsive Disorder and Gender Orgasm, Psychological Issues Relating to Pacific Islanders and Gender Pacific Islanders and Sexual Orientation Panic Disorder and Gender

Pansexuality Parental Expectations Parental Messages About Gender Parental Stressors Parenting Styles, Gender Differences in Passing Pathologizing Gender Identity Patriarchy Pedophilia and Gender Peer Pressure in Adolescence Perimenopause Perpetrators of Violence Personality Disorders and Gender Bias Physical Abuse Physical Assault, Female Survivors of Physical Assault, Male Survivors of Physical Assault, Transgender Survivors of Pornography and Gender Postpartum Depression Posttraumatic Stress Disorder and Gender Posttraumatic Stress Disorder and Gender Differences in Children Posttraumatic Stress Disorder and Gender Violence Power-Control and Gender Pregnancy Pregnancy Discrimination Pretend Play Psychoanalytic Approaches and Gender Psychoanalytic Feminism Psychoanalytic Theories of Gender Development. See Psychodynamic Theories of Gender Development Psychodynamic Approaches and Gender Psychodynamic Feminism Psychodynamic Theories of Gender Development Psychological Abuse Psychological Measurements, Gender Bias in Psychological Measurements, Sexual Orientation Bias in Psychopathy and Gender Psychosexual Development Psychosis and Gender. See Schizophrenia and Gender Puberty Puberty Suppression Queer Queerness

xii   List of Entries

Quid Pro Quo. See Women’s Issues: Overview; Workplace Sexual Harassment Race and Gender Racial Discrimination, Gender-Based Racial Discrimination, Sexual Orientation–Based Rape Rape Culture Reliability and Gender Reparative Therapy. See Sexual Orientation Change Efforts Reproductive Cancer and Mental Health in Men Reproductive Cancer and Mental Health in Women Reproductive Rights Movement Research: Overview Research Methodology and Gender Revictimization Role Models and Gender Romantic Relationships in Adolescence Romantic Relationships in Adulthood Safe Sex Safe Sex and Adolescence Sampling Bias and Gender Schizoid Personality Disorder and Gender Schizophrenia and Gender Second-Wave Feminism Self-Fulfilling Prophecy and Gender Self-Injury and Gender Sex Culture Sex Education Sex Education in Schools Sex Work Sexism Sexism, Psychological Consequences for Men Sexism, Psychological Consequences for Women Sexual Abuse Sexual Assault Sexual Assault, Adolescent Survivors of Sexual Assault, Child Survivors of Sexual Assault, Female Survivors of Sexual Assault, Male Survivors of Sexual Assault, Survivors of Sexual Coercion Sexual Desire Sexual Disorders and Gender Sexual Dysfunction Sexual Harassment Sexual Identity

Sexual Offenders Sexual Orientation: Overview Sexual Orientation as Research Variable Sexual Orientation Change Efforts Sexual Orientation Disturbance, History of Sexual Orientation Dynamics in Clinical Supervision Sexual Orientation Dynamics in Clinical Training Sexual Orientation Dynamics in Group Therapy Sexual Orientation Dynamics in Psychotherapy Sexual Orientation Identity Sexual Orientation Identity Development Sexuality and Adolescence Sexuality and Aging Sexuality and Men Sexuality and Social Media Sexuality and Women Sexually Transmitted Diseases Sleep Disorders and Gender Sleep Disorders and LGBTQ People Slut Shaming Social Anxiety Disorder and Gender Social Class and Gender Social Class and Sexual Orientation Social Media and Gender Social Role Theory Sociodramatic Play/Role-Play Socioeconomic Status and Gender Sodomy Laws Somatization Disorder and Gender Sororities Sperm Donor Spirituality and Gender Spirituality and Sexual Orientation Sports and Gender Spousal Rape Stalking STEM Fields and Gender Stereotype Threat and Gender Stereotype Threat in Education Stigma of Aging Stranger Rape Street Harassment Substance Use and Gender Substance Use Disorders and Gender. See Substance Use and Gender Subtle Sexism Suicide and Gender Suicide and Sexual Orientation Superwoman Complex

List of Entries   xiii

Superwoman Squeeze Surrogacy Take Back the Night Teacher Bias Teaching Feminism Teaching Human Sexuality Teen Fathers Teen Mothers Testosterone Theories and Therapeutic Approaches: Overview Third Gender Third-Wave Feminism Title IX Trans* Transgender and Gender Nonconforming Adolescents Transgender and Gender Nonconforming Identity Development Transgender Children Transgender Day of Action Transgender Day of Remembrance Transgender Experiences of Aging Transgender People Transgender People and Dating Transgender People and Health Disparities Transgender People and Resilience Transgender People and Romantic Relationships Transgender People and Violence Transgender Research, Bias in Transgender Studies Transmisogyny Transphobia Transphobia Bias in the DSM. See Anti-Trans Bias in the DSM Transsexual Transvestic Fetishism Turner Syndrome Two-Spirited People

Validity and Gender Vicarious Sexism Vicarious Trauma Victim Blaming Violence Against Women Act Violence and Gender: Overview Voting and Gender Voyeurism and Gender White/European Americans and Gender White/European Americans and Sexual Orientation White/European Americans and Transgender Identity Womanism Women and Aging Women and Leadership Women and War Women Athletes, Experiences of Women in Academia, Experiences of Women in Corporate Positions, Experiences of Women in Government, Experiences of Women in Public Safety, Experiences of Women in Religious Leadership, Experiences of Women in STEM Fields, Experiences of Women in the Military, Experiences of Women Leaders in Political Movements, Experiences of Women of Color and Discrimination Women’s Friendships Women’s Group Therapy Women’s Groups Women’s Health Women’s Issues: Overview Women’s Studies Womyn Workplace and Gender: Overview Workplace Sexual Harassment Worldviews and Gender Research

Reader’s Guide The Reader’s Guide is provided to assist readers in locating articles on related topics. It classifies articles into 20 general topical categories: Adolescence; Aging; Biological Sex Differences; Childhood; Developmental and Biological Processes; Education; Feminism; Gender and Society; Gender Nonconformity and Transgender Issues; Gender Roles; Health Issues and Gender; Men’s Issues; Mental Health and Gender; Multiculturalism and Gender; Research; Sexual Orientation; Theories and Therapeutic Approaches; Violence and Gender; Women’s Issues; The Workplace and Gender. Adolescence

Aging

Abstinence in Adolescence Adolescence and Gender: Overview Attraction Body Image and Adolescence Bullying, Gender-Based Bullying in Adolescence Coming Out Processes for LGBTQ Youth Cyberbullying Disability and Adolescence Emotions in Adolescence and Gender Family Relationships in Adolescence Friendships in Adolescence Gender Identity and Adolescence Gender Marginality in Adolescence Gender Norms and Adolescence Gender Socialization in Adolescence Gendered Behaviors in Adolescence Identity Formation in Adolescence Masculinity in Adolescence Peer Pressure in Adolescence Puberty Suppression Role Models and Gender Romantic Relationships in Adolescence Safe Sex and Adolescence Sexual Assault, Adolescent Survivors of Sexuality and Adolescence Teen Fathers Teen Mothers Transgender and Gender Nonconforming Adolescents

Ageism Aging and Gender: Overview Aging and Mental Health Body Image and Aging Brain Lateralization Caretakers, Experiences of Community and Aging Disability and Aging End-of-Life and Existential Issues Gender Socialization in Aging Identity Development and Aging Isolation and Aging Late Adulthood and Gender Lesbian, Gay, and Bisexual Experiences of Aging LGBQ Older Adults and Health Long-Term Care Men and Aging Menopause Middle Adulthood and Gender Sexuality and Aging Stigma of Aging Transgender Experiences of Aging Women and Aging Biological Sex Differences

Biological Sex and Cognitive Development Biological Sex and Health Outcomes Biological Sex and Language and Communication

xv

xvi   Reader’s Guide

Biological Sex and Mental Health Outcomes Biological Sex and Social Development Biological Sex and the Brain Biological Sex Differences: Overview Cognitive Disorders in Men Cognitive Disorders in Women Evolutionary Sex Differences Gender Versus Sex Intersex Neurofeminism Neurosexism Orgasm, Psychological Issues Relating to Turner Syndrome Childhood

Behavioral Disorders and Gender Bullying in Childhood Child Adoption and Gender Child Neglect Child Play Childhood and Gender: Overview Children With LGBTQ Parents Children With Transgender Parents Children’s Cognitive Development Children’s Moral Development Children’s Social-Emotional Development Disability and Childhood Gender Identity and Childhood Gender Self-Socialization Gender Socialization in Childhood Gender Variant Role Expression in Childhood Gendered Stereotyped Behaviors in Childhood Identity Formation in Childhood Lesbian, Gay, and Bisexual Children Nature Versus Nurture Parental Expectations Parental Messages About Gender Parental Stressors Parenting Styles, Gender Differences in Posttraumatic Stress Disorder and Gender Differences in Children Pretend Play Sexual Assault, Child Survivors of Transgender Children Developmental and Biological Processes

Asexuality Biopsychology Bisexual Identity Development

Congenital Adrenal Hyperplasia Developmental and Biological Processes: Overview Fetal Programming of Gender Fetal Sex Selection Gay Male Identity Development Gender Development, Theories of Gendered Behavior Inferiority Complex Internalized Heterosexism Internalized Sexism Internalized Transphobia Lesbian Identity Development Masturbation Psychosexual Development Puberty Sexual Desire Sexual Orientation Identity Development Transgender and Gender Nonconforming Identity Development Education

Abstinence-Only Education Career Choice and Gender Career Choice and Sexual Orientation Comprehensive Sexuality Education Education and Gender: Overview Ethics of Self-Care for Psychologists Gender Balance in Education Gender Bias in Education Gender Studies in Higher Education Gender Studies in K-12 Education Gender Tracking in Education Impostor Syndrome Men’s Studies Self-Fulfilling Prophecy and Gender Sex Education in Schools STEM Fields and Gender Stereotype Threat in Education Teacher Bias Transgender Studies Women’s Studies Feminism

Body Objectification Consciousness Raising Groups Critical Race Feminism Ecofeminism Equality Feminism

Reader’s Guide   xvii

Feminism: Overview Feminism and Men Feminist Identity Development Model Feminist Psychology First-Wave Feminism Neofeminism Second-Wave Feminism Teaching Feminism Third-Wave Feminism Womanism Women’s Studies Gender and Society

Ambivalent Sexism Anti-Feminist Backlash Benevolent Sexism Body Modification Breastfeeding Criminal Justice System and Gender Criminal Justice System and Sexual Orientation Criminal Justice System and Transgender People Division of Domestic Labor Fat Shaming Fatherhood Fraternities Gender and Society: Overview Gender Equality Gender Role Behavior Gender Segregation Gender Stereotypes Government and Gender Heteronormativity Heterosexism Homophobia Homosexuality Hostile Sexism Human Rights Institutional Sexism Juvenile Justice System and Gender Legal System and Gender Marriage Matriarchy Media and Gender Microaggressions Military and Gender Motherhood Patriarchy Pornography and Gender Race and Gender Reproductive Rights Movement

Romantic Relationships in Adulthood Sex Culture Sex Work Sexism Sexism, Psychological Consequences for Men Sexism, Psychological Consequences for Women Sexual Identity Sexual Orientation Identity Sexuality and Social Media Social Role Theory Sodomy Laws Sororities Sports and Gender Stalking Stereotype Threat and Gender Street Harassment Subtle Sexism Transgender People Vicarious Sexism Voting and Gender Gender Nonconformity and Transgender Issues

Androgyny Bi-Gender Cisgender Cissexism Coming Out Processes for Transgender People Criminal Justice System and Transgender People Criminalization of Gender Nonconformity Doing Gender Gender Affirming Medical Treatments Gender Dysphoria Gender Expression Gender Fluidity Gender Identity Gender Identity Disorder, History of Gender Nonconforming Behaviors Gender Nonconforming People Gender Nonconformity and Transgender Issues: Overview Gender Pronouns Gender Role Socialization Genderqueer Passing Pathologizing Gender Identity Physical Assault, Transgender Survivors of Third Gender Trans* Transgender People

xviii   Reader’s Guide

Transgender People and Dating Transgender People and Health Disparities Transgender People and Resilience Transgender People and Romantic Relationships Transphobia Transsexual Transvestic Fetishism Two-Spirited People Gender Roles

Butch Cultural Gender Role Norms Femininity Femme Gay Men and Gender Roles Gender Conformity Gender Role Behavior Gender Role Conflict Gender Role Socialization Gender Role Strain Paradigm Gender Role Stress Gender Roles: Overview Gender Stereotypes Gendered Behavior Gendered Behaviors in Adolescence Gendered Stereotyped Behaviors in Childhood Gendered Stereotyped Behaviors in Men Gendered Stereotyped Behaviors in Women Lesbians and Dating Lesbians and Gender Roles Masculinity Gender Norms Health Issues and Gender

Abortion Abstinence Assisted Reproduction and Alternative Families Body Image Contraception Eating Disorders and Gender Egg Donation Estrogen Gender Reaffirming Surgeries Health at Every Size Health Issues and Gender: Overview HIV/AIDS Hormone Replacement Therapy for Cisgender Men and Women Hormone Therapy for Transgender People

Hysterectomy In Vitro Fertilization Infertility Intimacy Low Testosterone Menopause Menstruation Orgasm, Psychological Issues Relating to Perimenopause Pregnancy Reproductive Cancer and Mental Health in Men Reproductive Cancer and Mental Health in Women Safe Sex Sex Education Sexual Dysfunction Sexually Transmitted Diseases Sperm Donor Substance Use and Gender Surrogacy Teaching Human Sexuality Testosterone Men’s Issues

Alexithymia Androcentrism Body Image Issues and Men Competition and Gender Depression and Men Fatherhood Fraternities Gay Men and Dating Gay Men and Feminism Gay Men and Health Gay Men and Romantic Relationships Gender Role Conflict Gender Role Strain Paradigm Gender Role Stress Gender Socialization in Men Gendered Stereotyped Behaviors in Men Hegemonic Masculinity Help-Seeking Behaviors and Men Heterosexual Male Identity Development Heterosexual Male Relationships Heterosexual Men and Dating Heterosexual Men and Feminism Heterosexual Romantic Relationships Male Privilege Masculinities

Reader’s Guide   xix

Masculinity Gender Norms Masculinity Ideology and Norms Masculinity Threats Men and Aging Men’s Friendships Men’s Group Therapy Men’s Health Men’s Issues: Overview Physical Assault, Male Survivors of Sexism, Psychological Consequences for Men Sexual Assault, Male Survivors of Sexuality and Men Mental Health and Gender

Agoraphobia and Gender Alcoholism and Gender Anorexia and Gender Antisocial Personality Disorder and Gender Anti-Trans Bias in the DSM Anxiety Disorders and Gender Assisted Suicide, Euthanasia, and Gender Avoidant Personality Disorder and Gender Behavioral Disorders and Gender Bipolar Disorder and Gender Body Dysmorphic Disorder and Gender Borderline Personality Disorder and Gender Bulimia and Gender Delusional Disorder and Gender Dependent Personality Disorder and Gender Depression and Gender Discursive Approaches Dissociative Disorders and Gender Dual Diagnosis and Gender Exhibitionism and Gender Fetishism and Gender Frotteurism and Gender Gambling and Gender Gender Bias in the DSM Gender Dysphoria Gender Identity Disorder, History of Grieving and Gender Heterosexist Bias in the DSM Histrionic Personality Disorder and Gender Hypochondriasis and Gender Identity Construction Intermittent Explosive Disorder and Gender Mania and Gender Mental Health and Gender: Overview Mental Health Stigma and Gender

Narcissistic Personality Disorder and Gender Obsessive-Compulsive Disorder and Gender Panic Disorder and Gender Pedophilia and Gender Personality Disorders and Gender Bias Postpartum Depression Posttraumatic Stress Disorder and Gender Psychopathy and Gender Schizoid Personality Disorder and Gender Schizophrenia and Gender Self-Injury and Gender Sexual Disorders and Gender Sexual Orientation Disturbance, History of Sleep Disorders and Gender Sleep Disorders and LGBTQ People Social Anxiety Disorder and Gender Somatization Disorder and Gender Suicide and Gender Suicide and Sexual Orientation Voyeurism and Gender Multiculturalism and Gender

Ability Status and Gender Ability Status and Sexual Orientation Allies Arab Americans and Gender Arab Americans and Sexual Orientation Arab Americans and Transgender Identity Asian Americans and Gender Asian Americans and Sexual Orientation Asian Americans and Transgender Identity Biculturalism and Gender Biculturalism and Sexual Orientation Biculturalism and Transgender Bisexuality Black Americans and Gender Black Americans and Sexual Orientation Black Americans and Transgender Identity Buddhism and Gender Buddhism and Sexual Orientation Bystanders Christianity and Gender Christianity and Sexual Orientation Colonialism and Gender Criminalization of Men of Color Criminalization of Transgender People Cross-Cultural Differences in Gender Cultural Gender Role Norms Dual Minority Status

xx   Reader’s Guide

Exoticization of LGBTQ People of Color Exoticization of Women of Color Gay Men Immigration and Gender Immigration and Sexualities Immigration and Transgender Identity Intersectional Identities Islam and Gender Islam and Sexual Orientation Judaism and Gender Judaism and Sexual Orientation Latina/o Americans and Gender Latina/o Americans and Sexual Orientation Latina/o Americans and Transgender Identity Lesbians LGBTQ Community, Experiences of Transgender People in LGBTQ Community, Gender Dynamics in LGBTQ People of Color and Discrimination Machismo Marianismo Minority Stress Multiculturalism and Gender: Overview Multiracial People and Gender Multiracial People and Sexual Orientation Multiracial People and Transgender Identity Native Americans and Gender Native Americans and Transgender Identity Pacific Islanders and Gender Pacific Islanders and Sexual Orientation Pansexuality Queer Queerness Racial Discrimination, Gender-Based Social Class and Gender Social Class and Sexual Orientation Socioeconomic Status and Gender Spirituality and Gender Spirituality and Sexual Orientation Superwoman Complex Superwoman Squeeze Transgender People White/ European Americans and Gender White/European Americans and Sexual Orientation White/ European Americans and Transgender Identity Women of Color and Discrimination Worldviews and Gender Research

Research

Bem Sex Role Inventory Ethics in Gender Research Gender Bias in Research Gender-Biased Language in Research Heteronormative Bias in Research Kinsey Reports Kinsey Scale, The Measuring Gender Measuring Gender Identity Measuring Gender Roles Measuring Sexual Orientation Psychological Measurements, Gender Bias in Psychological Measurements, Sexual Orientation Bias in Reliability and Gender Research: Overview Research Methodology and Gender Sampling Bias and Gender Sexual Orientation as Research Variable Transgender Research, Bias in Validity and Gender Women in STEM Fields, Experiences of Sexual Orientation

Arab Americans and Sexual Orientation Asexuality Asian Americans and Sexual Orientation Biculturalism and Sexual Orientation Biphobia Bisexual Identity Development Bisexuality Buddhism and Sexual Orientation Children With LGBTQ Parents Christianity and Sexual Orientation Coming Out Processes for LGBTQ Youth Criminal Justice System and Sexual Orientation Gay Male Identity Development Gay Men Gay Men and Health Heterosexual Male Identity Development Heterosexual Privilege Heterosexuality Homosexuality Immigration and Sexualities Internalized Heterosexism Islam and Sexual Orientation

Reader’s Guide   xxi

Judaism and Sexual Orientation Latina/o Americans and Sexual Orientation Lesbian, Gay, and Bisexual Children Lesbian, Gay, and Bisexual Experiences of Aging Lesbian Identity Development Lesbians Lesbians and Health LGBTQ Athletes, Experiences of Marriage Equality Measuring Sexual Orientation Multiracial People and Sexual Orientation Pacific Islanders and Sexual Orientation Pansexuality Passing Psychological Measurements, Sexual Orientation Bias in Queer Queerness Racial Discrimination, Sexual Orientation–Based Sexual Identity Sexual Orientation: Overview Sexual Orientation as Research Variable Sexual Orientation Identity Sexual Orientation Identity Development Social Class and Sexual Orientation Spirituality and Sexual Orientation White/European Americans and Sexual Orientation Theories and Therapeutic Approaches

Acceptance and Commitment Therapy Adlerian Theories of Gender Development Behavioral Approaches and Gender Behavioral Theories of Gender Development Biological Theories of Gender Development Cognitive Approaches and Gender Cognitive Theories of Gender Development Couples Therapy With Heterosexual Couples Couples Therapy With Same-Sex Couples Cross-Cultural Models or Approaches to Gender Cultural Competence Dialectical Behavior Therapy and Gender Ethics in Psychotherapy and Gender Existential Approaches and Gender Existential Theories of Gender Development Feminist Therapy Gender Dynamics in Clinical Supervision Gender Dynamics in Clinical Training

Gender Dynamics in Group Therapy Gender Dynamics in Psychotherapy Gender Self-Socialization Model Gilligan’s Moral Development Theory Humanistic Approaches and Gender Humanistic Theories of Gender Development International Perspectives on Women’s Mental Health Interpersonal Therapies and Gender Intersectional Theories Kohlberg’s Stages of Moral Development LGBTQQ-Affirmative Psychotherapy Psychoanalytic Approaches and Gender Psychoanalytic Feminism Psychodynamic Approaches and Gender Psychodynamic Feminism Psychodynamic Theories of Gender Development Sexual Orientation Change Efforts Sexual Orientation Dynamics in Clinical Supervision Sexual Orientation Dynamics in Clinical Training Sexual Orientation Dynamics in Group Therapy Sexual Orientation Dynamics in Psychotherapy Sociodramatic Play/Role-Play Theories and Therapeutic Approaches: Overview Women’s Group Therapy Violence and Gender

Acquaintance Rape Campus Rape Cycles of Abuse Date Rape Emotional Abuse Female Sex Offenders Gender-Based Violence Gender-Based Violence in Athletics Gender-Based Violence in the Media Hate Crimes Toward LGBTQ People Intimate Partner Violence Intimate Partner Violence in Same-Sex Couples Military Sexual Trauma Misogyny Perpetrators of Violence Physical Abuse Physical Assault, Female Survivors of Physical Assault, Male Survivors of Physical Assault, Transgender Survivors of Posttraumatic Stress Disorder and Gender Violence Power-Control and Gender

xxii   Reader’s Guide

Psychological Abuse Rape Rape Culture Revictimization Sexual Abuse Sexual Assault Sexual Assault, Adolescent Survivors of Sexual Assault, Child Survivors of Sexual Assault, Female Survivors of Sexual Assault, Male Survivors of Sexual Assault, Survivors of Sexual Coercion Sexual Offenders Slut Shaming Spousal Rape Stalking Stranger Rape Take Back the Night Transgender Day of Action Transgender Day of Remembrance Transgender People and Violence Transmisogyny Vicarious Trauma Victim Blaming Violence Against Women Act Violence and Gender: Overview Women’s Issues

Body Image Issues and Women Body Objectification Depression and Women Femininity Feminist Identity Development Model Gender Discrimination Gender Role Behavior Gender Socialization in Women Gendered Stereotyped Behaviors in Women Help-Seeking Behaviors and Women Heterosexual Romantic Relationships Heterosexual Women and Dating Inferiority Complex Internalized Sexism Lesbians and Dating Lesbians and Health

Lesbians and Romantic Relationships Motherhood Physical Assault, Female Survivors of Sexism Sexism, Psychological Consequences for Women Sexual Assault, Female Survivors of Sexual Harassment Sexuality and Women Street Harassment Women and Aging Women’s Friendships Women’s Groups Women’s Health Women’s Issues: Overview Womyn The Workplace and Gender

Affirmative Action Domestic Care Industry and Women Equal Employment Opportunity Equal Pay for Equal Work Gender Bias in Hiring Practices Gender Discrimination Gender Microinequities Gendered Organizations Labor Movement and Women Pregnancy Discrimination Sex Work Sexual Harassment Title IX Women and Leadership Women Athletes, Experiences of Women Coaches, Experiences of Women in Academia, Experiences of Women in Corporate Positions, Experiences of Women in Government, Experiences of Women in Public Safety, Experiences of Women in Religious Leadership, Experiences of Women in STEM Fields, Experiences of Women in the Military, Experiences of Women Leaders in Political Movements, Experiences of Workplace and Gender: Overview Workplace Sexual Harassment

About the Editors About the General Editor Kevin L. Nadal, PhD, is a professor of psychology at both John Jay College of Criminal Justice and the Graduate Center at The City University of New York. From 2014 to 2017, he was the executive director of the CLAGS: The Center for LGBTQ Studies at the Graduate Center at the City University of New York, and he was the first person of color to hold this position in 25 years of the organization. From 2015 to 2017, he was the president of the Asian American Psychological Association (AAPA); he was the first openly gay person to serve in this role. Within AAPA, he cofounded the Division on Filipino Americans in 2010 and the Division on LGBTQ Issues in 2012. He is a National Trustee of the ­Filipino American National Historical Society (FANHS) and coordinated the FANHS national conference in New York in June 2016. He is also the co-founder of the LGBTQ Scholars of Color Network—a national network committed to ­academics and researchers who identify as LGBTQ people of color, which has been funded by the Annie E. Casey Foundation and the Arcus Foundation. For 7 years, he served as a t­raining psychologist with the New York Police D ­ epartment—advocating for mental health awareness toward citizens with a range of psychological disorders. He is the CEO of Nadal and ­Associates—his consulting firm which has allowed him to facilitate trainings and workshops with corporations, hospitals, foundations, educational institutions, and nonprofit organizations, as well as serve as an expert witness for various court cases. Dr. Nadal received bachelor’s degrees in psychology and political science from the University of California at Irvine, a master’s degree in ­counseling from Michigan State University, and a

PhD in counseling psychology from Teachers ­College—Columbia University. He is one of the leading researchers in understanding the impacts of microaggressions, or subtle forms of discrimination, on the mental and physical health of ­people of color; lesbian, gay, bisexual, transgender, and queer people; and other marginalized groups. He has published over 100 works on multicultural issues in the fields of psychology and education. He is the author of several books: Filipino American Psychology: A H ­ andbook of Theory, Research, and Clinical Practice (2011, John Wiley and Sons), Women and Mental Disorders (2011, Praeger), That’s So Gay: Microaggressions and the Lesbian, Gay, Bisexual, and Transgender Community (2013, APA Books), Filipinos in New York City (2015, Arcadia), and Microaggressions and Trauma (expected 2018, APA Books). A California-bred New Yorker, Dr. Nadal was named one of People magazine’s hottest bachelors in 2006, he once won an argument with Bill O’Reilly on Fox News Channel’s The O’Reilly Factor, and he was even once a Hot Topic on ABC’s The View. He has been featured in The Huffington Post, The New York Times, Buzzfeed, PBS, The Weather Channel, The History Channel, HGTV, The Filipino Channel, Mic.com, and others. In 2014, Dr. Nadal launched the series “Out Talk With Dr. Kevin Nadal,” which airs online and on public access television in New York City. The show is committed to discussing issues that are often difficult for people to talk about—including issues like systemic racism, heterosexism, the model minority myth, and the disparities in the criminal justice system. In 2011, Dr. Nadal received the Early Career Award for Contributions to Excellence by the Asian American Psychological Association. In

xxiii

xxiv   About the Editors

2012, he received the Emerging Professional Award for Research from the American Psychological Association Division 45. In 2015, he received the Outstanding Filipino Americans of New York Award for Excellence in Education and Research. In 2016, he won the Faculty Scholarly Excellence Award at John Jay College of Criminal Justice. In 2017, he received the American Psychological Association Early Career Award ­ for Distinguished Contributions to the Public Interest. For more information, visit www.kevinnadal .com or follow him on twitter at @kevinnadal.

About the Associate Editors Silvia L. Mazzula, PhD, LPC, is a psychologist, educator, and speaker with extensive research, clinical, and consulting experience on issues of diversity, equity, and inclusion. Her research focuses on the intersection of racial cultural psychological processes and mental health, multicultural competencies, and Latina/o psychology. Her work has been funded by both private and federal institutes. Dr. Mazzula’s work has been published in scientific journals, book chapters, and encyclopedias. She is the co-author of Ethics for Counselors: Integrating Counseling and Psychology Standards (expected 2017, Springer). Dr. Mazzula has presented her work at over 80 colleges, universities, and professional science meetings throughout the country. She has appeared on NBC and featured in USA Today, ­Washington Times, Atlanta JournalConstitution, and ­others. She has received various accolades including Distinguished Teaching Award by John Jay College of Criminal Justice, Emerging Researcher Award by the New Jersey Psychological Association, and numerous recognitions for outstanding scholarly achievements and grantsmanship from the City University of New York. Dr  Mazzula is a tenured associate professor of psychology at John Jay ­College of Criminal Justice and former president of the Latino psychological

Association of New Jersey. She is nationally respected for her successful outreach to underrepresented scholars, students, and faculty members. She is the executive director of the Latina Researchers Network, the country’s first multidisciplinary network for Latina researchers, scholars, and allies, where she manages program design and incubation. Under her leadership, the Network has grown to over 3,000 scholars, investigators, professors, and academic leaders across the country since its inception in 2012. Website: www.SilviaMazzula.com; Twitter: @DrMazzula David P. Rivera, PhD, is an associate professor of counselor education at Queens College, City University of New York. Dr. Rivera holds degrees from Teachers College, Columbia University, Johns Hopkins University, and the University of Wyoming. A counseling psychologist by training, his practical work in higher education includes college counseling, academic advising, multicultural affairs, and leadership development. He has worked and trained at a variety of institutions including the University of Pennsylvania, the New School University, the Jack Kent Cooke Foundation, and the Addiction Institute of New York. His research focuses on cultural competency development and issues impacting the marginalization and well-being of people of color, oppressed sexual orientation and gender identity groups, and low-income/first-generation college students, with a focus on microaggressions. Dr. Rivera is board co-chair of CLAGS: The Center for LGBTQ Studies, on the executive committee of the Society for the Psychological study of Lesbian, Gay, Bisexual, and Transgender Issues, on the American Psychological Association’s Committee for Sexual Orientation and Gender Diversity, an adviser to the Steve Fund, and faculty with the Council for Opportunity in Education. He has received multiple recognitions for his work from the American Psychological Association, the American College Counseling Association, and the American College Personnel Association.

Contributors Dena Abbott Texas Woman’s University

Nadav Antebi-Gruszka Columbia University

Alexis Adams-Clark Johns Hopkins University

Miriam R. Arbeit Fordham University

Michael E. Addis Clark University

Mari Armstrong-Hough Yale University

Andrew Ahrendt University of Nevada Reno

James E. Arnett University of Tennessee

Nia Aitaoto University of Arkansas for Medical Sciences Northwest Campus

Victor Asal University at Albany

Dorcas Akinniyi University of Wisconsin–Madison

Leslie Ashburn-Nardo Indiana University–Purdue University Indianapolis

Jess K. Alberts Arizona State University

Brien K. Ashdown Hobart & William Smith Colleges

Danielle Alexander University of Louisville

Christopher D. Aults Florida Atlantic University

Saba Rasheed Ali University of Iowa

Michael Awad Teachers College, Columbia University

Kathleen M. Alto University of Akron

Marion Balla Adler Centre of Ottawa Canada

Mónica M. Alzate Baylor College of Medicine

Kimberly F. Balsam Palo Alto University

Julie R. Ancis Georgia Tech

Susan Basow Lafayette College

Natalie S. Anderson Southern Illinois University Edwardsville

Mary-Jo Bautista Independent Scholar

Stephanie M. Anderson The Graduate Center, CUNY

Makini Beck Education Consultant/Independent Scholar

Veanne N. Anderson Indiana State University

J. A. Beese Youngstown State University

Summer Angevin Alliant International University

Matthew Bejar University of Tennessee

xxv

xxvi   Contributors

L. Boyd Bellinger University of Illinois at Chicago

Travis Brace Texas Tech University

Kimberly Belmonte The Graduate Center, CUNY

Jennifer Brady University of Maryland

Adriene M. Beltz University of Michigan

Sara E. Branch Hobart and William Smith Colleges

Pearl Susan Berman Indiana University of Pennsylvania

Dana C. Branson Family Counseling Center, Inc.

Stephen Bernardini Rutgers University–Camden

Alfiee M. Breland-Noble Georgetown University Medical Center

Kristin N. Bertsch University of Pennsylvania

Aaron Samuel Breslow Teachers College, Columbia University

Thomas Bevan Bevan Industries

Melanie E. Brewster Teachers College, Columbia University

Julie Anna Biemer University of Texas at Dallas

Laure Brimbal John Jay College of Criminal Justice and the Graduate Center, CUNY

James Robert Bitter East Tennessee State University Pavel Blagov Whitman College Emily Blake University of Kent Brittany Bloodhart Colorado State University Robyn Bluhm Michigan State University Greg Bohall BHC Alhambra Hospital Teresa M. Bolzenkötter Boston University

Christia Spears Brown University of Kentucky Danice L. Brown Towson University Jill Brown Creighton University Laura S. Brown Private Practice Samantha Brown University of Iowa William J. Bryant University of Missouri–St. Louis Stephanie Budge University of Wisconsin–Madison

Rebecca Bonanno SUNY Empire State College

Stephanie Buehler The Buehler Institute

Jamila Bookwala Lafayette College

Mariel Buque Teachers College, Columbia University

Sarah K. Borowski University of Missouri

Emily C. Burish University of Wisconsin–Eau Claire

Kathryn L. Boucher University of Indianapolis

Theodore R. Burnes Antioch University

Marci Lee Bowers Mills-Peninsula Medical Center

Stephanie T. Burns Western Michigan University

Christin P. Bowman The Graduate Center, CUNY

Shanna E. Butler Pacifica Graduate Institute

Contributors   xxvii

Batsirai Bvunzawabaya University of Pennsylvania

Caleb Chadwick Georgia State University

Lisa G. Byers University of Oklahoma

Stephanie C. Chando University of Pennsylvania Health System

Daramola N. Cabral Empire State College

Doris F. Chang The New School for Social Research

Cynthia Calkins John Jay College of Criminal Justice, CUNY

Sand C. Chang Kaiser Permanente

Rebecca Rangel Campon Seton Hall University

Tiffany K. Chang Indiana University

Silvia Sara Canetto Colorado State University

Sapna Cheryan University of Washington

Annette Cantu University of Texas at Austin

Mun Yuk Chin University of Wisconsin–Madison

Christina M. Capodilupo Teachers College, Columbia University

Jennifer Chmielewski The Graduate Center, CUNY

Linda L. Carli Wellesley College

Sara Cho Kim George Washington University

Joseph K. Carpenter Boston University

Namok Choi University of Louisville

Megan A. Carpenter University of Puget Sound

Joan C. Chrisler Connecticut College

Gizelle V. Carr Howard University

Ann T. Chu A Better Way

Lynne Carroll University of North Florida

Kirstyn Y. S. Chun California State University, Long Beach

Bettina J. Casad University of Missouri–St. Louis

Y. Barry Chung Indiana University

Kim Case University of Houston–Clear Lake

Adam Clevenger Ohio State University

Jeanett Castellanos University of California, Irvine

Stacey L. Coffman-Rosen Rollins College

Jaime Castillo Syracuse University

Priscilla K. Coleman Bowling Green State University

Hannah P. Catalano University of North Carolina Wilmington

David Collict Carleton University

Angela Catena University of New Mexico

Lynn H. Collins La Salle University

Courtney Caviness University of California, Davis

Michael J. Comlish Pacifica Graduate Institute

Alison Cerezo San Francisco State University

Melissa Susan Conroy Muskingum University

xxviii   Contributors

Andres J. Consoli University of California, Santa Barbara

Cirleen DeBlaere Georgia State University

Sarah L. Cook Georgia State University

Ashley DeBlasi Fairleigh Dickinson University

Loree Cook-Daniels FORGE, Inc.

Kevin Delucio University of California, Santa Barbara

Melissa J. Corpus Veterans Affairs Medical Center

Florence L. Denmark Pace University

Ashley R. Cosentino The Chicago School of Professional Psychology

Tamara Deutsch John Jay College of Criminal Justice

Cathy R. Cox Texas Christian University

John Patrick Devine CSPP, Alliant International University

Crystallee Rene Crain California State University, East Bay

Aaron H. Devor University of Victoria

Gene Crofts University of New Mexico

Domenico Di Ceglie Tavistock & Portman NHS Foundation Trust

Angela M. Crossman John Jay College of Criminal Justice, CUNY

Bridget K. Diamond-Welch University of South Dakota

Maria C. Crouch University of Alaska Anchorage

lore m. dickey Louisiana Tech University

Candice Crowell University of Kentucky

Danielle diFilipo John Jay College of Criminal Justice and the Graduate Center, CUNY

Nicola Curtin Clark University T. Elon Dancy II University of Oklahoma Katie Darabos The Graduate Center, CUNY Corinne Cecile Datchi Seton Hall University

Muriel Dimen New York University Lisa M. Dinella Monmouth University Franco Dispenza Georgia State University Michael DiStaso The College of New Jersey

E. J. R. David University of Alaska Anchorage

Tessa Ditonto Iowa State University

Kristin C. Davidoff Independent Scholar

Martin J. Dorahy University of Canterbury

Lindsey S. Davis John Jay College of Criminal Justice, CUNY

Andrea L. Dottolo Rhode Island College

Maria Rosario T. de Guzman University of Nebraska–Lincoln

Naomi Drakeford University of Akron

Annelou L. C. de Vries VU University Medical Center

Donna J. Drucker Technische Universität Darmstadt

Kylan Mattias de Vries Southern Oregon University

Sean Duffy Rutgers University

Contributors   xxix

Melissa S. Dumont Fordham University

Michelle Fine The Graduate Center, CUNY

Andy Dunlap Elizabethtown College

Susan Fineran University of Southern Maine

Chelsie Dunn Alliant International University

Celia B. Fisher Fordham University

Erin C. Dupuis Loyola University

Lauren D. Fisher VA New York Harbor Healthcare System

Christina Dyar Stony Brook University

Leslee A. Fisher University of Tennessee

Rebecca Eaker University of Georgia

Elizabeth H. Flanagan Yale University

Judith A. Easton Texas State University

Mirella Flores University of Missouri–Kansas City

Emily R. Edwards John Jay College of Criminal Justice, CUNY

Yvette G. Flores University of California, Davis

Laura Edwards-Leeper Pacific University

Edna Foa University of Pennsylvania

Jeremy J. Eggleston Vassar College

Lourdes Dolores Follins Kingsborough Community College, CUNY

Elizabeth Devon Eldridge Medical College of Georgia

Alexis Forbes Bonora Rountree, LLC

Tanya Erazo John Jay College of Criminal Justice, CUNY

Aasha B. Foster Teachers College, Columbia University

Mindy J. Erchull University of Mary Washington

Molly Fox University of California, Los Angeles

Kirklyn Escondo Icahn School of Medicine at Mount Sinai

Darren J. Freeman-Coppadge University of Massachusetts Boston

Marie-Joelle Estrada University of Rochester

Bryana H. French University of St. Thomas

Randi Ettner New Health Foundation Worldwide

Adam L. Fried Fordham University

Rhonda J. Factor The New School

David M. Frost Columbia University

Breanne Fahs Arizona State University

Kevin M. Fry University of Tennessee, Knoxville

Sandra L. Faulkner Bowling Green State University

Michi Fu Alliant International University

Erin M. Fekete University of Indianapolis

Kathryn Fuentes The College of New Jersey

Theresa Fiani The Graduate Center, CUNY, and Queens College

Adrian Furnham University College London

xxx   Contributors

Cecile A. Gadson University of Tennessee, Knoxville

David E. Greenan Teachers College, Columbia University

Aileen Garcia University of Nebraska–Lincoln

Frederick G. Grieve Western Kentucky University

Christina Garrison-Diehn U.S. Department of Veterans Affairs

Felicia D. Griffin-Fennell Springfield Technical Community College

Anna Giraldo-Kerr Shades of Success, Inc.

Hali Griswold Fairleigh Dickinson University

Patti Giuffre Texas State University

Jillian Grose-Fifer John Jay College of Criminal Justice, CUNY

Judith Glassgold Independent Practice/Scholar

Joshua B. Grubbs Case Western Reserve University

Alberta M. Gloria University of Wisconsin–Madison

Aya Gruber University of Colorado

Jenna Glover Utah State University

Patrick R. Grzanka University of Tennessee

Laura M. Glynn Chapman University

John F. Gunn Rutgers University

Eva S. Goldfarb Montclair State University

Jeffrey T. Guterman Guterman Counseling Services

Jessica J. Good Davidson College

Cynthia E. Guzmán Kewa Pueblo Health Corporation

Kristopher M. Goodrich University of New Mexico

Tay Hack Angelo State University

Janelle R. Goodwill University of Michigan

Chris Hafen Northern Virginia Community College

Kirsten L. Graham Colorado State University

Elizabeth L. Haines William Paterson University

Rebecca K. Graham Black Dog Institute, University of New South Wales

Douglas C. Haldeman John F. Kennedy University

Jeffrey Grant Pacifica Graduate Institute Michele Grant SUNY Empire State College Debbie Green Fairleigh Dickinson University Eli R. Green William Paterson University Julii M. Green California School of Professional Psychology, Alliant International University

Willie J. Hale University of Texas at San Antonio Amber S. Haley Syracuse University Seydem Hancioglu Syracuse University Audrey Harkness University of California, Santa Barbara Gary W. Harper University of Michigan Meredith Marko Harrigan SUNY Geneseo

Contributors   xxxi

Marissa Hartwig Tennessee Tech University

Dawn M. Howerton Marshall University

Brittany E. Hawkshead University of Georgia

Michael A. Hoyt Hunter College, City University of New York

Robert Heasley Indiana University of Pennsylvania

Helen Hsu City of Fremont

Michael L. Hecht Pennsylvania State University

Majeda Humeidan Zayed University

Doug Henry University of North Texas

Chere Hunter Lehigh University

Krista Lynn Herbert Icahn School of Medicine at Mount Sinai

Farah A. Ibrahim University of Colorado Denver

Melanie D. Hetzel-Riggin Penn State Erie, Behrend College

Ayse Selin Ikizler University of Tennessee–Knoxville

Jianna R. Heuer Private Practice

Arpana G. Inman Lehigh University

Genevieve Heyne Palo Alto University

Jason Isbell University of Oregon

Nicole R. Hill Syracuse University Patrick L. Hill Carleton University Jennifer Hillman Penn State University, Berks College Natalie Eileen Hinchcliffe Philips Family Practice Institute for Family Health Tracy N. Hipp Georgia State University Kerensa Hocken Her Majesty’s Prison Service John P. Hoffmann Brigham Young University

Tania Israel University of California, Santa Barbara Derek Kenji Iwamoto University of Maryland Margo A. Jackson Fordham University at Lincoln Center Nicole L. Jackson U.S. Department of Veterans Affairs Cara Jacobson Loyola University Maryland Stefan Jadajewski University of Akron Nadia Jafari University of North Carolina at Charlotte Elizabeth L. Jeglic John Jay College of Criminal Justice, CUNY

Stefan G. Hofmann Boston University

David J. Johnson Private Clinical Practice & Research

Louise Holdsworth Southern Cross University

Marc P. Johnston-Guerrero Ohio State University

David S. Hong Stanford University

Tiffany Jones University of Wisconsin–Madison

Sharon G. Horne University of Massachusetts Boston

Troy Jones SUNY Empire State College

xxxii   Contributors

Jessica A. Joseph The New School for Social Research

Angela B. Kim CSPP, Alliant International University

Myriam Kadeba University of Akron

Chu Kim-Prieto College of New Jersey

Joseph Keawe’aimoku Kaholokula University of Hawai’i at Manoa

Hunter N. Kincaid The Graduate Center, CUNY

Allison Kalpakci University of Houston

Rukiya King John Jay College of Criminal Justice

Gregory A. Kanhai The New School for Social Research

Matthew Klubeck The College of New Jersey

Jessica Kansky University of Virginia

Anne M. Koenig University of San Diego

Ulas Kaplan Harvard University

Sarah Koenig University of Texas at Austin

Erin Karahuta Lehigh University Alian Kasabian University of Nebraska, Lincoln Anusha Kassan University of Calgary Steven Kassirer Syracuse University Debra M. Kawahara Alliant International University Lucas A. Keefer University of Dayton Steven T. Keener Virginia Commonwealth University Erika L. Kelley Ohio University

Car Mun Kok University of California Cooperative Extension–Mendocino County Akhila Elizabeth Kolesar Sacred Wheel Psychological Services Debra Kram-Fernandez SUNY Empire State College Maxine Krengel Boston University School of Medicine Matthew Kridel University of South Alabama Ann M. Kring University of California, Berkeley Christa Krüger University of Pretoria

Robyn Kelly University of Minnesota

Anniken Lucia Willumsen Laake John Jay College of Criminal Justice, CUNY

Sara G. Kern University of Missouri–St. Louis

Deborah Laible Lehigh University

Thomas A. Kernodle SUNY Empire State College

Jaime Lam University of Wisconsin–Madison

Mike Kersten Texas Christian University

Mark J. Landau University of Kansas

Mona A. Khalil Fordham University

Michael Larkin The College of New Jersey

Maryam Kia-Keating University of California, Santa Barbara

Campbell Leaper University of California, Santa Cruz

Contributors   xxxiii

Antoine Lebeaut Fordham University

Gabriela Lopez University of New Mexico

Brian N. Lee Western Kentucky University

Bernice Lott University of Rhode Island

Kari A. Leiting University of New Mexico

Jennifer E. Loveland John Jay College of Criminal Justice and the Graduate Center, CUNY

Matthew LeRoy University of Pennsylvania David Lester Richard Stockton College of New Jersey Mark Levand Widener University Ronald F. Levant University of Akron Cara A. Levine Syracuse University Heidi M. Levitt University of Massachusetts Boston Denise L. Levy Appalachian State University Jioni A. Lewis University of Tennessee, Knoxville Nathan A. Lewis Carleton University Christopher T. H. Liang Lehigh University Eric W. Lindsey Penn State Berks

Melissa Luke Syracuse University Paula K. Lundberg-Love University of Texas at Tyler Linh P. Luu Lehigh University Leigh Lyndon Licensed Clinical Psychologist, Private Practice Dario Maestripieri University of Chicago Cristina L. Magalhães Alliant International University Ellen S. Magalhães Alliant International University Katherine Magner Carleton University Chelsea Manchester George Washington University Dean Manning The College of New Jersey Diane Marano Rutgers University–Camden

Jennifer Lindsey Texas Tech University

Marvice D. Marcus Washington State University

Marcia M. Liu The New School

Ginny Maril California Lutheran University

William Ming Liu University of Iowa

Christopher R. Martell University of Wisconsin–Milwaukee and Martell Behavioral Activation Research Consulting

Pamela LiVecchi Northeastern Psychological Consultation, LLC

Jennifer L. Martin University of Mount Union

Jennifer Lodi-Smith Canisius College

Sara Martino Stockton University

Michael I. Loewy Alliant International University

Kaitlyn Masai Alliant International University

xxxiv   Contributors

Catherine J. Massey Slippery Rock University

Madhavi Menon Nova Southeastern University

Christina Massey John Jay College of Criminal Justice, CUNY

Meenakshi Menon Alliant International University

Robin M. Mathy University of Oxford

Rachel H. Messer Oklahoma State University

Randa Embry Matusiak University of Central Missouri

Ilan H. Meyer University of California, Los Angeles School of Law

Silvia Lorena Mazzula John Jay College of Criminal Justice, CUNY

Tracy Meyer Collin College

Ann M. McCaughan University of Illinois Springfield

Elizabeth Midlarsky Teachers College, Columbia University

Michael S. McCloskey Temple University

Joseph R. Miles University of Tennessee, Knoxville

Laurie “Lali” McCubbin Washington State University

Alan Miller Syracuse University

Eric R. McCurdy University of Akron

Carol T. Miller University of Vermont

Jessica McCurdy John Jay College of Criminal Justice and the Graduate Center, CUNY

L. Stephen Miller University of Georgia

Ryon C. McDermott University of South Alabama

Laura Minero University of Wisconsin–Madison

William G. McDonald SUNY Empire State College

Valory Mitchell California School of Professional Psychology, Alliant University

Sam G. McFarland Western Kentucky University

Marie L. Miville Teachers College, Columbia University

Maureen C. McHugh Indiana University of Pennsylvania

Kristine M. Molina University of Illinois at Chicago

Dean McKay Fordham University

Debra Mollen Texas Woman’s University

Daniel McKelvey University of South Alabama

Alejandro Morales California State Polytechnic University, Pomona

Carmen P. McLean University of Pennsylvania

Mohena Moreno Alliant International University

Jennifer McMahon-Howard Kennesaw State University

Ruth T. Morin Teachers College, Columbia University

Pranjal Mehta University of Oregon

David A. Moskowitz New York Medical College

Erica R. Meiners Northeastern Illinois University

Ariel J. Mosley University of Kansas

Contributors   xxxv

Jasmine Mote University of California, Berkeley

William O’Donohue University of Nevada Reno

Sylvie Mrug University of Alabama at Birmingham

Yuki Okubo Salisbury University

Jennifer J. Muehlenkamp University of Wisconsin–Eau Claire

Mukadder Okuyan Clark University

Melissa E. Munoz University of Missouri

C. Rebecca Oldham Texas Tech University

Michael Munson FORGE, Inc.

Joe Orovecz University of Wisconsin–Madison

Michael Murgo University of Miami

Kile M. Ortigo Palo Alto Veterans Institute for Research

Monica Cristina Murillo Parra John Jay College of Criminal Justice, CUNY

Kasim Ortiz University of New Mexico

Kevin L. Nadal John Jay College of Criminal Justice, CUNY Joel T. Nadler Southern Illinois University Edwardsville Nadine Nakamura University of La Verne Rachel L. Navarro University of North Dakota Rory Newlands University of Nevada, Reno David Nguyen Lehigh University

Lindsay O’Shea Alliant International University Augustine Osman University of Texas at San Antonio Christopher Overtree University of Massachusetts Amherst Konjit Vonetta Page University of San Francisco Michele A. Paludi Siena College Tyson Pankey University of Wisconsin–Madison

Khanh Nguyen California State University, Los Angeles

Daya Pant National Council of Educational Research and Training (retired)

Sylvia Niehuis Texas Tech University

Seth T. Pardo San Francisco Department of Public Health

Laura Niemi Harvard University

Michael E. Parent Carleton University

Amy E. Noser University of Kansas

Mike C. Parent Texas Tech University

M. K. Oakley University of Massachusetts Amherst

Gordon B. Parker Black Dog Institute, University of New South Wales

Jennifer L. O’Brien Massachusetts Institute of Technology Maureen O’Connor John Jay College of Criminal Justice and the Graduate Center, CUNY

Kenneth M. Pass University of Michigan Rachel E. Pauletti Florida Atlantic University

xxxvi   Contributors

Noelany Pelc Texas Woman’s University

Alexander Puhalla Temple University

William V. Pelfrey Virginia Commonwealth University

Carey Shayne Pulverman University of Texas at Austin

Silvia Perez Lehman College, CUNY

Nathaniel C. Pyle Laney College

Paul B. Perrin Virginia Commonwealth University

Carol Quintana Youth Consultation Services

Marissa Perrone Indiana University of Pennsylvania

Fredric Rabinowitz University of Redlands

David G. Perry Florida Atlantic University

Asa Radix Callen-Lorde Community Health Center

Jessica Petalio University of Alaska Anchorage

Chitra Raghavan John Jay College of Criminal Justice, CUNY

Zoë D. Peterson University of Missouri–St. Louis

Naomi Rayfield Teachers College, Columbia University

Zachary W. Petzel University of Missouri–St. Louis

Rebecca M. Redington Columbia University

Maya Elace Pignatore Independent Scholar

Thomas J. Reece Western Kentucky University

Cole Playter The College of New Jersey

Lauren A. Reed University of Michigan

Curtesia Plunkett University of Oklahoma

Naomi Reesor Carleton University

Mark Pope University of Missouri–St. Louis

Alan Reifman Texas Tech University

Torey Portrie-Bethke Walden University

Christopher S. Reigeluth Clark University

Karen Prager University of Texas of Dallas

Lee Joyce Richmond Loyola University Maryland

Maggi Price Boston College

G. Nicole Rider Howard University

Jerilynn C. Prior University of British Columbia

Victor Rios Palo Alto University

Mary E. Pritchard Boise State University

David P. Rivera Queens College, City University of New York

Jonathan Procter Long Island University Post

Karen E. Roberts Oshawa Psychological & Counselling Services

Markus M. Provence Texas State University

Aaron B. Rochlen University of Texas at Austin

Jae A. Puckett University of South Dakota

Ana Romero Morales University of California, Santa Barbara

Contributors   xxxvii

Joanna C. Min Jee Rooney Teachers College, Columbia University

Katherine A. Scott University of Texas at Tyler

Amanda J. Rose University of Missouri

Randolph Scott-McLaughlin Teachers College, Columbia University

Martha S. Rosenthal Florida Gulf Coast University

Liat Segal Teachers College, Columbia University

Cheskie Rosenzweig Teachers College, Columbia University

Steven J. Seiler Tennessee Tech University

Ryan S. Ross University of New Mexico

Christine Serpe University of Missouri–Kansas City

Mary P. Rowe MIT Sloan School of Management

Josephine Serrata National Latina Network for Healthy Families

Lisa R. Rubin The New School for Social Research

Derek X. Seward Syracuse University

Sean J. Ryan The Graduate Center, CUNY

Todd K. Shackelford Oakland University

Robert J. Rydell Indiana University

Meera Shah Callen-Lorde Community Health Center

Krystel Salandanan John Jay College of Criminal Justice

Carla Sharp University of Houston

Kaliris Salas-Ramirez Sophie Davis School of Biomedical Education

Munyi Shea California State University, Los Angeles

Hesham Saleh New York University School of Medicine

Kate Sheese Sigmund Freud University

shor salkas University of Wisconsin–Madison

Kimber Shelton KLS Counseling & Consulting Services

Shara Sand LaGuardia Community College

David S. Shen-Miller Tennessee State University

Varunee Faii Sangganjanavanich University of Akron

Terilyn C. Shigeno University of Tennessee

Jacob S. Sawyer Teachers College, Columbia University

Richard Q. Shin University of Maryland College Park

Maria R. Scharron-del Rio CUNY-Brooklyn College

Forouz Shirvani University of Texas at Dallas

Bassima Schbley Washburn University Michele M. Schlehofer Salisbury University

Julia Shulman John Jay College of Criminal Justice Alexandra E. Sigillo EdSurge, Inc.

Melanie Schneider Fairleigh Dickinson University

Margaret L. Signorella Pennsylvania State University, Greater Allegheny Campus

Elizabeth Schroeder Elizabeth Schroeder Consulting

Jessica Simonetti Palo Alto University

xxxviii   Contributors

Amekia Sims VA Palo Alto Health Care System

Katherine G. Spencer Program in Human Sexuality

Jefferson A. Singer Connecticut College

Andrew Spieldenner Hofstra University

Anneliese A. Singh University of Georgia

Amanda Spray New York University Langone Medical Center

Morgan Sinnard University of Texas at Austin Amanda Sisselman-Borgia SUNY Empire State College Matthew D. Skinta Palo Alto University Avy Skolnik U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research Andrew P. Smiler Private Practice Alyshia Smith Pacific University

Devika Srivastava Harris Center for Mental Health and IDD Kevin Stark University of Texas at Austin Leighann Starkey The Graduate Center, CUNY Janie Steckenrider Loyola Marymount University Gayle Stever SUNY Empire State College Stephen R. Stewart Indiana University

Eleanor R. Smith Fordham University

Brett G. Stoudt John Jay College of Criminal Justice and The Graduate Center, CUNY

Lance C. Smith University of Vermont

Wyntre Stout Lehigh University

Laura Smith Teachers College, Columbia University

Shufang Sun University of Wisconsin–Madison

Rachel M. Smith Portland State University

Brian N. Sweeney Long Island University

Sidney Smith U.S. Department of Veterans Affairs

Patrick Sweeney The Graduate Center, CUNY

Laura E. Sockol Davidson College

Ariella R. Tabaac Virginia Commonwealth University

Carey Jean Sojka University at Albany

Charlotte Tate San Francisco State University

Udi Sommer Tel Aviv University

Sarah Taylor University of Nebraska–Lincoln

Ge Song Lehigh University

Sylvie Taylor Antioch University Los Angeles

Megan Speciale Palo Alto University

Melissa Tehee Utah State University

Suzette L. Speight University of Akron

Harriet Tenenbaum University of Surrey

Contributors   xxxix

Jayden L. Thai University of Louisville

Beth A. Visser Lakehead University

Anita Jones Thomas University of Indianapolis

Devon Tyrone Wade Columbia University

D. Alexandra Thomas Teachers College, Columbia University

Ryan M. Wade University of Michigan School of Public Health

Christine Timko U.S. Department of Veterans Affairs

Laurie M. Wagner Kent State University School of Health Sciences

Diane Tober University of California, San Francisco

Samantha A. Wagner Canisius College

Richard M. Tolman University of Michigan, School of Social Work

Daphne C. Watkins University of Michigan

Gina C. Torino SUNY Empire State College

Laurel Watson University of Missouri–Kansas City

Aileen Torres Youth Consultation Services

Jennifer M. Weaver Boise State University

Cheryl B. Travis University of Tennessee

Arielle Webb Palo Alto University

Joseph W. Tu Alliant International University

Jennifer B. Webb University of North Carolina at Charlotte

Yael Uness Fordham University

Traice Webb-Bradley United Behavioral Health St. Louis Care Advocacy Center

Rhoda K. Unger Brandeis University Tammi Vacha-Haase Colorado State University Jacob J. van den Berg Brown University Erin A. Van Enkevort Texas Christian University Clare Van Norden Lehigh University Gina Vanegas Martinez University of California, Santa Barbara Beth Vayshenker John Jay College of Criminal Justice, CUNY

Elizabeth Weber Ollen Clark University Keri Weed University of South Carolina Aiken Rebecca A. Weiss John Jay College of Criminal Justice, CUNY James C. Welch University of Maryland, College Park Kamuela Werner University of Hawaii at Manoa Breanna R. Wexler University of Missouri–St. Louis

Brandon L. Velez Teachers College, Columbia University

Emily White Arizona School of Professional Psychology at Argosy University

Linwood G. Vereen Syracuse University

Roberta F. White Boston University School of Public Health

Cory Viehl Georgia State University

Susan Whiteland Arkansas State University

xl   Contributors

Chassitty N. Whitman John Jay College of Criminal Justice, CUNY Mark E. Williams University of Wisconsin–Milwaukee Marlene Williams University of Tennessee, Knoxville Stacey L. Williams East Tennessee State University Wendi S. Williams Long Island University–Brooklyn Lindsey L. Wilner The Chicago School of Professional Psychology Leo Wilton State University of New York at Binghamton Kasey E. Windnagel University of Indianapolis Erin Winterrowd Regis University Georgia M. Winters John Jay College of Criminal Justice and the Graduate Center, CUNY Erica H. Wise University of North Carolina at Chapel Hill Tarynn M. Witten Virginia Commonwealth University

Peggilee Wupperman John Jay College of Criminal Justice, CUNY Karen Fraser Wyche George Washington University Yan Xia University of Nebraska–Lincoln Oksana Yakushko Pacifica Graduate Institute Philip T. Yanos John Jay College of Criminal Justice, CUNY Mabel Yau Icahn School of Medicine at Mount Sinai Maggie Yau New Jersey Medical School Elizabeth A. Yeater University of New Mexico Kayoko Yokoyama John F. Kennedy University Shu Yuan Texas Tech University Yuliana Zaikman New Mexico State University Andrew Zarate Life by Dru, LLC

Michele J. Wong Georgetown University Medical Center

Talia Zarbiv Pace University

Stephanie J. Wong VA Palo Alto Health Care System

Virgil Zeigler-Hill Oakland University

Linda M. Woolf Webster University

David G. Zelaya Georgia State University

Christine M. Woywod University of Minnesota

Yizhu Zhou John Jay College of Criminal Justice

A. Jordan Wright SUNY Empire State College

Sianna Alia Ziegler University of Washington

Paul J. Wright University of Arizona

Samuele Zilioli Wayne State University

Introduction One of my earliest memories of gender was when I was 6 years old and I was teased by my older brothers for wanting to play with my female cousins and their Barbie dolls. While I thoroughly enjoyed seeing what Barbie and her friends looked like with different dresses and hairstyles, I learned that my behavior was unacceptable because I was a boy. I can’t remember if my parents or other adults explicitly punished me for playing with those dolls, but I do recall feeling the need to hide my behaviors by playing with Barbies in seclusion, or when my male peers or adults were not around. Perhaps these experiences are why my parents wanted me to play sports—enrolling my brothers and me in Little League Baseball or basketball through our local Catholic Youth Organization. While I was talented enough in both of these sports, I just did not have the passion for either. When I was about 10 years old, I told my parents that I would rather participate in performance arts—so I auditioned for the local musical theater group and joined the choir. My parents supported both endeavors, but I knew that I had to also continue playing sports—just so that I could be accepted by peers. As I was about to enter high school, my brothers and male peers continued to tease me as I became less interested in sports and more interested in musical theater. Because the teasing eventually led to bullying in school, I stopped both activities. I knew I did not want to play sports anymore, but I also believed I had to give up the arts too. When I started to discover my sexuality and recognized that I was attracted to men, I developed a deep sense of shame. I did not have any positive LGBTQ role models—at least not any LGBTQ role models who proudly lived their life out of the closet. In the media, I saw only stereotypical portrayals of LGBTQ people—with very few role models who were LGBTQ people of

color. Because of this, I felt so isolated that I concealed my identity for years—not telling a single other person of what I was going through. I spent most of my young adulthood living a double life— experimenting sexually in a world where no one knew my name, while hiding my true self within the circles of people who were supposed to love me the most. As an adult, I still struggle with gender role norms at times—switching between not ever feeling masculine enough to being content exactly how I am. I battle internalized heterosexism and feelings of shame, while navigating my privilege as a cisgender person and as a man. I perform gender in different contexts in the many aspects of my life—whether I’m with my Filipino American immigrant family, my circle of friends from all cultural backgrounds, a classroom filled with all sorts of students who are usually 10 to 20 years younger than me, or at home with my husband and our dog. Although some people may relate to parts of my story more than others, I am certain that people have their own complicated relationships with gender. Can you remember the earliest messages you learned about gender? Can you remember the first time you were taught that a certain behavior was “masculine” or “feminine,” or the first time that someone said that something was “only for boys” while other things were “only for girls”? How has the accumulation of these messages affected how you viewed the world as a child to how you navigate the world in your adult life?

Why an Encyclopedia on Psychology and Gender? Gender affects all human beings, and gender role expectations influence our lives—often in ways that we are not even conscious of. The messages xli

xlii   Introduction

we learn during our formative years have the potential to stay with us throughout our l­ ifetimes— influencing our personalities, our values, and our interests. Gender affects our identities, our relationships, our worldviews, and our behaviors. Gender affects how we dress, how we talk, how we cope, and how we express emotion. Gender affects all aspects of our psychological development, our mental health, and our belief in our abilities. It is because of this that the study of the intersection of psychology and gender is so stimulating to me. In the earliest introductions of Western psychology, gender was ignored or minimized—with many theorists proposing ideas that were either independent of gender completely or focused on gender only insignificantly. For instance, in Sigmund Freud’s original conceptualizations of psychosexual stages of development, he describes that newborns and toddlers navigate birth and their earliest ages fairly similarly. It is not until his conceptualizations of the phallic stage that he describes gendered differences (e.g., boys would develop an Oedipal complex, while girls developed penis envy). Meanwhile, B. F. Skinner’s earliest work on behaviorism and operant conditioning did not discuss the influence of gender, explicitly at all, while Albert Bandura’s social learning theory only briefly mentioned that some children engaged in behaviors they observed or modeled that may or may not be “gender appropriate.” While Karen Horney attempted to describe how gender influenced psychoanalysis and psychological development in the 1920s and 1930s, it was not until the 1960s and 1970s that it became a bit more common for psychologists to describe gender differences between men and women. The Association for Women in Psychology was created in 1969; and the American Psychological Association (APA) Division 35 (later known as the Society for Psychology of Women) was established in 1973. Psychologists like Phyllis Chesler, Nancy Henley, and Sandra Bem began to integrate feminist ideas into psychology, which would later become the foundations of feminist psychology. In 1973, the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM), resulting in a similar movement around the field of psychology and sexual orientation. While gender and sexual orientation were (and are) viewed as

two separate concepts, it was clear that gender roles and gender norms influenced what was viewed as normative behavior for men and women. Thus, early lesbian and gay psychologists advocated against issues like reparative therapy and eventually formed the APA Division 44 (the Society for the Psychological Study of Lesbian and Gay Issues). For the past 40 years, the psychological study of gender started to examine how various intersectional identities like race, ethnicity, immigration, religion, ability, and others may influence gender development. Many psychologists of color have critiqued earlier feminist psychology for not being inclusive of experiences of women of color or understanding how cultural identities influenced gender experiences. Accordingly, research on gendered experiences of different racial and ethnic groups emerged, with many organizations creating spaces to empower women. For instance, in 1995, the Asian American Psychological Association created a Division on Women. Furthermore, issues related to gender identity— particularly involving transgender people and gender nonconforming people—have only become more standardized in psychology training and education in the past 10 or 15 years. In fact, the APA first published about transgender issues in 2006 in its brochure “Answers to Your Questions About Transgender People, Gender Identity, and G ­ ender Expression.” In 2013, the American Psychiatric Association removed gender identity disorder from the DSM—replacing it with gender dysphoria; and in 2015, the APA published “Guidelines for Psychological Practice With Transgender and Gender Nonconforming People.” So, while the visibility of transgender people may have increased significantly in general society, the psychological study of transgender issues is still relatively new. One of the main motivations for creating The SAGE Encyclopedia of Psychology and Gender is the lack of comprehensive texts that outline the psychological study of gender. While there have been many attempts to outline the history of feminist psychology, as well as many texts that endeavor to understand sex differences or gender roles, there are no known resources that comprehensively examine issues related to psychology and gender while using an intersectional, culturally integrated, queer affirming, and trans i­nclusive approach.

Introduction   xliii

Finally, one unique element about this text is that it is so comprehensive and covers a diverse spectrum of topics related to psychology and gender. In fact, we attempted to organize the entries in ways that made it easy to locate entries on related topics. Thus, we created the Reader’s Guide, which classifies articles into 20 general topical categories: •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• ••

Adolescence Aging Biological Sex Differences Childhood Developmental and Biological Processes Education Feminism Gender and Society Gender Nonconformity and Transgender Issues Gender Roles Health Issues and Gender Men’s Issues Mental Health and Gender Multiculturalism and Gender Research Sexual Orientation Theories and Therapeutic Approaches Violence and Gender Women’s Issues The Workplace and Gender

The Process When I was first approached about editing an encyclopedia set on the intersections of psychology and gender, I felt honored, overwhelmed, and activated. I was honored to be given the opportunity to create a comprehensive text with some of the most influential leaders in the field of psychology—especially in multicultural psychol­ ogy, women’s psychology, men’s psychology, and LGBTQ psychology. I felt overwhelmed because I knew that we could cover so much, as gender is an integral part of all of our lives. I wondered if we could possibly do justice to everything that needed to be included, and I realized that it would be nearly impossible to do so. Finally, I felt activated, as I knew that I was given the unique privilege of writing about psychology and gender in a way that felt most complete and genuine to me. Given my identities as a queer person of color, a lifelong advocate for social justice, and a proponent of

understanding intersectional identities, I was so happy in knowing that we could change the narrative in how gender and psychology were discussed. No longer would gender be written about in c­ olorblind ways, nor would people’s sexualities, gender identities, racial and ethnic backgrounds, or other identities be an afterthought when discussing experiences of gender. To have the ­ power to ensure that cultural components were integrated throughout the entries was not only a privilege, but also a responsibility. We did our best to ensure that these topics were discussed in ways that were as i­ nclusive as possible—advocating that historically marginalized groups like transgender and queer people, people of color, people with disabilities, i­mmigrants, and others felt that their experiences mattered too. The first step in ensuring that this process matched my mission and goals was to assemble a team of visionaries who I believed represented different identities, perspectives, and lived experiences. I chose my associate editors, Dr. Silvia ­Mazzula and Dr. David Rivera, not just because of our friendship (all three of us had graduated from the doctoral program in counseling psychology from Teachers College, Columbia University), but because I knew that their work ethic, commitment to social justice, and overall compassion would make us meld as a perfect team. I sought out an editorial board with similar backgrounds, who I knew could ensure high-quality work. I was honored that Dr. lore m. dickey, Dr. Michelle ­ Fine, Dr. Michi Fu, Dr. Beverly A. Green, Dr. Jioni  A. Lewis, and Dr. Gina C. Torino agreed to join, for they were instrumental in the success of this project. Together, we represented different stages in our professional work (i.e., senior level, midcareer, and early career professionals), as well as different psychology specialties (i.e., counseling psychology, clinical psychology, and social psychology). Our team consisted of people with various genders and gender identities, sexual orientations, racial and ethnic groups, immigration experiences, social class backgrounds, ages, religions, and the intersections of them all. Two of our editorial board members are renowned and trailblazing scholars in the field, while our other board members are “rising stars” who are destined for greatness and have already been groundbreaking in their ­scholarship and service.

xliv   Introduction

As an editorial board, our task was twofold. First, we had to decide which topics we found to be most salient when thinking about gender and psychology. We started with broad categories that would inspire the types of entries we are interested in; through our brainstorming process, we created even more categories that we deemed important to include. From there, we created an exhaustive list of categories and topics—resulting in almost 600 entries covering the broad range of scholarly areas on psychology and gender. Our second task was to find the most qualified experts to write these entries. We aimed to invite highly qualified ­scholars—while prioritizing individuals who have also demonstrated their passion for social justice issues in psychology. While it took us up to a year to find all of our authors (and almost another year to finalize all of our entries), we were very satisfied with our diverse list of scholars and the robust quality of their work.

Acknowledgments This encyclopedia would not be possible without the many people who contributed to the process. First, I thank Carole Maurer, Maureen Adams, and the entire staff at SAGE, for their guidance,

encouragement, and kindness. I am so grateful to Sue Moskowitz, our managing editor, for being so proficient in managing all of our authors and entries. I send my thanks to Silvia, David, lore, Michelle, Michi, Beverly, Jioni, and Gina, for agreeing to be part of my “dream team” and ensuring that we completed this project in a way that matched our commitment to social justice. I thank all of our contributors for their expertise and thoughtfulness in conceptualizing the ways we study and think about psychology and gender. I thank my parents for accepting me as the boy I was and the man I have become, and my husband for encouraging me to become the person I never knew I could be. Finally, I thank the readers for being open to learning about the psychological study of gender in new and critical ways. I hope that you gain knowledge that you can take with you, to ensure that people have less complicated relationships with gender and can develop healthy and happy lives. Kevin L. Nadal, PhD Professor, John Jay College of Criminal Justice and The Graduate Center at City University of New York

A Ability Status

and

Gender and Ability Status: Current Research

Gender

For most people with disabilities, disability status is seen as a normal identity construct. For people with congenital disabilities (occurring at birth), it is a normal experience. Disability is entwined with identity. Persons with disabilities often do not desire a cure despite chronic pain, discrimination, and stigma. For the culturally Deaf (distinguished with a capital “D”), deafness is not considered a disability but a shared aspect of cultural norms and a common linguistic heritage, such as ­American Sign Language. As psychologist Rhoda Olkin writes, in the world of disability, “abnormal is normal.” Despite differences in regarding disability as physical and social in its consequences, the majority of the literature refers to disability as a form of oppression, akin to racism and sexism. In 1963, Erving Goffman referred to disability as a “spoiled identity” and a form of stigma to be managed, hidden, or eliminated in all social spaces whenever possible. More recently, as an adjunct to the disability rights movement, disability is considered a vital aspect of identity to be claimed as an aspect of personhood. In 1998, psychologist Simi Linton referred to disabled identity as a method of social action and transformation to be claimed, launching an important text and viewpoint in disability studies.

Ability status tends to be divided along lines of gender, ethnicity, class, and sexual orientation. Early research on ability status and gender focused almost exclusively on the experiences of White men with spinal cord injuries, excluding the ­experiences of women and persons with other disabilities. The focus of research has changed, and research is now inclusive of a wider variety of ­disability experiences. Scholars in multiple disciplines differentiate between impairment and disability, and between sex and gender. Impairment refers to a medical condition or diagnosis. Disability refers to the social consequences and constraints imposed by society as a result of that condition. Like impairment, sex is biological. Like disability, gender is cultural and imposed by society. Disability may encompass a variety of developmental, invisible, physical, and psychiatric impairments that interfere with one or more aspects of daily living. Thus, disability exists as a spectrum of experiences. Regardless of gender, people with disabilities are too often categorized as asexual or denied gender status, such as not being seen as female or male. According to health researcher Carol Thomas, disability status is stratified according to gender. This entry examines disparities in ability status along gender lines and other identities.

1

2

Ability Status and Gender

On the spectrum of ability status, the general population often defines away disability status. This often occurs when a person with a disability does not meet their conceptualizations and stereotypes of disability. People who are not disabled may offer platitudes such as “Everyone is disabled” or “I don’t see you as disabled.” Some empirical research with disabled persons demonstrates the frustration of denied disability status. Although each person has a variety of strengths and weaknesses, people who are not disabled do not face the somatic and structural consequences of disability. Also, for people with visible disabilities or those who use walkers, wheelchairs, or visible “markers,” the decision to disclose ability status is rarely a choice. Although persons with visible disabilities might not have a choice of whether to disclose their ability status, they do possess some autonomy when deciding when, to whom, and how much to disclose regarding intimate details of their lives and identities. Apparent disabilities are often accompanied by “the gaze” or “the stare,” as documented comprehensively by researcher Rosemarie Garland-Thomson. For some persons with disabilities, it is possible to stare back and “divert the gaze” to challenge power differentials. This provides some autonomy from the constant occupation of a body and identity treated as “other.” This has been described by other scholars as “attempts to pass” or “reframing the conversation” to diminish disability status. Disability is now being discussed in concert with other aspects of identity, such as sexuality, especially queer identity. As historical queer theorists such as Judith Butler and Michel Foucault have argued, embodiments of gender and sexuality serve as performances of identity and power. Just as heterosexuality is assumed and compulsory, so is ability status. This means that all people are assumed to be heterosexual and able-bodied. Theorists argue that disability status, gender, and sexuality are temporal and contextual, challenging ideologies grounded in static and rigid conceptions of bodies and identities. Current disability scholars are quickly expanding this knowledge and questioning what it means to live in a body that is “queered” and often denied sexuality. For people of a variety of ability statuses, gender identities, and sexual orientations, this is exciting

territory that augments previous heteronormative and cisgender conversations. Ability status and social stratification encompass race/ethnicity, gender, social class, and sexual orientation, pointing to intersecting oppression in all aspects of public life. Thus, persons with disabilities are never solely disabled. Eli Clare, a disabled transgender scholar, refers to multiple ­ identities as a pile rather than an intersection. Identities cannot be easily separated out, and they coexist in ways that are complicated and messy. Multiple identities are not easily differentiated. Each identity category influences the other and cannot be pulled out without affecting all the others. As in a game of pick-up sticks, even if identities are color coded and deemed separate, pulling at one identity displaces and affects all the others.

Models Within disability studies, ability status is classified according to several major categories. The medical model focuses on the diagnosis of impairment and the medical implications of the diagnosis. From the perspective of the medical model, disabilities are individual problems to be internalized. In contrast, the social or minority model refers to the societal consequences of impairment and explains how ability status operates in everyday life. It frames the oppression, marginalization, and exclusion people with disabilities encounter in society. The social model encompasses both physical and social barriers, including the lack of accessibility and universal design. Disability scholars confirm that the greatest obstacles encountered as a result of disability are socially imposed. The social model of disability externalizes the experience of impairment. The social model identifies social and structural problems as the cause of inequity, not the body or medical condition. The social experience of disability results in difficulties related to the workplace, education, housing, income, relationships, and sexuality. People with disabilities are more likely to be unemployed and underemployed. The social model highlights the problem of disability as society’s negative interpretations and actions at the personal, political, and structural levels. The minority and social models, rather than the medical condition, are used interchangeably to note the difficulties imposed by

Ability Status and Gender

society. The minority model treats people with disabilities as a minority group working to access equal rights in a discriminatory and inequitable society. One way to differentiate between the social model and the minority model is that the social model focuses on the structural barriers in society, as sociology focuses on macroinstitutions, whereas the minority model focuses on the experiences of the individual within a minority group or ­culture— in this case, disability. This parallels general psychology’s focus on microexperiences and ­ ­individual behavior, cognitions, and emotions. The goal of the social model is to focus on the disabling attitudes of society. Disability scholars embrace the social model because it encourages people to change their interpretations of disability and analyze the way cognitions become behaviors. For instance, a societal belief in accessibility as an individual medical problem diminishes the need for universal access to all public places.

Reframing the Disability Experience In adulthood, persons with disabilities often begin to reframe and reinterpret their medical experiences, and often medical trauma, along with the physical nature of disability. Over time, disability promotes opportunities for posttraumatic growth as adults learn to integrate their disability as a positive aspect of self-concept. Researchers speculate that disability pride comes from personally changing the definition of disability and telling detrimental stories of disability in empowering ways. Persons with disabilities are then the narrators rather than the subjects of their experiences. A variety of researchers describe the different ways in which disability is reinterpreted throughout the life span, often depending on exposure to the disability community. In 2015, disability rights activists celebrated the 25th anniversary of the Americans with Disabilities Act, which culminated in pride parades and activist retreats that demonstrated how far society has come in that time. These celebrations also highlighted how much work the movement has left to be done before persons with disabilities are truly equal in terms of housing, income, social space, and sexual and marriage equality. Ironically, this celebration occurred on the heels of the U.S. Supreme Court decision in

3

Obergefell v. Hodges (2015), making same-sex marriage legal across the nation. Disability activists note that marriage equality is still not attainable for some people with disabilities who will lose their disability benefits if they declare a spouse. Multiple methods of taking back negative conceptualizations of disability exist, according to current research. People with positive identities of disability often refer to it as an external hardship made more difficult by structural difficulties such as lack of housing, unemployment or underemployment, and lack of access to romantic relationships and sexual partners. The social and minority models of disability state that the burdens of disability are strongly rooted in structural barriers implemented by an ableist society. In terms of the psychology of gender, men and women with disabilities challenge the idea that people with disabilities are asexual or not “true” men and women. Relating these models to the helping professions, several theoretical orientations may be beneficial to help persons with disabilities come to terms with conflicting messages regarding disability. Some modalities and theoretical orientations that come to mind are narrative therapy, positive psychology and strengths-based assessment, and feminist theory. In terms of empowerment, the therapist should not do anything for the client that the person is able to do independently. The therapist should not make assumptions but should ask what the client’s needs are and when assistance may be required. Narrative therapy could potentially help persons with disabilities serve as the narrator of their own life stories. Mental health professionals may assist with this process through the art of purposeful questions or the use of writing (serving as a scribe or a facilitator if necessary) to get the stories the client wants to be told on paper or out loud. Narrative therapy also has a strong activist component where the therapist assists the clients in making changes. These may be structural, such as the therapist helping the client actively seek resources that increase the desired independence. For example, the client and the therapist may write letters to school or university administrators or employers regarding ways to decrease social and physical barriers in the environment. Positive psychology and strengths-based assessment help the client and the therapist gauge what

4

Ability Status and Gender

is working in the client’s life, and work on strategies to continue those successes and apply those strategies to problem areas, such as communicating with parents about increased independence. Clients may want help increasing their communication and assertiveness skills when dealing with a romantic relationship or a spouse. Strengths-based assessment may be especially helpful for diffusing stigma. Stigma should not be ignored or minimized, but helping the client celebrate victories and plan or chart new ones may be beneficial when working on issues of self-esteem, body image, and disability pride. Similarly, feminist inventories such as those designed by psychologist Carolyn Zerbe Enns may help the client and the mental health professional set appropriate goals that account for the multiple identities brought into the therapy room. With support, it may be useful to use these identities for change beyond the walls of the session.

Ability Status, Romance, and Defiance of Gender Norms Although significant work has been done on the sexuality and identity of men with disabilities, research on the sexuality and identity of women with disabilities significantly lags behind. Empirical research on masculinity and disability shows that men with disabilities are social actors engaged in performances of masculinity and ability. Men with disabilities who eschew traditional gender norms and boundaries are more likely to have successful romantic partnerships and higher selfesteem, while the same applies for their partners. Several issues coincide for partners of persons with disabilities, according to researcher Russell Shuttleworth. Nondisabled partners are assumed to have something wrong with them or to be less desirable to choose to be in a relationship with a person with a disability. Stigma has a contagion effect on both people in the relationship. By rejecting traditional gender norms, men with disabilities do not have to fit within a rigid framework of masculinity that eschews disability. They can ask for help, be sensitive, and place less emphasis on intercourse, which expands the repertoire of sexuality. The 2005 documentary Murderball illustrates these concepts. A heterosexual

quadriplegic rugby player uses his performance of disability to attract women. He describes that the more pitiful and needy he acts, the more likely he is to meet women. This is in stark contrast to his rugged and masculine behavior on the court. Despite his performance of diminished masculinity in social settings, he is quite capable, as demonstrated by his intelligence and athletic prowess. Wheelchair rugby is a high-contact, high-risk sport. For women with disabilities, compulsory aspects apply to gender and sexuality. Typically, they are assigned heterosexual or asexual scripts. False identities and social constructions are placed on women with disabilities, but significantly more research is needed on interpersonal relationships, gender norms, and sexuality. Personal narratives in qualitative research emphasize a lack of opportunities for romantic relationships (whether heterosexual or otherwise), low sexual self-esteem, and poor body image. The lack of resources regarding sexuality demonstrates that more information is needed about the mechanics of sex for women with disabilities and ways to adapt sexual practices with a partner. Interpersonal dialogue with the partner may help alleviate fears, designate how accommodations and adaptations can be erotic, and determine how each partner achieves the most pleasure whether this encompasses intercourse or not.

Further Research Researchers cite a need for fluid disability identity development models that explore how ability status vacillates across the life span. More research is needed on ability status and gender, particularly in understudied and minority communities. There is also a need for further research on the differences in identity status between those with congenital and acquired disabilities. Future research may extend the idea of disability as performance, expanding on Judith Butler’s idea of gender as performance, while differentiating the ways in which disability is performed in both public and private spaces. In addition, scholars also emphasize a need for new categories and models of disability that stretch beyond the social model. Although the social/minority model has

Ability Status and Sexual Orientation

been the preferred category to describe the lived experience of disability and the oppression imposed by society, it lacks emphasis on the embodied experience that comes along with the societal barriers. A biopsychosocial model that combines aspects of the moral, medical, and social models could be useful to explain the simultaneous aspects of disability that are embodied and compounded by biological (impairment), psychological (emotional/ behavioral), and sociological (societal/structural) factors in daily life. Researchers identify a gap in research on embodiment and disability, due to the body/mind binary. Some research has a singular focus on the mind and society, whereas medical research typically focuses solely on the body. Fusing the two would provide greater understanding of the full person, especially if more attention is devoted to the psychology of gender and disability. Researchers need to consider how both embodiment and structural factors play a role in the experience of disability. As for ability status and gender, much research is needed in this area as well. Psychologists and others in the helping, or caregiving, professions should consider the impact of gender on the disability experience and how it reflects and challenges stereotypical gender norms and the performance of gender in society. Despite the classification of disability as a minority experience, it is historically neglected in feminist research on intersectionality. Although improvements have been made in the breadth and depth of feminist disability research, there are still large gaps remaining in research on how gender, ability status, sexual orientation, ethnicity, and socioeconomic status affect women and men with disabilities. Stacey L. Coffman-Rosen See also Ability Status and Sexual Orientation; Disability and Adolescence; Doing Gender; Feminist Therapy; Gender Role Behavior; Health Issues and Gender: Overview; Identity Construction; Intersectional Identities

Further Readings Davis, L. J. (Ed.). (2013). The disability studies reader. New York, NY: Routledge. Edwards, S. E. (2007). Disablement and personal identity. Medicine, Health Care, and Philosophy, 10, 209–215.

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Enns, C. Z. (2004). Feminist theories and feminist psychotherapies: Origins, themes, and diversity (2nd ed.). New York, NY: Haworth Press. Garland-Thomson, R. (2005). Feminist disability studies. Signs, 30(2), 1557–1586. Kafer, A. (2013). Feminist, queer, crip. Bloomington: Indiana University Press. Linton, S. (1998). Claiming disability: Knowledge and identity. New York, NY: New York University Press. Obergefell v. Hodges, 576 ___ (2015). Olkin, R. (1999). What psychotherapists should know about disability. New York, NY: Guilford Press. Rapala, S., & Manderson, L. (2005). Recovering in-validated adulthood, masculinity, and sexuality. Sexuality and Disability, 23(3), 160–180. Shuttleworth, R. P. (2000). The search for sexual intimacy for men with cerebral palsy. Sexuality and Disability, 18(4), 263–282. Shuttleworth, R. P. (2002). Defusing the adverse context of disability and desirability as a practice of self for men with cerebral palsy. In M. Corker & T. Shakespeare (Eds.), Disability/postmodernity: Embodying disability theory (pp. 112–116). London, England: Continuum.

Ability Status Orientation

and

Sexual

Chronic illness and/or disability (CID) conditions interact with various life domains, including one’s own biopsychosocial development, activities of daily living, interpersonal relationships, educational and vocational endeavors, and access to health and community resources. The impact of CID is further nuanced by the richly diverse racial, ethnic, gender, religious, cultural, and linguistic identities of persons living with CID. Relatedly, persons living with CID have diverse sexual orientations, although sexuality is a topic that has been long neglected, ignored, or believed to be nonexistent among persons living with CID. If sexuality is at all considered, persons living with CID are often assumed to be heterosexual. However, persons living with CID are just as likely to indicate a minority sexual orientation identity (e.g., lesbian, gay, bisexual, queer [LGBQ]). This entry focuses exclusively on the intersection of LGBQ identity and CID.

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Ability Status and Sexual Orientation

Contextualizing Sexual Orientation and CID Sexual orientation is used to describe the emotional, mental, and physical attraction that one has toward someone of the same or opposite gender. There are numerous labels used to signify sexual orientation, including lesbian, gay, bisexual, queer, straight, or heterosexual. Sexual orientation is often regarded as fluid and is not necessarily considered static or stable across one’s life span. As defined by the Americans with Disabilities Act (ADA) and the ADA Amendments Act of 2008, a person is said to have a disability if they (a) have a physical and/or a mental impairment that ­substantially limits one or more major life activities, (b) have a record and/or history of such an impairment, or (c) are regarded as having such an impairment. The impairments must be deemed severe enough to interfere with one or more major life activities. Major life activities include, but are not limited to, caring for oneself, working, breathing, eating, walking, learning, thinking, and communicating (verbally and nonverbally). Major life activities also include the functioning of the pulmonary, cardiovascular, neurological, endocrinological, immunological, and gastrointestinal bodily systems. Under the ADA and the ADA Amendments Act of 2008, persons living with chronic illness conditions that are not transitory and that substantially limit one or more major life activities are protected under the law. For instance, persons living with HIV/AIDS, cancer, mental illness, epilepsy, or intellectual or learning disorders are protected. Persons living with conditions that are short in duration (e.g., flu, a broken bone) would not be protected under the ADA.

CID Conditions and Disparities Among LGBQ Persons Similar to other diverse groups, LGBQ persons are just as likely to be living with physical (e.g., spinal cord injuries, multiple sclerosis), cognitive (e.g., intellectual, learning, or attention-deficit/hyperactivity disorder), sensory (e.g., visual or hearing defects), or developmental (e.g., autism, cerebral palsy) disabilities. However, more recently, researchers have indicated that the prevalence of CID is higher among sexual minorities than among

persons who identify as heterosexual, indicating significant disparities in health and sexual orientation. CID disparities include cardiovascular diseases, cancer, HIV/AIDS, hypertension, chronic pain and fatigue, asthma, arthritis, as well as gastrointestinal and urinary tract conditions. Furthermore, relative to heterosexual identified persons, sexual minorities present with disproportionately higher rates of psychiatric morbidities. LGBQ identified persons are more likely to report psychological distress, depression, panic attacks, and generalized anxiety and more likely to endorse past suicidal attempts and behaviors. Alcohol and drug dependency syndromes are also more prevalent among LGBQ identified persons than among heterosexual identified persons. As might be expected, the degree of functionality and impairment for each medical and psychiatric CID condition is likely to vary from individual to individual. However, research has indicated that LGBQ identified persons living with one or more CID conditions subjectively evaluate themselves as having poorer health when compared with the selfevaluations of heterosexuals. LGBQ persons living with CID are also likely to indicate that their health status interferes with daily physical activities, and they are also more likely to indicate a higher use of adaptive modifications (e.g., wheelchair or cane) because of health-impaired related functionality.

Theoretical Approaches to Sexual Orientation and CID Scholars, educators, and practitioners could benefit from a variety of theoretical approaches when addressing the lives of LGBQ persons living with CID. Two particular theories that have demonstrated great utility with regard to LGBQ persons living with CID are social constructionism and intersectionality. These theories could be used in conjunction with other theoretical paradigms, as well as to guide future research studies or psychologically relevant practices. Social constructionism is a theoretical framework that has been utilized by both disability and sexuality scholars since the 1990s. According to the theoretical tenets of social constructionism, human beings construct significant meaning of the social world and use language as the mechanism

Ability Status and Sexual Orientation

by which the social world is constructed. According to social constructionism, persons living with a variety of CID conditions live within physical and social infrastructures that privilege persons who are of able body and mind. The “disability” label is then placed on persons who display “impairments” in environments that privilege ability over disability. With regard to sexuality, social constructionism contends that sexual identity and expression are not determined by biological essentialism but, rather, are socially reinforced by sexuality and gender binary cultural belief systems. LGBQ persons living with CID are not demographically homogeneous by any means. In addition to sexual orientation and ability status, LGBQ persons living with CID are likely to possess other identities, including diverse genders, races, ethnicities, cultural beliefs, and socioeconomic statuses. As a result of this, intersectionality is another theoretical framework that could be applied with LGBQ persons living with CID. Intersectionality states that persons will encounter unique experiences due to their multiple intersecting identities and that social identities are best understood in combination. Furthermore, intersectionality adheres to the notion that social identities are most meaningful in context. Therefore, aspects of privilege and oppression will vary depending on the intersection of various identities, or matrices of oppression, and they can be subtle or blatant. For instance, a 32-year-old European American gay man with a psychiatric disability may experience blatant discrimination related to his marginalized identities (i.e., sexual orientation and disability) as a result of living in a rural setting, whereas a 32-year-old Asian American bisexual woman with a spinal cord injury may encounter less discrimination related to her living with a disability as a result of living in an urban setting with more resources for persons with physical disabilities. However, this same woman’s racial/ethnic and sexual orientation identities, and the intersection of these identities, could translate to her being the target of overt discrimination in other ways (e.g., sexism, racism, heterosexism). These examples illustrate the critical importance of considering identities uniquely and in tandem within an individual’s familial, community, and geographic contexts; the salience of identities can vary greatly by these contexts.

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Discrimination and Stigma The ADA is considered a form of federal civil rights legislation that protects U.S. Americans living with CID from discrimination in all aspects of public life, including work, education, transportation, and public and private places (e.g., community resources, parks, restaurants, hotels, etc.). LGBQ persons living with CID may continue to be at risk of experiencing discrimination at work, in school, and in their communities as a result of their sexual orientation identities, regardless of the protection they may be afforded as people living with CID. Put simply, LGBQ persons living with CID can be targets of multiple forms of marginalization, including ableism, disablism, heterosexism, homophobia, and horizontal oppression. Although scholars have yet to universally agree on the definitional composition of ableism and disablism, they maintain that there are nuanced differences between the two terms. Used more among international scholars, disablism constitutes both attitudes and practices that discriminate against persons living with CID and prevent them from interacting with the rest of society. Ableism maintains similar connotations to disablism but is more popular with American scholars. However, it differs from disablism in that being “able”-bodied and/or “able”-minded are idealistic norms of our society. Persons who are not able-bodied or ­able-minded—persons with disabilities—are marginalized and excluded from freely interacting in the environmental, social, and vocational domains of our society. For instance, a woman living with cerebral palsy, who relies on the use of a motorized wheelchair for mobility, may experience disablism if denied employment as a result of living with cerebral palsy. She may also experience ableism if there is no accessible ramp or restroom in that physical environment to permit her a full range of mobility with her motorized wheelchair. Indicators of ableism may also include not having reading or visual material for persons with a wide range of cognitive or intellectual capacities, or the expectation that it should always be persons living with CID who should consider and propose reasonable accommodations. LGBQ persons living with CID are also likely to experience sexual prejudices, such as heterosexim and homophobia. Whereas homophobia signifies

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Ability Status and Sexual Orientation

negative attitudes and behaviors directly targeted at a person who possesses a sexual orientation other than heterosexual, heterosexism can be viewed as a pervasive societal creed that indirectly oppresses and marginalizes sexual minorities. So a lesbian woman living with cerebral palsy may experience homophobia if she is denied or terminated from employment should her same-sex romantic partnership be disclosed or revealed. That same woman may experience heterosexism if her place of employment only permits spousal benefits for those in heterosexual partnerships. Relatedly, LGBQ persons living with CID may also experience horizontal oppression. This is an experience that occurs when individuals perceive and experience stigma in their own respective communities. LGBQ persons living with CID may be criticized or marginalized for possessing a sexual minority identity by other members of their CID community. Relatedly, LGBQ persons living with CID may be ignored by other members of the LGBQ community, or they may not have a wide range of access to LGBQ establishments (e.g., bars, pride events, community organizations). As a result of experiencing stigma associated with possessing multiple stigmatized identities, LGBQ persons living with CID may develop negative responses, such as feelings of insecurity, anxiety, suspicion, and withdrawal. In some instances, LGBQ persons living with CID could internalize elements of both heterosexism and ableism, leading to feelings of self-loathing and dislike for either their CID or their sexual minority identity, or both of them. Any form of internalized stigma, whether it be internalized ableism or internalized heterosexism/homophobia, has the potential of perpetuating feelings of demoralization, fear, anger, and helplessness in LGBQ persons living with CID. In addition to developing negative responses to stigma, forms of internalized stigma may manifest in low expectations of one’s vocational or social potential and an increase in the likelihood of engaging in high-risk behaviors (e.g., substance abuse, unsafe sex).

Life Span Development CID conditions could be congenital or acquired at any point during one’s life span. Relatedly, one could become aware and come out as LGBQ

during any stage of their life span trajectory. As such, sexual orientation and CID could intersect each other at various developmental stages of the life span, leading to a variety of unique psychosocial experiences. One may come out as LGBQ long after having a CID condition, or both sexual orientation and CID condition could develop simultaneously. Below is a brief discussion of three different life span stages and some implications for LGBQ persons living with CID. Youth and Adolescents

As a whole, youth and adolescents are often preoccupied with their physical appearances, developing peer relationships, and individuating from their families to develop a sense of autonomy. Sexuality development also becomes more salient at this time. It is not uncommon for people to incorrectly label youth and adolescents living with CID as asexual, despite the notion that their psychosexual development does not differ from that of youth and adolescents not living with any CID conditions. During the physical manifestations of puberty (e.g., development of secondary sex characteristics, hormonal fluctuations, and biological growth), youth living with CID are just as likely to develop sexual desires and interests as those not living with CID. Youth and adolescents living with CID may develop desires for the same sex and undergo the same stages of sexual minority identity development as those not living with CID. LGBQ youth living with CID may also become preoccupied by body image concerns depending on the CID and may struggle over how to develop meaningful and satisfying peer and romantic relationships. Special education and supported living services for youth living with CID do not always adequately address sexuality, let alone provide services geared toward LGBQ identified youth living with CID. For instance, youth living with CID may receive inadequate sexual education services, or they may be entirely excluded from sex education. The lack of universally inclusive sexual education puts all youth and adolescents living with CID at risk of acquiring sexually transmitted infections and unwanted pregnancies. The lack of sex education is also especially concerning since youth and adolescents living with CID, regardless of sexual

Ability Status and Sexual Orientation

orientation, are vulnerable to sexual victimization. Some researchers have reported that sexual victimization and abuse are even higher among youth living with certain CID conditions (e.g., those ­living with developmental or intellectual disabilities). Adulthood

Just like heterosexual persons, LGBQ adults living with CID will have to navigate employment, social and romantic relationships, and family. However, the social and vocational trajectory for LGBQ adults living with CID may not be the same as for those who identify as heterosexual or those not living with a CID. Vocational interests, abilities, and opportunities for employment may be altered as a result of having a CID condition. Sexual minorities living with CID may have to consider disengaging from work or may seek vocational rehabilitation services to find employment situations that are more amenable to their CID condition. Vocational development may also be delayed as a result of navigating the stigma of an LGBQ identity. LGBQ persons continue to endure workplace heterosexism and discrimination. Intimate and social relationships may also be difficult to establish or maintain due to the negative societal attitudes that others may have toward LGBQ persons or persons living with CID. In certain instances, LGBQ persons living with CID may  even disengage from social and romantic relationships. Older Adulthood

Although individual changes are variable, changes in physical, sensory, and cognitive functioning are to be expected as one enters older adulthood. Older LGBQ adults living with CID may require the care of a spouse or partner. In addition to potential caregiver stress, spouses or partners of older LGBQ adults living with CID may encounter discrimination for being in a samesex relationship. In jurisdictions in which same-sex partnerships and marriages are not recognized, older LGBQ adults living with CID may have to create legally binding contracts to afford their spouses or partners the opportunity to make medically based decisions. In addition, older LGBQ adults living with CID who are not able to care for

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themselves or have spouses or partners living with CID conditions might have to consider assisted living or retirement facilities to help manage their care. In these instances, older LGBQ adults living with CID may have difficulty locating facilities that are affirmative, or at the very least not marginalizing, of LGBQ identity. Franco Dispenza and Cirleen DeBlaere See also Ability Status and Gender; Disability and Adolescence; Disability and Aging; Disability and Childhood; Sexual Orientation: Overview

Further Readings Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64, 170–180. doi:10.1037/a0014564 Duke, T. S. (2011). Lesbian, gay, bisexual, and transgender youth with disabilities: A meta-synthesis. Journal of LGBT Youth, 8(1), 1–52. doi:10.1080/1936 1653.2011.519181 Falvo, D. (2014). Medical and psychosocial aspects of chronic illness and disability (5th ed.). Boston, MA: Jones & Bartlett. Fredriksen-Goldsen, K. I., Kim, H. J., & Barkan, S. E. (2012). Disability among lesbian, gay, and bisexual adults: Disparities in prevalence and risk. American Journal of Public Health, 102(1), e16–e21. doi: 10.2105/AJPH.2011.300379 Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103(10), 1802–1809. doi:10.2105/AJPH.2012.301110 Fredriksen-Goldsen, K. I., Kim, H.-J., Muraco, A., & Mincer, S. (2009). Chronically ill midlife and older lesbians, gay men, and bisexuals and their informal caregivers: The impact of the social context. Journal of Sexuality Research and Social Policy, 6(4), 52–64. Hanjorgiris, W. F., Rath, J. F., & O’Neill, J. H. (2004). Gay men living with chronic illness or disability: A sociocultural, minority group perspective on mental health. Journal of Gay & Lesbian Social Services, 17(2), 25–41. doi:10.1300/J041v17n02_02 Hunt, B., Matthews, C., Milsom, A., & Lammel, J. A. (2006). Lesbians with physical disabilities: A qualitative study of their experiences with counseling. Journal of Counseling and Development, 84(2), 163–173.

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Abortion

Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8(5), 521–548. doi:10.1177/1745691613497965 Lipton, G. (2004). Gay men living with non-HIV chronic illnesses. Journal of Gay & Lesbian Social Services, 17(2), 1–23. doi:10.1300/J041v17n02_01 Marini, I., Glover-Graf, N. M., & Millington, M. J. (2012). Psychosocial aspects of disability: Insider perspectives and counseling strategies. New York, NY: Spring. Whitney, C. (2006). Intersection in identity: Identity development among queer women with disabilities. Sexuality and Disability, 24(1), 39–52. doi:10.1007/ s11195-005-9002-4

Abortion The term induced abortion refers to a variety of medical procedures designed to terminate pregnancy and result in extraction of an embryo or fetus, depending on gestational age. The topic of abortion can be addressed from a physical, psychological, moral, legal, or cultural perspective. Addressing all aspects is beyond the scope of this relatively brief entry; therefore, the objective is to examine abortion from the perspective of women choosing abortion. Specifically, the relationship between decision-making variables and subsequent adjustment and mental health is the focus, with sensitivity to the individual experiences and needs of women. The young woman in the following excerpt from Ernest Hemingway’s 1927 short story, Hills Like White Elephants, conveys appreciation of the psychological complexity of the decision to abort. The story, told mostly through dialogue as the couple awaits a train in Spain, offers a striking contrast to the simplistic contemporary portrayals of abortion decision making, whether in fiction, film, or pamphlets offered to women by abortion providers. “It’s really an awfully simple operation, Jig,” the man said. “It’s not really an operation at all.” The girl looked at the ground the table legs rested on.

“I know you wouldn’t mind it, Jig. It’s really not anything. It’s just to let the air in.” The girl did not say anything. “I’ll go with you and I’ll stay with you all the time. They just let the air in and then it’s all perfectly natural.” “Then what will we do afterwards?” “We’ll be fine afterward. Just like we were before.” “What makes you think so?”

The body of scientific evidence that has accrued over the past several decades reveals that the experience of abortion is indeed multifaceted and varies dramatically among women. Given the many diverse characteristics of the individuals opting for abortion, as well as the great environmental variability in which the decisions are embedded, efforts to understand abortion decisions and adjustment should incorporate a wide spectrum of variables: (a) demographic factors (e.g., age, ethnicity, socioeconomic status, reproductive history, and marital history), history of stressful life experiences, personality variables, intelligence, personal beliefs, and psychological and physical health; (b) relationship history, including family of origin/attachment dynamics, present family situation, current and past intimate relationships, and friendships; (c) social support systems; (d) the material and social circumstances surrounding the abortion decision; and (e) cultural values and norms ­pertaining to abortion. Awareness of the complex bidirectional and multidirectional relations among the many personal characteristics and environmental factors influencing the decision to abort is ­likewise needed to fully comprehend abortion decisions. Moreover, truly understanding how and why individual women choose to terminate pregnancies necessitates unpacking the multiple layers of ­influence that define past experiences, current functioning, and prospects for future development. Efforts to articulate a typical psychological trajectory for women electing abortion is not possible; however, based on evidence established in the medical and behavioral sciences, women who seem to be at an elevated risk for abortion-related distress can be identified. This information is ­ beginning to inform pre- and post-abortion counseling protocols in order to empower women to

Abortion

make the healthiest possible decisions. An expansive international scientific literature has addressed the risk factors for adverse psychological reactions to abortion. There is now a consensus among most professional organizations, authors of abortion textbooks, and researchers that women who possess particular demographic, personal, situational, and relational characteristics are more prone to experiencing abortion as an adverse life event. Among the negative psychological outcomes described in the world literatures are substance abuse, depression, various forms of anxiety, and suicidal behaviors. Individual women faced with an unintended pregnancy report different levels of connectivity to the developing fetus, and those who feel some attachment prior to the choice to abort are at higher risk for postabortion mental health problems. There is evidence that a meaningful proportion of women fully planning to abort do actually experience attachment to the fetus. In an Australian study, a significant segment of the sample of women attending an abortion clinic engaged in attachment-related emotions and behaviors, ­including daydreaming about what type of mother they would be (50%), talking to their fetus (40%), rubbing their stomachs affectionately (30%), and ­feeling protective of the pregnancy (15%). Highly elaborate neural mechanisms and oxytocin, a nanopeptide hormone, play a vital role in the emergence of maternal attachment behavior. Plasma oxytocin levels are often stable throughout pregnancy, and levels early in pregnancy and in the postpartum period have been shown to be predictive of maternal bonding behaviors including gaze, vocalizations, positive affect, affectionate touch, maternal attachment–related thoughts, and frequent checking on the infant. First pregnancies are more likely to be terminated than later pregnancies because many young women find themselves ­pregnant prior to feeling ready to begin a family. However, the outcome of an abortion decision can be particularly difficult for first-time mothers as there is empirical evidence that first-time mothers experience more pronounced ­feelings of maternalfetal attachment than experienced mothers. In addition to the experience of attachment, a number of other risk factors for adverse postabortion psychological reactions have a great deal of

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support in the scientific and clinical literature. For example, a 2009 National Abortion Federation textbook intended for abortion providers lists the following risk factors: (a) perceived coercion to have the abortion; (b) significant ambivalence about the abortion decision; (c) putting great effort into keeping the abortion a secret for fear of stigma; (d) preexisting experience of trauma; (e) past or present sexual, physical, or emotional abuse; (f) unresolved past losses and perception of abortion as a loss; (g) intense guilt and shame before the abortion; (h) an existing emotional ­disorder or mental illness prior to the abortion; (i) appraisal of abortion as extremely stressful before it occurs; (j)  expecting depression, severe grief or guilt, and regret after the abortion; (k) belief that abortion is the same act as killing a newborn infant. Many of the established risk factors occur simultaneously and are intricately interconnected. For example, a woman who has some interest in continuing the pregnancy may be pressured by her partner to abort if the relationship is unstable, initiating mixed feelings and distress. If she is depressed as well and has difficulty articulating her feelings, she may yield to the partner’s pressure. In this case, the woman would be at a highly elevated risk for mental health problems following the abortion. Women who seek an abortion are usually provided with information pertaining to how the procedure will affect them physically; however, ­ criticism levelled against pre-abortion counseling has focused on insufficient assistance with the decision process. The available data indicate that professionals will more effectively serve women by helping them avoid a decision that may be regretted later. To this end, substantive pre-abortion counseling is essential to identify the risk factors present in each individual case and to assist women in autonomous, personalized pregnancy decision making. The extent to which a decision is voluntary is complex and undoubtedly falls on a continuum, as pregnancy-related decisions are embedded in a layered social context. Professionals should seek to sensitively identify any pressures women are under, the intensity of such pressures, and women’s ability to assert autonomy in order to make comfortable decisions. Warren Hern, a well-known abortion provider, has emphasized the central role of

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Abortion

pre-abortion counseling in evaluating women’s mental status, circumstances, and abortion readiness, while stressing the importance of developing a supportive relationship between the counselor and the patient to prevent complications. Abortion is unique among medical procedures because it is optional and involves two biological systems (mother and fetus). A developing fetus, whether viewed as an actual life or a potential life, is purposefully destroyed through the act of abortion, and efforts to answer basic questions regarding the extent to which abortion is advantageous or detrimental to women’s physical and psychological health cannot be realistically separated from deep ethical and moral questions. Each woman faces these questions and answers them on some level to arrive at the decision to abort based on her personal belief system. The resolution may be reached through avoidance of the ethical issues and focusing on practical and situational factors to arrive at the decision (e.g., There is no way I can care for an infant right now given my financial situation; I want the relationship with my partner to end and having a child now will force us to be connected for years), or the woman may face the ethical questions and arrive at a comfortable resolution (e.g., I don’t believe the developing fetus is human in its present form, and I have the right to control my body and my destiny; therefore, I am comfortable with my decision), or finally the decision may give way to negative emotions such as guilt, self-reproach, anxiety, or depression because of ethical conflicts (e.g., I know abortion involves the taking of a human life and I feel awful about this decision, but I cannot cope with the thought of motherhood right now. It would be the end of everything I’ve hoped for). The need for objectivity and a dispassionate approach to the study of abortion decision making and adjustment cannot be overstated. However, because research indicates that a minimum of 25% of women who choose abortion believe that they are ending a human life, failure to fully appreciate the connection to ethical issues has moved the academic study of abortion further away from understanding its true meaning in women’s lives. For example, if researchers simply quantify the likelihood of abortion being associated with subsequent mental health problems, such as depression, they miss the opportunity to understand how and why

abortion might be associated with elevated risk. Identification of mediating mechanisms, some of which may be directly tied to ethical questions (e.g., guilt, self-reproach) and some of which may not (e.g., feelings of loss, relationship problems), demystifies the connection between abortion and well-being while providing critical information for ­prevention and intervention efforts should mental health problems arise. These factors indicate that an individual’s beliefs pertaining to the ethics of abortion are relevant to the science and it is beneficial to include appreciation for this dimension as researchers examine the risks and benefits of abortion. The magnitude of this topic is revealed when one recognizes that abortion touches virtually everyone in some way. Affecting more than 1  ­million U.S. women and their partners each year, abortion is a personal experience—sometimes positive, sometimes negative, and frequently mixed. For hundreds of thousands more, it is a choice to be considered. Among defenders of women’s rights, abortion has increasingly become a central focus. For the spiritual, abortion may be a crime against God and nature. At the societal level, there is intense political conflict that multiplies with each passing election. The sociopolitical struggles surrounding abortion have tended to obfuscate the very real needs of women before and after abortion. A conservative estimate indicates that a m ­ inimum of 20% of women experience adverse psychological consequences associated with abortion, which might sometimes endure for many years and interfere with their ability to fully experience life. There is a need for substantive, e­ vidence-based pre- and postabortion counseling protocols, incorporating the needs of diverse women. Widespread professional recognition that oversimplification is detrimental to women’s health would facilitate such protocols. Priscilla K. Coleman See also Grieving and Gender; Pregnancy; Reproductive Rights Movement; Teen Mothers; Women’s Issues: Overview

Further Readings Coleman, P. K. (2011). Abortion and mental health: A quantitative synthesis and analysis of research

Abstinence published from 1995–2009. British Journal of Psychiatry, 199, 180–186. Hern, W. (1990). Abortion practice. Philadelphia, PA: Lippincott. Husfeldt, C., Hansen, S. K., Lyngberg, A., Noddebo, M., & Pettersson, B. (1995). Ambivalence among women applying for abortion. Acta Obstetricia et Gynecologica Scandinavica, 74, 813–817. Joffe, C. (2013). The politicization of abortion and the evolution of abortion counseling. American Journal of Public Health, 103, 57–65. Kero, A., & Lalos, A. (2000). Ambivalence—A logical response to legal abortion: A prospective study among women and men. Journal of Psychosomatic Obstetrics and Gynecology, 21, 81–91. Paul, M., Lichtenberg, E. S., Borgatta, L., Grimes, D. A., Stubblefield, P. G., & Creinin, M. D. (Eds.). (2009). Management of unintended and abnormal pregnancy: Comprehensive abortion care. Chichester, England: Wiley-Blackwell. Skjeldestad, F. E. (1994). When pregnant: Why induced abortion? Scandinavian Journal of Social Medicine, 22, 68–73. Soderberg, H., Andersson, C., Janzon, L., & Slosberg, N.-O. (1997). Continued pregnancy among abortion applicants. A study of women having a change of mind. Acta Obstetricia et Gynecologica Scandinavica, 76, 942–947. Stites, M. C. (1982). Decision making model of pregnancy counseling. Journal of American College Health, 30, 244–247. Thorp, J., Hartmann, K., & Shadigan, E. (2003). Longterm physical and psychological health consequences of induced abortion: Review of the evidence. Obstetrical and Gynecological Survey, 58, 67–79.

Abstinence The meaning and consequences of sexual abstinence are interwoven with gender, development, and sexual orientation. When abstinence is normatively appropriate, it is associated with markers of good social functioning, but when abstinence occurs out of step with social norms, it is associated with poorer functioning. This entry explains that different people have different ideas about what abstinence is because they have different definitions of what sex is. It further explains that people who are not having sex

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are considered to be abstinent only if sexual behavior is seen as normative for their stage of life. It points out that in many cultures abstinence is more valued for girls and women than it is for boys and men. The entry describes the prevalence of abstinence across the life span, as well as gender, sexual orientation, age, and cultural differences in the reasons for abstinence. It concludes by examining the consequences of abstinence and explains some of the difficulties that occur in trying to distinguish whether abstinence is beneficial or harmful.

Differences in Definitions Sexual abstinence means different things to different people. For many people, abstinence involves refraining from specific behaviors that they consider to be sex. A difficulty arises because people have different views about which specific behaviors define what sex is. Teens and young adults generally believe that sex includes heterosexual vaginal sex. There is less agreement about whether oral sex, anal sex, petting, kissing, and touching are sexual behaviors. For instance, in a 2007 survey of an ethnically diverse sample of California teens ranging in age from 14 to 19 years, the only definition of abstinence that the teens agreed on was that people are not abstinent if they engage in penetrative vaginal sex. This phallocentric definition poorly describes the sexual experiences of gay, lesbian, and bisexual individuals. Religious beliefs sometimes shape conceptions of abstinence, resulting in definitions that exclude any behavior, such as masturbation, that provides sexual gratification. Scientists who study sexually transmitted diseases often define sex as a behavior that exposes the person or the person’s partner to a sexually transmitted disease. By that definition, oral sex is sex, whereas behavior that does not involve penetration, such as mutual genital touching, is not. Much of the research on abstinence among gay males has taken a disease prevention approach to defining abstinence because AIDS first appeared, and remains prevalent, among men who have sex with men. From the disease transmission perspective, it is alarming that many people do not think that oral sex is sex, since this behavior carries some risk of transmitting diseases. An alternative to thinking about abstinence as refraining from certain behaviors is thinking of it

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Abstinence

as a set of proactive behaviors. Both youth and adults who define abstinence as proactive ­behaviors talk about exerting self-control, being consistent with attitudes and values, respecting oneself, making an investment in the future, and understanding that there are options for close relationships other than sexual relationships. There is considerable overlap between gay and heterosexual youth in the reasons why they decide to refrain from sex. Another feature of how people define abstinence is that people who refrain from sexual behaviors are considered to be abstinent only when they are assumed to have a culturally normative interest in having sex. Young children prior to puberty typically are not thought of as being abstinent. Once people reach old age, they are stereotyped as having little sex drive, and thus people may not think of very elderly people who do not have sex as being abstinent.

Social and Cultural Norms Throughout history and in many contemporary cultures, abstinence is more highly prized for girls and women than it is for boys and men. Girls have often been expected to refrain from sex until they marry, whereas boys are often thought to benefit from sexual experience prior to marriage. In 20thand 21st-century Western societies, this double standard in expectations about abstinence faded. However, in other cultures, such as certain African and Middle Eastern cultures, unmarried girls and women are expected to be abstinent and can be subjected to severe social penalties if they are not. In part this is because these are cultures of honor, in which the honor of the immediate and extended family, especially the honor of the males in the family, is tied to the purity of its female members. Not only is abstinence often less valued in men than in women, but men also may face social disapproval if they are abstinent. Dominant cultural views about masculinity include the notion that men are highly sexually motivated. Being abstinent raises questions about a male’s manhood, and sexually abstinent boys and men may be assumed to be gay. This conception of manhood is so strong that in some cultures people believe that normal men are not able to abstain from sex. For example, in some cultures extramarital sex by a husband is thought to be normal and unavoidable if the man’s

spouse is unable to have sex. In contrast, where cultural norms define the only acceptable sex as heterosexual sex, gay males are expected to be abstinent throughout their lifetime.

Abstinence Across the Life Span Few people are abstinent for their entire lives. For instance, results of a 2009 national survey of U.S. adults who were 25 to 45 years old at the time indicated that only 13.9% of men and 8.9% of women reported that they had never had sexual intercourse. People who have never had sex are referred to as primary abstainers. People who had been sexually active at some point but currently are abstinent are referred to as secondary abstainers. Several national surveys of 9th- to 12th-grade students indicate that between 60% and 70% of them are primary abstainers and up to 15% are secondary abstainers. At the other end of the age spectrum, a 2004 national survey of adults in the United States showed that abstinence rates were 27% for people 57 to 64 years of age, 47% for people 65 to 74 years of age, and 74% for people 75 to 85 years of age. Among heterosexual adolescents, common reasons for abstinence include avoiding unwanted pregnancy, preventing the occurrence of sexually transmitted diseases, not feeling that they are ready for sex, believing that sex is not appropriate for people of their age, parental disapproval, and wanting to wait until marriage. Fear of becoming pregnant motivates heterosexual girls to abstain from sex more than fear of making someone pregnant motivates boys. Gay and bisexual youth share many of these reasons for abstinence, but they also face issues connected with coming out, identifying possible sexual partners, and forming relationships in a heterosexist society that may discourage homosexual activity. Among adult abstainers, fear of sexually transmitted diseases, lack of available sex partners, and illness often motivate abstinence. People who have been diagnosed with HIV typically go through a period of abstinence. Periods of abstinence also commonly occur after women give birth. Reasons for abstinence vary across cultures. In some African countries, for example, Tanzania, Ghana, and the Ivory Coast, prolonged abstinence after childbirth is considered normal. African couples abstain because they believe that babies are

Abstinence

more likely to thrive if the mother is not having sex and because they want to space out the intervals between children. An important question about abstinence is whether abstinent people are better or worse off than people who have sex. The answer depends partly on the stage of life during which abstinence occurs. U.S. federal guidelines for sex education require that adolescents be informed that having sex before marriage has negative effects on physical and mental health. There is some research that suggests that delaying sex may benefit at least some young people. For example, abstinence is associated with less likelihood of engaging in other behaviors—such as alcohol consumption—that society also thinks should be delayed until adulthood. It is important to keep in mind, though, that an association can occur because risky behaviors such as alcohol use may lead to earlier sexual behavior, not because abstinence reduces risky behaviors. In addition, the association between abstinence and reductions in risky behaviors may be due to some other important influence such as family stability, which can affect both sexual behavior and behaviors that are risky or that society thinks are appropriate only for adults. The most informative research on this question follows adolescents over time. In this way, researchers can see if being abstinent at one point in time can predict a behavior or condition that occurs later on. For example, researchers at the University of Connecticut Health Center and University of Missouri used survey data from a study that followed 13- to 19-year-old boys and girls for the next several years. They found that among adolescents who had never had sex at the start of the study, those who used alcohol heavily (more drinks per sitting and drinking until intoxicated) at the start of the study were more likely to have had multiple sex partners, sex with strangers, and onenight stands approximately 5 years later than were initially abstinent adolescents who did not drink heavily. The reverse was also true. Adolescents who engaged in risky sexual behaviors at the start of the study were more likely to be heavy drinkers several years later—even when the effects of their being heavy drinkers at the start of the study were taken into account. There is some evidence that abstinence may be more beneficial for girls than for boys. Girls who

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have sex in early adolescence have lower selfesteem, more depression, and more suicidal thoughts than those who delay sex until they are older. They also are more likely to drop out before finishing high school. Sex is less consistently related to these harmful outcomes for boys and does not appear to be related to boys’ educational attainment. For both girls and boys, the benefits related to abstinence tend to diminish as they enter early adulthood, and become hard to detect once they reach their mid-20s and beyond. Once people reach adulthood, being sexually active is considered to be a normative part of healthy functioning. It is very common for adults, however, whether they have a partner or not, to be  abstinent for several months at a time due to ­illness, job pressures, child rearing, and other reasons. Lesbian couples often report having sex relatively infrequently, although it is unclear whether this means they have little intimate physical c­ ontact with each other or whether this is because physical intimacy that does not include heterosexual vaginal sex is not defined as sex. Abstinence becomes troubling for many adults only if they feel that they are out of step with the normative expectations for their stage of life. The consequences of abstinence also may depend on whether it is voluntary or involuntary. Some people are voluntarily abstinent, often for religious or philosophical reasons. Others are involuntarily abstinent because they lack a willing partner or for other reasons like fear of unwanted pregnancy. Negative outcomes linked with adult involuntary abstinence include depression, anxiety, loneliness, and social isolation. Some research indicates that delaying sex beyond the age by which most people have experienced sex, especially for men, is associated with difficulties in sexual functioning, including difficulties with arousal and orgasm. It is important to remember, however, that these associations might occur because people who are depressed or lonely also have difficulty establishing or maintaining sexual relationships. It could also be the case that fear of intimacy and inability to establish good relationships may contribute to both psychological distress and abstinence. In addition, there are similarities between the psychological states associated with abstinence and those associated with engaging in risky sexual behaviors that suggest that both abstinence and risky sexual

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Abstinence in Adolescence

behaviors may reflect the same underlying psychological dynamics. Carol T. Miller See also Abstinence in Adolescence; Abstinence-Only Education; Ageism; Safe Sex and Adolescence

Further Readings Bersamin, M. M., Fisher, D. A., Walker, S., Hill, D. L., & Grube, J. W. (2007). Defining virginity and abstinence: Adolescents’ interpretations of sexual behaviors. Journal of Adolescent Health, 41(2), 182–188. doi:10.1016/j.jadohealth.2007.03.011 Donnelly, D., Burgess, E., Anderson, S., Davis, R., & Dillard, J. (2001). Involuntary celibacy: A life course analysis. Journal of Sex Research, 38(2), 159–169. DuBois, L. Z., Macapagal, K. R., Rivera, Z., Prescott, T. L., Ybarra, M. L., & Mustanski, B. (2015). To have sex or not to have sex? An online focus group study of sexual decision making among sexually experienced and inexperienced gay and bisexual adolescent men. Archives of Sexual Behavior, 44(7), 2027–2040. doi:10.1007/s10508-015-0521-5 Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O’Muircheartaigh, C. A., & Waite, L. J. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357(8), 762–774. Loewenson, P. R., Ireland, M., & Resnick, M. D. (2004). Primary and secondary sexual abstinence in high school students. Journal of Adolescent Health, 34(3), 209–215. doi:10.1016/j.jadohealth.2003.05.002 Mbekenga, C. K., Pembe, A. B., Darj, E., Christensson, K., & Olsson, P. (2013). Prolonged sexual abstinence after childbirth: Gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb. BMC International Health and Human Rights, 13(1), 4. Miller, C. T., Solomon, S. E., Bunn, J. Y., Varni, S. E., & Hodge, J. J. (2015). Psychological symptoms are associated with both abstinence and risky sex among men with HIV. Archives of Sexual Behavior, 44(2), 453–465. doi:10.1007/s10508-014-0464-2 O’Hara, R. E., & Cooper, M. L. (2015). Bidirectional associations between alcohol use and sexual risktaking behavior from adolescence into young adulthood. Archives of Sexual Behavior, 44(4), 857–871. doi:10.1007/s10508-015-0510-8 Ott, M. A., Pfeiffer, E. J., & Fortenberry, J. D. (2006). Perceptions of sexual abstinence among high-risk early and middle adolescents. Journal of Adolescent Health, 39(2), 192–198. doi:10.1016/j.jadohealth.2005.12.009

Sabia, J. J., & Rees, D. I. (2011). Boys will be boys: Are there gender differences in the effect of sexual abstinence on schooling? Health Economics, 20(3), 287–305. doi:10.1002/hec.1589 Sandfort, T. G., Orr, M., Hirsch, J. S., & Santelli, J. (2008). Long-term health correlates of timing of sexual debut: Results from a national US study. American Journal of Public Health, 98(1), 155–161.

Websites Centers for Disease Control and Prevention, Youth Online: http://nccd.cdc.gov/youthonline/App/Results.aspx

Abstinence

in

Adolescence

Abstinence refers to the act of voluntarily refraining from some desired behavior for a period of time, often for religious or health reasons. Although the term abstinence can be applied to any number of behaviors, when referring to adolescents it is typically used to mean avoiding certain sexual behaviors. Depending on the goals of abstaining, those behaviors that are excluded can vary. If the purpose is to avoid an unintended pregnancy or a sexually transmitted disease, abstinence involves refraining from those sexual behaviors that can put one at risk for those outcomes (e.g., unprotected vaginal, oral, or anal intercourse). If the purpose of abstinence is based on religious or moral values, it can involve refraining from a much wider range of behaviors that can include flirting and kissing. Sexual abstinence as it is typically taught to adolescents tends to focus on girls as the gatekeepers of sexual behaviors. Since the 1980s, when federal funding for abstinence education began to increase dramatically in the United States, it has continued to stir controversy and draw criticism as a strategy aimed at reducing adolescent sexual behaviors. This entry reviews the different approaches to abstinence education and discusses its gendered focus. The entry concludes with a brief overview of its effectiveness among adolescents.

Divergent Approaches to Abstinence Education Approaches to education about sexual abstinence can be categorized into two distinct camps based

Abstinence in Adolescence

on divergent philosophies as to what the purpose and goals of sexual abstinence should be. Abstinence-only education (sometimes called ­ abstinence-only-until-marriage education) has as its exclusive purpose the promotion of sexual abstinence outside marriage. Such programs teach about the social, psychological, and health gains of abstaining from sexual activity outside marriage. Abstinence-only approaches do not include discussions of safer sex, condoms, or other contraception—other than to emphasize failure ­ rates. This approach typically relies on religiously based concepts such as chastity, virginity, purity, and the sanctity of marriage to encourage abstinence among its target audience, which is typically adolescents, although its prohibition of sexual activity outside marriage includes others as well. The abstinence-only approach has been criticized for being both cisnormative and heteronormative. All allusions to relationships and sexual behaviors are within the context of two people of “the opposite sex,” a phrase that also connotes a reinforcement of traditional gender roles and excludes people who are not married either by choice or because they are forbidden to marry by law. Unlike the morality-based approach of abstinence-only education, abstinence-plus education (also known as abstinence-based education) stems from a p ­ ublic health approach to pregnancy and disease prevention. With this focus, such programs emphasize abstinence from those behaviors that put a person at risk for unintended pregnancy and sexually transmitted diseases. This approach, however, envisions abstinence as one means toward sexual health along with many others, including the use of contraception and safer sex.

Abstinence and Gender The idea that one needs to use self-restraint to refrain from something desirous is inherent in the concept of abstinence. How great a challenge abstinence poses, then, depends partly on the level of one’s desire for the activity to be avoided, as well as the strength of one’s self-restraint. It is this fundamental understanding that results in a gendered treatment of sexual abstinence. Whether subtle or overt, an essentialist and heteronormative view of gender undergirds virtually all abstinence promotion efforts. Such a view holds that “boys will be boys” and cannot be trusted to contain

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their naturally powerful sexual urges. Conversely, girls are seen as naturally having more control over their less virulent sexual desires and, therefore, more likely to have success at being abstinent. This supposedly stronger self-restraint on the part of female partners will, by association, ensure that their male partners abstain as well. Therefore, abstinence messages tend to be aimed at heterosexual girls. This focus on girls is consistent with sexual script theory, which identifies submissiveness and passivity as the dominant cultural script for heterosexual women and posits that women are expected to be the gatekeepers to sexual behaviors and to be responsible for pregnancy prevention. Scholars have found that such emphasis on traditional gender norms can have a negative impact on the sexual development of adolescents, regardless of gender.

Effectiveness of Abstinence Among Adolescents Delaying sexual intercourse is associated with many positive health outcomes for adolescents, including less risk for unintended pregnancy, fewer sexually transmitted diseases as well as less regret about the timing of the first sexual experience, and lower likelihood of being in a coercive sexual relationship. The success of sexual abstinence depends on many factors, including the adolescent’s age, perceived peer and social norms around sexual activity, relationship status, alcohol and drug consumption, awareness of and access to viable alternatives to the sexual behaviors being avoided, and level of interpersonal communication skills, as well as other developmental, social, emotional, psychological, and cultural factors. Reports on the effectiveness of abstinence programs aimed at adolescents have been mixed, with some supporting effectiveness and others not supporting effectiveness. Evidence on the effectiveness of abstinence-plus programs has been more promising, but it is likely that the combination of abstinence messages along with information about contraception (e.g., condoms) is what has led to lowered pregnancy and sexually transmitted disease outcomes from some programs. Adolescents’ use of abstinence for long periods of time has been found to be inconsistent. Like their use of condoms and other forms of contraception, adolescents’ inconsistent and incorrect use

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Abstinence-Only Education

of abstinence results in a reduction of the method’s effectiveness in preventing negative outcomes of sexual activity. Factors that contribute to young people’s inconsistent or incorrect use of abstinence include those related to adolescent development, such as unwillingness to acknowledge one’s own sexual activity, not seeing oneself as vulnerable to the potential consequences of risky sexual behaviors, and, especially for younger adolescents, difficulty planning ahead and wanting to live in the moment. Eva S. Goldfarb See also Abstinence; Abstinence-Only Education; Gender Norms and Adolescence; Sex Education; Sexuality and Adolescence

Further Readings Advocates for Youth. (2001). The controversy over abstinence-only-until-marriage programs. Washington, DC: Author. Retrieved from http://www .advocatesforyouth.org/publications/publications-a-z/ 937-the-controversy-over-abstinence-only-until-marriageprograms Elia, J. P., & Eliason, M. (2010). Dangerous omissions: Abstinence-only-until-marriage school-based sexuality education and the betrayal of LGBTQ youth. American Journal of Sexuality Education, 5, 17–35. Goesling, B., Colman, S., Trenholm, C., Terzian, M., & Moore, K. (2014). Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: A systematic review. Journal of Adolescent Health, 54(5), 499–507. Goldfarb, E. S. (2009). A crisis of identity for sexuality education in America: How did we get here and where are we going? In E. Schroeder & J. Kuriansky (Eds.), Sexuality education: Past, present, and future (Vol. 1, pp. 8–30). Westport, CT: Praeger. Sanchez, D., Fetterolf, J. C., & Rudman, L. A. (2012). The consequences and determinants of traditional gender role adherence in intimate relationships. Journal of Sex Research, 49, 168–183.

Abstinence-Only Education Abstinence-only sex education teaches that people should be sexually abstinent prior to marriage and that abstinence is the only safe and effective way

to avoid unintended pregnancy and sexually transmitted diseases (STDs). Research on the effectiveness of abstinence-only education programs has produced mixed results, with some studies supporting effectiveness and others not supporting effectiveness. Some evaluations indicate that, on average, participants in abstinence-only programs are more likely to abstain from sex than comparison groups but are no more or less likely to engage in risky sexual behavior. However, evaluations using the most effective practices find much weaker positive effects than those that can only approximate these practices. This entry notes that abstinence-only programs often reinforce tradi­ tional gender roles and neglect issues faced by sexual minorities. Finally, it describes how ­abstinence-only programs have been exported to the developing world through U.S. efforts to combat the global AIDS epidemic. This entry explains the role that conservative social and political perspectives played in U.S. public policy shifts to promote abstinence-only programs, and describes practices for evaluating program effectiveness.

Social and Political Perspectives The goals of sex education are to equip participants to make decisions about sexual behavior that protect themselves and others from unintended pregnancy, STDs, and emotional and physical harm. Virtually all sex education for preteens and adolescents gives attention to the benefits of waiting to initiate sex. What distinguishes ­abstinence-only programs from other approaches (which usually are referred to as comprehensive sex education) is their singular focus on sexual abstinence as the only way to promote health and prevent harm, and their emphasis on the unreliability and drawbacks of using contraception to prevent pregnancy and condoms to prevent STDs and HIV. Although comprehensive sex education programs discuss the benefits of abstinence, they do not describe it as the only preferred prevention method for young people. They also provide information about sexual risk reduction strategies that focuses on both benefits and drawbacks. U.S. federal funding for abstinence-only programs surged dramatically between 1998 and 2008 from $4 million to more than $176 million annually. Since 2009, funding has dropped, but the

Abstinence-Only Education

national health care overhaul that began in 2010 still included $50 million annually over the next 5 years for abstinence-only programs. The funding surge for abstinence-only programs occurred at the same time when social and political conservatives gained increased political influence, especially during the presidency of George W. Bush. The confluence of conservative social and religious perspectives with abstinence-only programming is reflected in what these programs teach. During the peak years of federal support for abstinence-only programs, eligibility for most federal sex education funding required that programs must have the exclusive purpose of teaching about the benefits of abstaining from sexual activity. Programs also had to teach that abstinence until ­ marriage is the expected standard for all school ­children, that mutually faithful monogamous relationships within marriage is the expected standard for adults, and that sexual activity outside marriage is likely to have harmful psychological and physical effects. Programs also were required to teach that sexual abstinence is the only certain way to avoid pregnancy, STDs, and other associated health problems. Prioritizing abstinence-only programs for federal funding was an unwelcome development for many professionals and organizations concerned with the prevention of unintended pregnancies, STDs, and HIV. Examples of these organizations are the Guttmacher Institute, the Sexuality Information and Education Council of the United States, and the American Academy of Pediatrics. They feared that if abstinence-only programs failed in their main objective of getting young people to abstain from sex, their emphasis on the unreliability and harmfulness of methods of contraception and disease prevention would lead to an increase in risky sex. Many argued that policy was being made based on political and religious views rather than on evidence about what approaches achieve the best outcomes. Proponents of ­abstinence-only programs, which include organizations such as the Heritage Foundation and the National Abstinence Education Foundation, counter that abstinenceonly programs are effective in getting young people to delay sex and that comprehensive sex education encourages young people to have sex without successfully convincing them to use protective ­ measures consistently or effectively.

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Effectiveness Evaluations The most accurate practice for discovering if a treatment or intervention is effective is a randomized clinical trial. Applied to sex education, this means that program participants are assigned randomly to receive abstinence-only education or they are assigned to a comparison group. The comparison group might be a group that receives no sex education, or it may be a group that receives ­comprehensive sex education. The main advantage of a randomized trial is that it reduces the likelihood that there are preexisting differences between people who do and do not participate in an ­abstinence-only program that might account for any postprogram differences in behavior. A 2012 review of 23 evaluations of the effectiveness of abstinence-only programs published in the American Journal of Preventative Medicine found that all but one of the programs were aimed at early adolescents, 10 to 14 years old. About half of the evaluations were randomized clinical trials. The rest were quasi-experimental designs. In this type of evaluation, participants in an abstinence-only program are compared with people who (it is hoped) are comparable except that they do not participate in the program. The validity of quasi-experiments depends on having a comparable comparison group. In some quasi-experimental evaluations, there are important preprogram differences between the groups, for example, differences in race and commitment to abstinence. Moreover, even if there are no preprogram group differences on baseline measures, there still could be differences on unmeasured variables between those who do and do not participate in the program that may in fact be responsible for the apparent effects of the program. Results of the 2012 review indicated that abstinence-only programs on average increase ­ abstinence among program participants, with no reliable differences in risky sex. However, results for different programs were extremely variable, and positive effects on sexual behavior were much smaller in randomized clinical trials than they were for quasi-experimental designs. These findings led an independent organization of public health experts to conclude that there is insufficient evidence to justify abstinence-only programs as an effective way to prevent adolescent pregnancy and the spread of STDs and HIV.

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Abstinence-Only Education

This conclusion does not mean that abstinenceonly programs are never effective. Programs differ tremendously in duration, setting (school based vs. community based), targeted audience (early vs. middle adolescence), and instructor training, to name just a few. There has been almost no research to try to unpack which program elements or features are critical to success. A randomized clinical trial that was published in 2010 is an example of how this can be done. Participants were sixth- and seventh-grade African American students in urban public schools. Some students were randomly assigned to an abstinence-only intervention that specifically targeted beliefs and attitudes about abstinence as an effective way to prevent pregnancy and STDs, without focusing on other p ­ reventive methods. However, unlike other ­ abstinence-only programs, this program did not criticize the reliability of condoms and contraceptives and did not promote abstinence as the expected standard for all unmarried people. In other words, this program was not intended to meet the federal criteria for  what constitutes an abstinence-only program. The early adolescents who participated in this ­abstinence-only program were less likely to engage in sex during the follow-up period than were those who participated in a health promotion intervention that targeted health issues unrelated to sexual behavior. These results suggest that teaching that monogamous married sex is the only acceptable form of sexual behavior and that abstinence is the only effective preventive strategy is not necessary to promote abstinence.

Implications for Sexual Minority Youth and Gender Inequality The typical abstinence-only curriculum does not address the needs of sexual minority group members and may even be hostile to them. Until 2015, marriage between people of the same sex was illegal in most states. Teaching that abstinence is the only acceptable behavior prior to marriage leaves gay, lesbian, bisexual, and transgendered youth with no option except lifelong abstinence. For most people, this is neither possible nor healthy. Moreover, withholding accurate information about alternative disease preventive strategies denies sexual minority youth information that they need to protect their health. The moralistic perspective that inspires most abstinence-only programs is

insensitive to the issues facing sexual minority youth and can reinforce negative attitudes toward them. For example, there is evidence that sexual minority youth experience greater harassment in schools with abstinence-only programs. The social and religious conservatism that gave rise to abstinence-only programs also influences what they teach about gender roles. These programs often present traditional gender stereotypes as fact. This is important because gender inequity is implicated in unintended pregnancies, the spread of STDs and HIV, and sexual violence. Traditional gender roles make it difficult for girls and women to set limits on sexual behavior or insist that sexual partners use condoms. Abstinence-only programs tend to equate abstaining from sex with having self-respect, but the traditional gender ideologies they espouse undermine the ability of girls and women to see themselves as valued people who are worthy of respect. The religious and political perspectives that influenced U.S. domestic policies also influenced U.S. foreign aid programs to combat the global AIDS epidemic. Approximately 35 million people are living with HIV/AIDS globally, with the vast majority living in middle- and low-income countries in sub-Saharan Africa, where infection rates are as high as 35% of all adults and AIDS is the leading cause of death. In 2003, the United States launched the Presidents’ Emergency Plan for AIDS Relief, a 5-year, 15-billion-dollar program to assist high-prevalence countries to implement AIDS prevention, treatment, and care. By 2006, legislative mandates required that nearly two thirds of the funds allocated for preventing the sexual transmission of HIV be devoted to programs that promote abstinence for unmarried people and fidelity for married people. Federal guidelines specifically prohibited programs from “sending conflicting signals” by promoting condom use or presenting safer-sex practices as a viable alternative to abstinence. These restrictions meshed poorly with the social, cultural, and economic realities of the people who live in the affected countries. Economic necessity drives many girls and women into the sex trade, and gender inequality reduces their sexual autonomy. Male infidelity is common, and so monogamy offers married women little protection from HIV infection. Uganda is the only country in this region that experienced a substantial decline in prevalence rates. Although some observers credit

Acceptance and Commitment Therapy

this decline to programs advocating the ABCs of HIV/AIDS prevention (abstain, be faithful, use condoms), Uganda also mobilized a massive response to the epidemic that included public attention to issues of gender inequality. By 2012, the enthusiasm for international abstinence-only programs had faded. The 2012 blueprint for continued operation of the international programs gives little attention to abstinence-only programming and instead calls for comprehensive approaches to education about sex, sexuality, reproductive health, and HIV. Carol T. Miller See also Abstinence; Abstinence in Adolescence; HIV/ AIDS; Homosexuality; Safe Sex and Adolescence; Sex Education; Sex Education in Schools

Further Readings Boonstra, H. D. (2009). Advocates call for a new approach after the era of “abstinence-only” sex education. Guttmacher Policy Review, 12(1), 6–11. The Community Guide. (n.d.). Preventing HIV/AIDS, other STIs, and teen pregnancy: Group-based abstinence education interventions for adolescents. Atlanta, GA: Author. Retrieved from http://www .thecommunityguide.org/hiv/abstinence_ed.html Goesling, B., Colman, S., Trenholm, C., Terzian, M., & Moore, K. (2014). Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: A systematic review. Journal of Adolescent Health, 54(5), 499–507. Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (2010). Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archives of Pediatrics & Adolescent Medicine, 164(2), 152–159. Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344–351. doi:10.1016/j.jadohealth.2007.08.026 Murphy, E. M., Greene, M. E., Mihailovic, A., & OlupotOlupot, P. (2006). Was the “ABC” approach (abstinence, being faithful, using condoms) responsible for Uganda’s decline in HIV? PLoS Med, 3(9), e379. Retrieved from http://journals.plos.org/plosmedicine/ article?id=10.1371/journal.pmed.0030379 Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs.

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Journal of Adolescent Health, 38(1), 72–81. doi:10.1016/j.jadohealth.2005.10.006 Trenholm, C., Devaney, B., Fortson, K., Clark, M., Quay, L., & Wheeler, J. (2008). Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases. Journal of Policy Analysis and Management, 27(2), 255–276. Waxman, H. (2004). The content of federally funded abstinence-only education programs. Washington, DC: U.S. House of Representatives Committee on Government Reform, Minority Staff Special Investigations Division. Retrieved from http:// spot.colorado.edu/~tooley/HenryWaxman.pdf Weed, S. E., Ericksen, I. H., Lewis, A., Grant, G. E., & Wibberly, K. H. (2008). An abstinence program’s impact on cognitive mediators and sexual initiation. American Journal of Health Behavior, 32(1), 60–73.

Acceptance Therapy

and

Commitment

Acceptance and commitment therapy (ACT, which is said as one word) is a practice that guides individuals who experience negative mental and behavioral patterns (e.g., anxiety) to accept and process those patterns rather than avoid experiencing them. ACT is grounded in relational frame theory, which is a modern behavioral analytic approach that focuses on language and cognition. The linguistic process thorough which individuals interact with their environments can affect psychological functioning, causing them to frame a situation as good or bad. ACT has been described as one of the third-wave behavioral therapies. This entry explores the constituents, practice, and effectiveness of ACT.

Psychological Flexibility and Experiential Avoidance The overarching goal of ACT is greater psychological flexibility, or an increased range of mental techniques with which to cope with one’s symptoms. From an ACT perspective, some traits and diagnoses of mental disorders are derived from experiential avoidance, or the avoidance of emotions and symptoms that an individual perceives as negative. Individuals are taught that they should “control” their symptoms; however, from an ACT

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Acceptance and Commitment Therapy

perspective, control is ineffective. An example used within the therapeutic relationship is the polygraph metaphor. When using this metaphor, clinicians suggest to their clients that they are hooking them up to the most sensitive polygraph machine and that the clients’ only responsibility is to relax. However, during this process, it is suggested that the clinicians are going to hold a gun to their head and if they get nervous then the only option is for the clinicians to pull the trigger. In this scenario, what do you think will happen? The client usually will respond by saying that it would be impossible to relax. This provides a workable experience for the client to process experiential avoidance and how control is ineffective. Overall, experiential avoidance causes an individual to engage in rigid thinking and behavioral patterns that ultimately affect their ability to thrive in therapy and in their everyday lives. For example, with anxiety, avoidance and escape behavior can cause an individual from an outside perspective to interpret that the individual living with the disordered anxiety does not want to engage in activities fully; however, that is usually not the case. Most individuals who have been diagnosed with anxiety disorders have created a context in which they are unwilling to “be with” their anxiety in situations. It should be noted that experiential avoidance serves as a coping mechanism that individuals use to relate to their emotions. As such, it takes a typical experience (e.g., anxiety, sadness) and functions to sustain the tangled experiences related to the emotion.

Six Core Processes of ACT The ACT “hexaflex model” is made up of six key processes: (1) acceptance, (2) cognitive defusion, (3) contact with the present moment, (4) self as context, (5) values, and (6) committed action. The model itself is divided into two parts: (1) mindfulness and acceptance processes and commitment and (2) behavior change processes. When viewing the model in diagram form, “Psychological Flexibility” is in the middle, suggesting that with all six parts of the model an individual can experience greater psychological flexibility—the end goal. Acceptance

When thinking about acceptance, it is important to remember that it is an alternative to experiential avoidance. Acceptance requires individuals

to “be with” their thoughts, emotions, private events, and bodily sensations without attempting to change them. If the individual tries to change them in duration, frequency, or manifestation, then it could exacerbate the symptoms the individual is currently experiencing (e.g., the polygraph metaphor). For example, an individual who is experiencing panic attacks may try to escape the fear of impending doom, dizziness, or other physical manifestations that accompany the fight-or-flight response. Instead, individuals are taught to feel the manifestations and sensations as fully as possible without judgment. Cognitive Defusion

Cognitive defusion is a technique that some clinicians adopt to separate a client’s thoughts and words about an experience from the experience itself. This technique allows clinicians flexibility to tailor the clinical conversation. When engaging in cognitive diffusion, the objective is to allow clients to gain some distance between what actually is occurring and what their mind is telling them is occurring. As shown in the previous example of experiencing panic, many individuals think, “I am dying” or “I am having a heart attack or stroke” based on their physical experiences. If the client were able to engage in defusion effectively, he or she would be able to show a change in evaluative statements. For example, instead of saying “I am dying,” the client would replace the statement with “I am having the thought that I am dying” or “I am having the feeling of being frightened by my physical symptoms.” The aim is to have the client approach the feeling, sensation, and thought from an observer perspective. Contact With the Present Moment

Contact with the present moment consists of having clients experience their world in a more direct manner. In doing so, clients have improved psychological flexibility. Self as Context

Self as context is an abstract idea, and it can be difficult for some clinicians and clients to grasp it initially. This conceptual idea is easier to understand if the individual views himself or herself as an observer. When clients are engaging in this, they

Acceptance and Commitment Therapy

are observing experiences without labeling them as good or bad. Clinicians will often use metaphors throughout the therapeutic relationship to help bring the abstract idea to light. It can be helpful in the beginning to explain to clients that we are not our thoughts, behaviors, or emotions. ACT clinicians stress that all of these symptoms come and go and that clients do not possess the power to make them disappear—even if they do not like them. ACT clinicians also point out that one thought is not more important than another emotion or any other bodily sensation. Other ways in which clinicians foster the self as context is through mindfulness based exercises and other experiential processes. Values

Values are an important aspect to ascertain in any individual when working within a therapeutic relationship. From an ACT perspective, values include things that may not be obtained as physical objects (e.g., intimate relationships, family, friends) but can be experienced in the moment. Within the counseling relationship, it is often beneficial for the clinician to help the client understand the difference between values and goals. ACT clinicians and clients have sometimes used worksheets and questionnaires to construct a conversation around actions guided by values. Committed Action

In the process of committed action, clinicians encourage individuals to link effective action with the previously chosen values. There are different ways in which clinicians work to build patterns of committed action. The clinician may first build a plan of action that is based on the client’s life values. A form may be implemented weekly to ­ monitor the client’s activities and help promote conversation within the therapeutic relationship. An ACT clinician may encourage small steps, reinforcing that in committed action quality is more important than quantity, and also encourage the client to move with any barriers that they ­experience—explaining that it is part of the process. Within the therapeutic dialogue, the clinician can use language to help the client understand the hidden obstacles to their committed action. Finally, an ACT clinician integrates relapses into ongoing

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future effective action, helping the client see missteps as opportunities to grow.

The Efficacy and Future of ACT A meta-analysis of theory literature supports the efficacy of ACT in clinical practice. Researchers have suggested that ACT appears to be beneficial in treating a number of mental and physical disorders, including depression, psychosis, eating disorders, chronic pain, schizophrenia, trichotillomania, and anxiety. In addition, ACT has been used to explore workplace stressors that individuals may experience. Researchers are upfront in suggesting that the outcomes of the data are relatively new and still growing. In addition, clinicians acknowledge that the approach that ACT uses can seem counterintuitive to both themselves and the clients they serve. With that said, the future of ACT in practice will depend on whether it continues to provide the outcomes that researchers have seen and if the clients and clinicians consider it worthwhile. Furthermore, while ACT has been found to be effective with both cisgender men and cisgender women, some scholars have cited that gender-­ tailored interventions may be useful, particularly in understanding any differences that may occur between genders. For instance, perhaps there are some elements of ACT treatment that may have varied effectiveness between cisgender men and cisgender women, given the histories of systemic sexism, the expectations of masculine and feminine gender roles, and the clinical dynamics with therapists and clients. There have also been studies that have focused on the effectiveness of ACT with gay men—particularly on issues related to body image, substance use, and HIV stigma. Given the scarcity of literature on ACT and sexual orientation and gender identity, however, future research demonstrating ACT effectiveness with LGBTQ populations would be valuable too. Jonathan Procter See also Behavioral Approaches and Gender; Behavioral Theories of Gender Development; Couples Therapy With Heterosexual Couples; Couples Therapy With Same-Sex Couples; Dialectical Behavior Therapy and Gender; Gender Dynamics in Group Therapy; LGBTQQ-Affirmative Psychotherapy; Sexual Orientation Dynamics in Group Therapy

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Acquaintance Rape

Further Readings Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.

Acquaintance Rape Acquaintance rape refers to forced sexual penetration or oral sex that occurs between individuals who know each other (as opposed to stranger rape). As a broad definition, acquaintance rape may include individuals who are married or involved in a domestic partnership (often referred to using the subcategory of “marital rape” or “intimate partner sexual assault”). Traditionally, acquaintance rape has been referred to as date rape; however, this term is a misnomer as the individuals involved in acquaintance rape may or may not be engaged in dating behavior or an intimate relationship. For example, the individuals may be coworkers, friends, casual acquaintances, or former dating partners. This entry focuses on the prevalence of acquaintance rape, the societal attributions of responsibility to the perpetrator or the survivor (or victim), and the motivations of the perpetrator and the effects on the survivor.

Prevalence and Reporting Approximately two thirds of sexual assaults are perpetrated by a person (or persons) known to the survivor; however, acquaintance rape is underreported in comparison with stranger rape. Survivors of acquaintance rape may not believe that acquaintance rape is “real rape,” may blame themselves or feel ashamed, may fear the social or familial repercussions, and/or may not want the perpetrator to get in trouble with the law; thus, estimates of the prevalence of acquaintance rape may vary. Prevalence also varies for the general population versus the college population. According to the U.S. Department of Justice, the late high school and

college years are the most dangerous for women; the risk of rape in this time period is four times higher than in the general population. An estimated 50% to 90% of rapes during this risk period are acquaintance rapes. Men are also not immune to sexual violence. Although 90% of adult rape victims are female, an estimated 1 in 10 victims of rape is male. Because cultural scripts dictate that males are supposed to enjoy sexual encounters, statistics concerning male victims of acquaintance rape are unlikely to be inaccurate due to issues of underreporting.

Victim Blaming and Attribution of Responsibility When a survivor is acquainted with a perpetrator, responsibility for the event becomes harder to discern for both the survivor and observers ­ (e.g., friends, campus discipline boards, and jury members). As previously mentioned, even victims sometimes do not realize that the assault counts as a real rape. Compounding the problem are factors such as resistance used by the victim, alcohol or drug use, prior sexual history of the victim, and any sexual activity preceding the assault. Victim blaming may occur for many reasons, including belief in a just world, an individual’s cognitive and social scripts regarding appropriate sexual behavior, sexism, fundamental attribution error, and rape myth acceptance. Kimberly Lonsway and Louise Fitzgerald proposed that rape myths (i.e., generally false attitudes held about rape that are nonetheless prevalent) are used as defense mechanisms and help protect individuals from feeling vulnerable or acknowledging the prevalence of sexual assault. Common rape myths include that women secretly enjoy being raped, that a man who pays for a date deserves to have sex, and that a victim who dresses seductively or drinks alcohol is “asking for it.” Belief in rape myths has important real-world consequences as the individuals who have these beliefs are more likely to engage in victim blaming and less likely to blame the perpetrator. Jury members, for example, may be less likely to find the perpetrator of an acquaintance rape guilty. A victim may also fail to resist an attacker, not because the victim wants the event to occur but rather because the victim may be afraid to resist,

Adlerian Theories of Gender Development

may be in a state of shock or disbelief, or may be in a state of incapacitation due to alcohol or drugs. Victims who have resisted verbally (saying no) and/or physically (e.g., kicking, pushing, hitting) are generally held less responsible than victims who fail to resist. Perpetrators (and later observers) may believe that failure to resist is a form of silent consent. There have been numerous national and collegiate efforts to encourage an initiator of sexual intercourse to receive verbal consent from a partner.

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are normal reactions to trauma and stress but may require therapeutic intervention. Although it is a common perception that acquaintance rape is “not as serious” as stranger rape, current knowledge suggests that acquaintance rape survivors are blamed more, may suffer from serious psychological trauma and stress, and underreport their rapes. Erin C. Dupuis See also Campus Rape; Date Rape; Rape; Rape Culture; Victim Blaming

Perpetrator Motivation Most perpetrators of acquaintance rape are never prosecuted for their crime due to reasons of underreporting, victim blaming, and faulty police investigation. Rape perpetrators may use rape as a form of sexual gratification or a means to feel powerful. They may view their targets as sexual objects and as being deserving of sexual violence. Nicholas Groth developed a typology of the “rapist,” which includes two distinct subtypes that exemplify acquaintance rapists. Anger rapists include persons who are angry in general, angry at an entire demographic (e.g., women) in general, or at a specific victim and are verbally and physically abusive toward their victims. Power rapists use rape as a means to gain control over a victim, and they tend to choose physically vulnerable victims. Certain subcultures perpetuate a norm of sexual violence against women. In some fraternities, college men engage in rape to become or remain a part of the group. They may fear being ostracized for resisting the group norm.

Effect on Survivors Survivors of acquaintance rape may experience symptoms of or be diagnosed with posttraumatic stress disorder. These reactions may include fear and avoidance of similar people or situations, fear of losing control over their lives, recurrent traumatic memories and pervasive thoughts about the attack, trouble concentrating, feelings of depression, loss of interest in usual activities such as sex or relationships with others, and feelings of shame, self-blame, or disgust. Thus, acquaintance rape may cause the survivor to experience behavioral, physical, and mental responses. These responses

Further Readings Raphael, J. (2013). Rape is rape: How denial, distortion, and victim blaming are fueling a hidden acquaintance rape crisis. Chicago, IL: Chicago Review Press. Ryan, K. M. (2011). The relationship between rape myths and sexual scripts: The social construction of rape. Sex Roles, 65(11/12), 774–782. doi:10.1007/ s11199-011-0033-2 Watson, B. A., Kovack, K. A., & McHugh, M. C. (2012). Stranger and acquaintance rape: Cultural constructions, reactions, and victim experiences. In P. K. Lundberg-Love, K. L. Nadal, M. A. Paludi (Eds.), Women and mental disorders (Vols. 1–4, pp. 1–21). Santa Barbara, CA: Praeger/ABC-CLIO.

Adlerian Theories Development

of

Gender

In 1910, Alfred Adler’s development of his individual psychology model profoundly disturbed the Vienna Psychoanalytic Society and its leader, Sigmund Freud. Adler proposed that the formation of personality, and indeed all of personal development, was not based on sexuality but on the individual’s movement from a feeling of inferiority or inadequacy, striving toward a perceived better or superior outcome—from a felt-minus position to a felt-plus position. Adler claimed that the most powerful expression of this movement was in protest against masculine privilege, which both women and men experienced in society. Indeed, each person’s gender identity was in part an interpretation of their position in relation to masculine privilege.

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Adlerian Theories of Gender Development

In this sense, Adler’s theory, based on socialism and feminism, was the first socio-clinical perspective on gender development. This entry discusses the tenets of Adler’s theories and the societal context in which he developed these theories. Adler’s community, including his wife Raissa and other Russian socialists, saw socialism as a political force that could humanize the world and address the needs of the poor and the oppressed. In this sense, socialism was not a redesigning of the economies of nations but, rather, a means to correct social wrongs. Feminism and the rights of women were fully integrated in their socialist ideals. Adler’s theories of psychological development, which he called individual psychology, would never be fully separate from the social ideals they sought in these early conversations.

Adler and Gender Development in Individual Psychology In 1907, Adler published A Study of Organ Inferiority, in which he initiated a social model of psychology that would seriously differentiate his work from that of Freud. In that book, Adler outlines his belief that people who experience inferiority feelings in relation to organic disabilities tend to compensate by striving to overcome their limitations. This is the first full delineation of his belief that people are always moving from a felt-minus position toward a felt-plus position. In 1910, a ­ year before his formal split with Freud, Adler published his seminal article “Psychic Hermaphroditism in Life and in the Neurosis.” His use of the term hermaphroditism reflected his belief that all people exhibited traits that were traditionally and mistakenly called masculine or feminine. To emphasize this sociopsychological integration, Adler began to use the term masculine protest to describe the individual’s personal striving toward a felt-plus position. Society had privileged men in such a manner that their traits, assertiveness, ambition, aggression, and even defiance were prized. Women, growing up in the world of men, were always placed in a position below that of men, a less-than position, which no one can easily tolerate. In the natural development of women, Adler proposed the existence of a protest against this masculine privilege. Here, Adler is using the word protest

with two meanings: (1) “to bear witness to,” as in the Latin protesto or protestare, and the more common understanding (2) “to stand against.” Women experiencing masculine protest, according to Adler, have been urged there by the oppression and restrictions they experience in society. They are in revolt against masculine privilege, and this revolt affects their development. For Adler, women tend to cope with their designated societal role by taking one of three positions: 1. They adopt the masculine, privileged position for themselves and reject all that is feminine. 2. They become resigned to their feminine role, becoming adaptive to masculine demands, obedient, and humble and resorting to manipulation when desperate. 3. They become an advocate for the male’s privileged position, attributing all ability and competence only to men and demanding a special position for men.

Adler was married to a woman who rejected the latter two options outright and dedicated much of her efforts toward creating a new position for women. Adler, himself, would note that no one could be expected to fully develop in the face of Western culture until women achieved equal rights with men. Indeed, the overly aggressive traits and achievement standards expected of successful men often led to neurosis in even the masculine gender. If the standard for “real men” were higher than what an individual male might feel possible, he too would experience feelings of inferiority and revolt against these expectations. Every man compares and evaluates his position against the perceived standard for what real men are like, and those who feel themselves coming up short are left with inferiority feelings that are hard to overcome. Until World War I, Adler remained politically engaged while building his psychology and its practice. After the war, he eschewed politics in favor of developing a scientific basis for his theory. Throughout his writings, however, Adler fully integrated positions related to women’s rights that are still central to women’s equality in the 21st century. He developed a socio-clinical psychology fully embedded in systemic analysis, social consciousness, and social equality between the sexes

Adlerian Theories of Gender Development

and between generations. Adler directly challenged the alleged inferiority of women and the myth of masculine superiority. He supported women’s right to work and to equal pay, noting that as long as women were paid less than men for the same work, they would be kept in a subservient position, with detrimental psychological effects. He also noted that male cruelty and violence were compensations in the perpetrator for perceived weaknesses as a man. Adler was pro-choice, and he noted that the choice was important for the well-being of not just women but also those whom they birthed: Children brought into the world should, he indicated, be raised by people who want them. Adlerians also posit that little girls are often more restricted and more oppressed than little boys. In both Adler’s time and today, girls are often socialized to hold back and act with dignity and reserve. In contrast, little boys are often expected to be more aggressive, outgoing, and engaged in life.

Dreikurs and the Evolution of Modern Adlerian Theory Starting in 1940, Rudolf Dreikurs, Adler’s protégé and colleague, identified four goals of children’s misbehavior: (1) attention getting, (2) power struggles, (3) revenge, and (4) demonstrations of inadequacy (or the desire to be left alone). Even these goals had both active and passive forms of movement, with the former more commonly associated with boys and the latter associated with girls. While birth order as interpreted by the individual still has a major influence on personality and psychological development, parents set gender guiding lines for their children. Jane Griffith and Robert L. Powers noted in The Lexicon of Adlerian Psychology that the child’s images of mother and father form the norms for what it means to be a man or a woman. All men and women in the person’s life are assessed against these norms. Gender guiding lines are treated as if they are destiny, as if identification with the norm is inevitable: A little boy looks at his father, and a little girl looks at her mother, and both think, “When I grow up, I will be like that unless I do something about it.” When two heterosexual parents raise a child, the relationship between the parents tells the child what to expect in marriage

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as well as what to expect in the societal relationships between men and women in general. Because gender guiding lines play such a significant role in development, single-parent and same-sex families often include significant role models for the absent gender. Role models, however, are rarely as powerful an influence as people who become established as gender guiding lines in the mind of the child. Alternative role models serve more as options to consider than as gender imperatives. Gender guiding lines not only affect the child’s individual development but also tend to highly influence the person’s choice of a mate or partner later in life. Dreikurs was an Adlerian who did much to advance the psychological imperative of social equality. For Dreikurs, social equality did not imply that people were the same. Clearly, one person is always different from another; men are different from women; children are different from adults. In a society, cultures are often different from one another; not even languages and customs may be the same within a given region; and states differ from one another just as nations also differ from one another. Even within a single society, management (business) may differ from labor; political parties almost always differ; and branches of government serve different functions. So with all this difference, how can there be equality? Dreikurs answered this by defining social equality as the right of all people to be valued and respected. By 1946, Dreikurs saw the inequality between men and women as a war between the sexes. Indeed, he believed that there was no problem in a heterosexual marriage that did not reflect the larger issues between men and women in society. Dreikurs believed that male dominance and male privilege were never useful but too often were present in psychological development. He even referred to descriptions of matriarchal societies in August Bebel’s Women and Socialism as evidence that masculine dominance was neither natural nor an unbroken norm from the beginning of human history. Echoing Adler, Dreikurs noted that the appearance of harmony between the sexes was more appropriately understood as fear: submissive acts performed by those stripped of power and status in the world. For Dreikurs and most contemporary Adlerians, social equality is the antidote to social injustice and a necessary foundation for psychological

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Adlerian Theories of Gender Development

well-being in the world. Democracy fully realized in social justice is the political form that supports equality between all people. In a broad range of psychotherapy with individuals, groups, couples, and families, Dreikurs and his associates sought to improve lives by moving people into more socially equal relationships.

Gender Development Within an Adlerian-Feminist Model Society typically assigns certain traits as feminine, whether or not there is neurobiology to support these valuations. Furthermore, these trait assignments have changed over time depending on the desired outcome of the dominant culture. ­Adlerians would argue that gender traits are not natural phenomena but, rather, the interpretations and expressions of individuals who have been restricted to specific ways of being, whose styles of life and behavioral patterns have been narrowed by culturally specific conceptions of power. While Adler was 50 years ahead of his time with regard to his views on women, his written positions on homosexuality reflected the dominant culture of the time. In his therapeutic practice, however, Adler expressed compassion and acceptance of gay or lesbian individuals as they were and sought to help these individuals realize the purposes of their coping styles and to see if there might be effective ways for them to reach their personal life goals. Adlerian therapy, in general, is still founded on this compassionate understanding of people coupled with a teleological investigation of individual styles of living, and a redirection toward a more useful, socially equal, and socially interested approach to life. Adlerians believe that no individual wants to accept second-class status, regardless of race, gender, age, economic status, sexual orientation, or physical ability. All individuals with second-class status suffer in relation to the privileges asserted as rights by the dominant culture. Second-class positions have a high tendency to result in depression, anxiety, self-absorption, substance abuse, or even delusions, mostly in an effort to safeguard the self against perceived failure or to escape ongoing oppression. Self-harm, suicide, posttraumatic stress disorder, and personality disorders are more prevalent in the oppressed. Some

men may also compensate for insecurities of their own masculinity by resorting to cruelty or violence against women, children, or even other men: This is clearly true in those diagnosed with antisocial personality disorder or narcissistic personality disorder, which some Adlerians feel could be more accurately renamed male dominance disorder. Although such psychological pain may be expressed directly through anger, it is not uncommon for many to retreat into the powers of weakness—that is, to use manipulation and even seduction. In this sense, Adlerians understand that all people enter life seeking to move from a felt-minus to a felt-plus position. In terms of gender development, this movement is often characterized by Adler’s masculine protest, the experience that one’s gender is less than adequate and relegated to ­second-class status. Protests in this sense are used by the individual to compensate, to cope, and to rise above the perceived minus position. James Robert Bitter and Marion Balla See also Feminism: Overview; Gender Discrimination; Gender Socialization in Childhood; Gendered Behavior

Further Readings Adler, A. (2003). Psychological hermaphroditism in life and the neurosis. In H. T. Stein (Ed.), The collected classical works of Alfred Adler: Journal articles: 1910–1913. Elaborating on the basic principles of individual psychology (pp. 1–8). Bellingham, WA: Classical Adlerian Translation Project. (Original work published 1910) Ansbacher, H. L., & Ansbacher, R. R. (Eds.). (1982). Alfred Adler: Cooperation between the sexes. New York, NY: W. W. Norton. Balla, M. (2003). Raissa Epstein Adler: Socialist, activist, feminist. In Adlerian yearbook: 2003 (pp. 50–58). London, England: Adlerian Society (U.K.) and Institute for Individual Psychology. Bitter, J. R., Robertson, P. E., Healey, A. C., & Jones Cole, L. K. (2009). Reclaiming a pro-feminist orientation in Adlerian therapy. Journal of Individual Psychology, 65(1), 13–33. Bottome, P. (1939). Alfred Adler: Apostle of freedom. London, England: Faber & Faber. Dreikurs, R. (1946). The challenge of marriage. New York, NY: Hawthorn.

Adolescence and Gender: Overview Hoffman, E. (1994). The drive for self: Alfred Adler and the founding of individual psychology. Reading, MA: Addison-Wesley.

Adolescence Overview

and

Gender:

Adolescence is a time of transition: Children move into new roles, learning about adulthood and how to function independently in society. Identity formation, including gender identity, is an integral part of the transition. Puberty is a time of physical change and hormonal development, often leading to increased awareness of sexuality, gender, and associated gender roles. Society and media presence often play a large role in the social and psychological aspects of development. Similarly, ­culture and ethnicity have a large impact on the ways in which adolescents develop their identity as individuals. This entry overviews the topic of adolescence, touching on aspects of biological, psychological, and social development as these factors relate to gender and gender identity. This entry also discusses the importance of peer relationships and issues related to mental health and gender in adolescence.

Gender Differences in Adolescent Development Physical Development

Puberty and biological changes in boys and girls are often the first signs that adolescence is approaching. Boys and girls both begin to develop sex organs and notice changes produced by surges in hormones, such as hair growth, increased sweat production, and, in boys, deepening voices. Girls begin menstruation and ovulation (development of eggs), while boys begin to produce sperm. Girls will typically begin showing signs of puberty before boys, between the ages of 9 and 17 years, while boys will start showing signs between the ages of 11 and 16 years. Growth spurts, including changes in bone structure, follow the initial pubertal changes. For example, girls’ hips and boys’ shoulders will both widen.

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Boys and girls in adolescence require additional sleep and begin to notice changes in their sleep patterns, feeling more awake in the nighttime hours. These changes in sleep patterns do not always coincide with the usual school day and required hours of attendance. This leaves many adolescents, both boys and girls, sleep deprived, not getting the needed hours of sleep to assist with brain development and other biological shifts and changes during this time. Sleep deprivation can lead to poor academic performance as well as mood swings, which are also exacerbated by changes in hormone levels. For transgender or gender nonconforming (TGNC) adolescents, physical changes may cause some psychological distress. For example, a transgender girl (who was assigned male sex at birth) may start to notice a deeper voice, larger male genitals, unwanted hair on the face and chest, or broader shoulders—which may be incongruent with her perception of her female identity. Because of this, some transgender adolescents may opt for puberty blockers or inhibitors, which may delay these physical changes until they are old enough for gender affirming medical treatments. Social Development

During the 1950s, Sigmund Freud, one of the earliest developmental theorists, proposed a theory of development that focused on psychosexual development, or the stages of childhood and adolescent development as they relate to sexual and gender identity. The genital stage in this theoretical model focuses on adolescence and the desire for sex and intimacy, leading to reproduction. Freud ended his developmental stages here, reasoning that development ceased once individuals grew into puberty and reached the ability to enjoy sex, with the motivation to reproduce. Through the 1960s, Eric Erikson furthered this idea and created a new model of psychosocial development, proposing that development continued through to older adulthood. Erikson focused on adolescents’ developing identity and understanding of their role in society, in a broader context than their family of origin. Later, in 1986, Morris Rosenberg put forward a more encompassing idea about adolescent development, suggesting that identity has three components: (1) social

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Adolescence and Gender: Overview

identity, (2) dispositions, and (3) physical characteristics. Social identity includes aspects of identity that are influenced by the outside world, such as the media, parents, school personnel, and other outside people. Dispositions are parts of identity that come from within one’s own self and understanding of the world, while physical characteristics are appearance related, such as height and weight. These theoretical perspectives provide a context with which to understand the importance of the adolescence stage in forming an individual’s identity. In 1971, a researcher by the name of S. L. Bem developed a measurement tool, or scale, to measure “sex roles.” It is called the Bem Sex Role Inventory and helps ascertain how individuals identify themselves based on gender stereotypes. Gender stereotypes form much of how individuals understand their own gender identity, thus when an individual does not feel that they fit within the stereotypical notions that are so often publicized in the media and by society, it can be disruptive, especially in adolescence. Furthermore, more recent analysts and theorists contend that this method of conceptualizing gender is problematic because it polarizes gender, and current research demonstrates that an individual can exhibit certain gender traits in one area and others in another. For example, a young adolescent boy might show interest in household activities or cooking, yet also be interested in sports and athletic activities involving strength and muscle development. Newer research also shows that adolescents’ perceptions of how they fit within their gender group are also important in assessing gender identity, as well as how important this fit is to them. Understanding gender identity development in adolescents is of utmost importance as adolescents with atypical gender development experience more bullying and are more likely to experience mental health distress. Anxiety and depression are more likely in adolescents who do not identify with typical gender roles. Researchers believe that it is important to remove the pressure of gender conformity as children grow and develop. Social identity development also involves an adolescent’s ethnic and cultural background. Research shows that adolescents from minority backgrounds are likely to develop strong ethnic identities. This can be challenging as they are also

struggling with identification with gender norms, as well as identifying with national cultural norms. Family involvement is a strong predictor of adolescents’ identification with their ethnic background, as this identity generally forms within the context of one’s family. Because ethnic identification is so important to many minority youth, they are likely to develop the ability to function within the national culture as well as that of their family background. Communities of color often have differences in gender norms, especially as part of first- or secondgeneration immigrant families. Boys and men are often expected to be heads of households and protect families and female members of the household, both physically and financially. For example, the Latino culture uses the term machismo to describe the feelings of responsibility and pride felt by Latino men. Adolescent boys learn about machismo and similar concepts in other ethnically identified families and work to portray this. Machismo is often recognized as physical strength and ability, with traditional male gender roles. Men and boys who do not portray machismo are often bullied or not accepted within the family or cultural community. Latino adolescent boys often feel that they must defend their honor by fighting to show their strength. Families play an important function in the overall social development of adolescents. One of the primary tasks at this stage of life is to develop one’s own sense of self and primary identity away from the family of origin. The family of origin and its cultural background heavily affect the separation process. Each culture has its own understanding of what the separation and individuation process should look like. Within Western culture, first- and second-generation immigrant families are more likely to expect their adolescents to maintain strong ties with the family, so individuation and separation will be harder for these adolescents. Developing one identity within the family and another one in the broader societal sense to fit in with peers and others in school and work environments is a challenge. Another important aspect of adolescents’ social development is their relationships with peers and romantic partners. Adolescents relate to their peers more as they separate from their parents and family of origin. Peer relationships allow adolescents

Adolescence and Gender: Overview

to learn how best to relate to others and find common interests. Because adolescents are still developing their identities and learning how to relate outside the family, they may find themselves encountering negative peer behaviors as well. Navigating this and maintaining status in a peer group is another significant challenge of adolescence. For example, an adolescent girl may become friends with a group of girls at school, and in an effort to “fit in” and relate to her peers, she may begin dressing in a way that is different and not acceptable to her parents. In another example, a young girl may feel that smoking cigarettes or trying drugs is the only way to make her peers accept her. As adolescents begin to develop physical traits such as sex hormones, they begin to take an interest in romantic relationships. These relationships are also ways in which adolescents learn to relate to peers outside the familial context, but they are sexually satisfying as well. The romantic relationship allows the adolescent to develop attachment and learn about intimacy in relationships. The average age when adolescents begin to be sexually active in the United States is approximately 16 years, as in other developed countries. Most youth also develop sexual identity or orientation during this time, leaving those with same-sex attractions and orientations feeling different from societal “norms.” Despite strides in legalizing same-sex marriage, research shows that adolescents identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ) feel different from the majority and often experience greater mental health concerns than their heterosexual counterparts. In addition to determining sexual orientation, adolescents also begin to struggle with the consequences of sexual activity, such as sexually transmitted diseases (STDs) and pregnancy. Rates of STDs in adolescents are high, as research demonstrates that approximately 50% of those diagnosed with STDs in the United States are adolescents and young adults between the ages of 15 and 24 years. Rates of HIV and AIDS are also increasing in this age group, all indicating that adolescents are in need of better education around safe-sex practices. Media and electronic communication, in different forms, greatly affect an adolescent’s social development, with important gender differences. Both boys and girls play video games, but

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adolescent boys are more likely to have interest in the games and play for extended periods of time. Girls are more likely to use texting, social media, and instant messaging. As technology becomes increasingly present in the lives of adolescents, so does its impact. Video games and social media, as well as electronic communications through texting and e-mail, have become more common means of communication and interaction for adolescent boys and girls. Using forms of electronic communication removes the face-to-face or voice contact, and in many instances, it causes individuals to lose inhibitions related to face-to-face or voice contact. Cognitive development in adolescence often means that impulsive behavior and lowered inhibition are pervasive. Thus, adolescent girls often use these media forms of communication to bully other adolescents without having to “see” the reaction on the other side. Some adolescents use video games to connect with others, as the games allow for online play between real people whom they know as well as others in the gaming community whom they do not know. Lack of inhibition and impulsive behavior in these circumstances can also lead to dangerous situations, in which boys are either left vulnerable or in a position to bully others. LGBQ adolescents may struggle with social development at this time, as a result of their sexual orientation. While they may begin to notice romantic and sexual attraction to those of the same gender, they may also recognize the stigma and discrimination that may result if they were to disclose these feelings. Furthermore, though there has been an increase in media presence of LGBQ people on television, many portrayals are stereotypical, comical, or negative—resulting in few role models for healthy LGBQ identity development. LGBQ adolescents of color may see even fewer positive depictions of LGBQ Black, Latina/Latino, Asian, Native American, Middle Eastern, or multiracial people in the media—further negatively affecting their sexual orientation identity development. As a result of this, many LGBQ people may hide their sexual orientation, to be accepted by their peers or to avoid violence in their families or communities. TGNC adolescents may struggle with gender identity development during this time—­particularly if they are in environments where gender norms are rigid and family members are hostile or overtly transphobic. Some TGNC adolescents experience

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Adolescence and Gender: Overview

violence in their homes or are forced or encouraged to leave their families—leaving many of them homeless and without any support. As a result, many TGNC youth may choose to conceal their gender identities until they are adults, so that they  have more independence to navigate their identities. Cognitive Development

Adolescents’ brains are still developing, as are their cognitive skills. Adolescents tend to react impulsively, feeling as if they are invincible, and might sometimes act before going through a ­decision-making process. The reasoning skills that help adults think about the consequences and balance out pros and cons are still developing through this stage, creating difficulties and challenges around maintaining peer relationships, managing peer pressure, and making healthful decisions. Although both male and female adolescents struggle with impulsivity, males report significantly more risky behaviors and impulsive acts than females. Jean Piaget was another famous developmental theorist who examined childhood and adolescent development through a cognitive lens, discussing the ways in which children’s thought processes shift and evolve. Adolescents begin to develop empathy for others, helping them develop interpersonal relationships and begin to explore intimacy. They are also better able to think abstractly and understand more complex concepts, as well as to start thinking about the future. One common concern with Piaget’s theory and stage model is that he did not focus on gender or individual differences that might play a role in an individual’s cognitions, or how environment or culture might play a role in cognitive development. Furthermore, there is little known about cognitive development in TGNC adolescents.

Mental Health Issues and Gender Differences in Adolescence In the United States, rates of adolescent depression are double for girls than they are for boys: 4% nationally versus 2%, respectively. Researchers believe that these rates are due to hormonal changes in girls in combination with environmental and societal pressures, from the media, family,

and peers, to look and behave in certain ways. Family conflict and instability in the home, along with poor relationships with parents, are also associated with a greater likelihood for depressive symptoms in girls. Girls also report higher rates of anxiety than boys. It is uncertain whether or not the stigma associated with mental health issues keeps boys from reporting issues as much as girls report or if the incidence is indeed that much higher in girls. Increased depression and anxiety are also associated with being bullied, as is increased risk for suicidal thoughts and behaviors. Related to anxiety and depressive symptoms is the increased incidence of eating-disordered behavior in adolescent girls. Body image is of great concern among adolescent girls, as the media and society objectify women’s bodies, normalizing thin shapes and giving messages that only a small range of body types are acceptable. This creates exceptional difficulties for adolescent girls, who are already in a period of transition and identity development, almost to the point of crisis in many. Adolescent girls report concern about body shape and image, including fears and thoughts about being fat or overweight, when in fact they are at weights that are medically healthy for their age and height. Body image distortions, or envisioning oneself as a different shape or weight than is actually true, is also common in adolescent girls as their body shapes begin to develop in puberty. Stress and conflicted relationships with parents are risk factors for eating disorders and body image distortions. Although girls have higher rates of eating disorders in adolescence, more recent research suggests that boys who are medically underweight or obese are also at risk for body dissatisfaction, which is a risk factor for eating-disordered behaviors and weight control behaviors. Boys who are underweight often use protein powders or stimulants to attempt to increase their ability to build muscle and weight through excessive bodybuilding or weight training. Boys who are overweight or obese are at a higher risk of being bullied, as well as higher risk for depression. In adolescent girls, weight control is often a form of anxiety reduction and gaining control over their feelings and emotions, which are often very difficult to manage due to hormonal changes related to puberty and increased attention to peer

Adolescence and Gender: Overview

and romantic relationships. Adolescent girls are also at a higher risk for nonsuicidal self-injury or cutting. This is another form of controlling one’s difficult emotions in an effort to gain some control and find a release. Both weight control and nonsuicidal self-injury are dangerous and should be taken seriously, as they can lead to more serious lifethreatening injuries and health issues. When adolescent boys are depressed or anxious, they are more likely to show aggressive behaviors and anger rather than self-injurious behaviors. Exposure to violence in the home, community violence, and physical, emotional, and sexual abuse are all predictors of aggressive behavior in adolescent boys and self-injurious behavior in adolescent girls. These risk factors also predict higher levels of depressive symptoms and withdrawal, as well as anxiety in both boys and girls. LGBTQ adolescents may experience additional mental health issues, particularly if they live in family environments and communities that are not supportive of their sexual orientation or gender identities. Previous research has found that LGBTQ youth are at risk for depression, suicide, trauma, and substance abuse. Furthermore, many LGBTQ youth run away or are forced out of their homes, which results in a disproportionate amount of homelessness among LGBTQ youth. When LGBTQ youth are homeless, they have difficulty finding jobs or making money, which leads to involvement in crime, substance use, or survival sex. Youth of color may experience unique mental health issues, due to the intersection of their age, race, immigration background, and more. Many youth of color experience racism (both overt and microaggressive), which may cause significant psychological stress. Adolescents from immigrant backgrounds may encounter acculturative stress, including adjusting to life in the United States and navigating cultural or familial expectations.

Protective Factors in Adolescence Protective factors help the adolescent develop healthfully, despite the challenges associated with this time period. These factors “protect” against risks and issues such as living in a poor, lower– socioeconomic status neighborhood; conflicted relationships with parents; living in an area where

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community violence is prevalent; or peer pressure. Positive parental relationships protect against these risks, including parents who are open with and supportive of their children, using boundaries to protect them when necessary. Research also demonstrates that adolescents with a positive adult role model (whether this is a teacher, family member, counselor, neighbor, or other adult) are less likely to use drugs or participate in other maladaptive, risky, or impulsive behaviors or risky acts. Role models and protective factors are particularly important for youth and adolescents who are of lower socioeconomic status or come from poor neighborhoods where crime is high and drugs and prostitution are rampant. Youth and adolescents from poor neighborhoods are at higher risk of dropping out of high school, drug and alcohol use, contracting STDs, and teenage pregnancy. Additional protective factors include access to education and support for college applications. Adolescents must learn the skills necessary to be successful in the outside world and society. Involvement in team sports or school clubs and activities is also a protective factor for adolescent boys and girls. These activities allow adolescents to learn team-building skills and trust in the context of peer relationships and adult guidance. Team sports and school clubs also allow adolescents to learn to abide by the rules and thereby learn about consequences and rewards.

Case Example Charles and Carla are 16-year-old twins living in Brooklyn who identify as Mexican American. They were born in the United States and live with their mother but do not have a relationship with their father. Their mother is very loving and supportive but works two jobs to support the family. She is very tired when she is at home. She immigrated to the United States with their father when she was pregnant, hoping to give them a new life and opportunities. When the twins were 1 year old, their father left to go back to Mexico to care for his ailing father. He never returned, and their mother lost contact with him. Because she is so busy, the twins’ mother made sure that they each had smartphones to keep in contact with them at all times, but she rarely has time to monitor their activity on these phones.

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Adolescence and Gender: Overview

Charles and Carla were both recently referred to the school counseling center because they were exhibiting troubling behaviors. Carla was referred for being “oversexualized” and disruptive in class, and Charles was found engaged in a physical fight in the hall with another boy from one of his classes. Until now, Charles and Carla were both “under the radar,” and their mother had not received any phone calls. She is now very angry at both of them and concerned that they are heading down the wrong path. The counselors at the school counseling center specialize in adolescent development and gender and are well aware of the issues facing Charles and  Carla as adolescents in a single-parent, first-­ generation immigrant home in New York City. To mitigate the presenting issues and work with Charles and Carla toward a positive transition toward adulthood, the counselor assigned to their case developed a plan. Charles and Carla were both offered opportunities to join a sports team at the school or to receive counseling. Charles chose to join the sports team, and Carla chose counseling. Carla was concerned that she would not be seen as feminine enough by the boys if she played a sport, while Charles was concerned that taking counseling sessions would leave him vulnerable to being teased by his peers and labeled “soft.” Understanding their concerns, the school counselors agreed and capitalized on the opportunities to become involved with these adolescents. Charles developed a relationship with his basketball coach, while Carla developed a trusting relationship with her counselor. They both learned how to relate to adults, as well as to their peers, in more meaningful ways through these different experiences. The twins’ mother noticed more respectful behavior from both of them within 6 months of the interventions. Through involvement with the school counseling center, she recognized the need to be more present in their lives; she began to make an effort to see Charles’s basketball games when they fell on a date she was not working and found time to spend with Carla to engage in fun activities. Had the counselors pushed the twins to do both counseling and a sport, they might have lost interest, furthering their disruptive or oppositional behavior. By understanding the cultural, gender, and age-related issues of adolescence, they were able to successfully intervene.

Future Directions Adolescence is a time of transition and major physical, social, cognitive, and emotional development. Gender and gender roles and norms are a huge piece of this phase of development, as the focus is on identity formation. There are many factors that contribute to the development and ­ ­ well-being of adolescents, including their school ­environment, family, and cultural or ethnic identification. Access to healthy foods and positive learning environments is essential for youth to develop and transition successfully into adulthood. Youth with the most access to learning tools and positive environments still have much to tackle in this difficult stage of childhood. Thus, those who are lacking supports and access have more challenges to overcome and are left with more risk factors and hurdles to overcome. Future research on youth and adolescent development must focus more carefully on the ­differences in ethnicity and culture with regard to gender identity development. There is a need for clinical practices in psychology and related fields to focus on working with adolescents in order to understand the many facets of identity development, including understanding where they fall on the gender norms or behaviors spectrum. Normalizing behaviors that fall in all areas of the spectrum should become regular practice, providing space for adolescents to safely learn and experiment as they develop. Amanda Sisselman-Borgia See also Bullying in Adolescence; Gender Identity and Adolescence; Gender Norms and Adolescence; Gender Socialization in Adolescence

Further Readings Bolognini, M., Plancherel, B., Bettschart, W., & Halfon, O. (1996). Self-esteem and mental health in early adolescence: Development and gender differences. Journal of Adolescence, 19(3), 233–245. Collier, K. L., van Beusekom, G., Bos, H. M., & Sandfort, T. G. (2013). Sexual orientation and gender identity/ expression related peer victimization in adolescence: A systematic review of associated psychosocial and health outcomes. Journal of Sex Research, 50(3/4), 299–317. doi:10.1080/00224499.2012.750639

Affirmative Action Hutchison, E. D. (2010). Dimensions of human behavior: The changing life course. Thousand Oaks, CA: Sage. Marcus, R. F. (2007). Aggression and violence in adolescence. New York, NY: Cambridge University Press. Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, S. B. (2013). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: An 11-year longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 143–152. doi:10.1016/j.jaac.2012.11.006 Santrock, J. W. (1996). Adolescence: An introduction. New York, NY: Brown & Benchmark.

Affirmative Action Affirmative action in the United States is the purposeful effort to better opportunities for protected groups (e.g., women, people of color) in workplace and education settings. Such efforts include but are not limited to targeted recruitment policies, employment procedures, and admission programs. Specialized actions seeking a balance of opportunities between groups are viewed as a solution to the effects of past discrimination and as a means to prevent further discriminatory practices. The initial quintessential form, which has been officially banned in the United States since 1978, was the method of using minority quotas. Although this active form of addressing inequity no longer captures contemporary affirmative action policies, critics have continued to describe affirmative action as arranged “reverse discrimination.” Early-21st-century efforts mainly focus on effectively obtaining diversity in pools of applicants that is more representative of regional workforce populations. This entry discusses the origins of affirmative action and its effect on different demographics within the U.S. populace.

History With Title VII of the Civil Rights Act of 1964, discrimination on the basis of race, color, religion, sex, or national origin became prohibited in public education, employment, and voting processes. Executive Order 10925, signed by President John

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F. Kennedy 3 years earlier, had placed the first legislative stepping stone by requiring affirmative action to be taken to guarantee that no preferential treatment would be given due to race, creed, color, or national origin. On top of adding sex as a protected demographic, President Lyndon B. Johnson also established the Office of Federal Contract Compliance and the Equal Employment Opportunity Commission, within the Department of Labor. These agencies were tasked with ensuring that discrimination would no longer be an issue and with awarding government contracts and personnel selection, respectively. In addition to Title VII of the Civil Rights Act of 1964, the Equal Employment Opportunity Commission enforces other equal employment opportunity legislation, like the Family and Medical Leave Act of 1993, Title I of the Americans with Disabilities Act of 1990, the Age Discrimination in Employment Act of 1967, and the Equal Pay Act of 1963.

Case Law Throughout the decades, court cases have held precedence in determining what kind of implementation of affirmative action is legal. Most notably, Regents of the University of California v. Bakke (1978) determined that the use of quotas was unlawful. Considering that most of the affirmative action policies of the time abided by this system of setting aside a certain number of spots solely for the top minority applicants, Allan Bakke’s case against the university’s medical school admission process became a landmark affirmative action case. The university had been reserving 16 spots of every 100 students accepted for minority students. Bakke was rejected twice despite having higher scores than all of the minority students accepted, because he was not among the top 84 White students. The disadvantaged minority applicants were being given preferential treatment exclusively based on their race. Organizations had to revamp how they went about selecting applicants from underrepresented groups of people. They were still allowed to use race as a factor in selection, but it could not be the only factor. Despite such practices being banned early on, quota arrangements continue to be the assumed practice when affirmative action is discussed in the media and by critics.

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Affirmative Action

Public schools continued to face litigation due to giving too much weight to the race of their applicants. Hopwood v. Texas (1996) reaffirmed that rigid quota policies needed to be terminated. The University of Texas Law School did not accept Cheryl Hopwood despite her having better qualifications than numerous minority applicants who were accepted. The Appeals Court stated that race could be used as a minor factor to decide which candidate of a pair of candidates who tied on all other determinants of future success the school should select. The number of minority applicants for state universities dropped considerably once Texas and states with similar systems, like Louisiana and Mississippi, had to do away with their racial quotas. The solution that states arrived at was to accept any student in the top 10% of their high school class. While such a policy did restore minority applicant numbers, the public is still not satisfied. There is a belief that more could be done to attract the high performers among minority students since the top 10% policy does not directly address race. The court cases that the University of Michigan faced in 2003 clarified to organizations that race had to only be considered on an individualized, case-to-case basis. Specifically, the University of Michigan’s undergraduate selection process was deemed illegal in Gratz v. Bollinger. The school had predetermined that each bonus aspect of an applicant would result in a certain number of points, since a quantitative system was needed to sort out great numbers of applicants quickly. Because race resulted in a 20-point advantage, and relevant skills like artistic creativity only received 5  points, the University of Michigan’s College of Literature, Science, and the Arts lost the case.

Santa Clara County (1987), the court upheld the employer’s system of specifically looking for qualified women to fill their positions for skilled craftsmen, a position that women had yet to hold. The current issue calling for attention is the absence of women in science, technology, engineering, and mathematics (STEM) fields. This underrepresentation has created a high demand for recent female college graduates with these degrees and more scholarships for them. Greater efforts are being made to pique the interest of young girls in these subjects prior to their attending college. The Census Bureau found in 2011 that female presence in STEM fields was only 24%. Considering that more college degrees across all majors are being awarded to women than to men, some speculate that affirmative action can only do so much to alleviate the disparity in gender representation in all fields. In the case of overwhelmingly genderdominated industries, many point to the larger societal problem of how we socialize gender roles, resulting in women and men “choosing” to pursue different career paths. The overall benefit that affirmative action programs can have in addressing these larger cultural concerns remains a controversial topic.

In Support of Affirmative Action

Supporters of affirmative action contend that eliminating such policies would be ignoring the privileges that come with being a U.S. native, White, and male. Affirmative action is seen as one tool for addressing past systemic barriers that females and minorities have faced and continue to face. Attempts to judge everyone as if they are on an equal playing field, when in reality certain groups must overcome numerous additional obstacles, is viewed as the biggest hindrance to a society Gender and Affirmative Action pursuing true equality in opportunities. While the landmark cases most directly reflect how Arguments have been made that without extra affirmative action can best be legally implemented efforts to consider underrepresented groups of to create equal opportunities between demographic people for recruitment in organizations, a cyclical groups in education settings, the lessons throughprocess causes minority numbers to diminish and out the history of affirmative action have also been diminish. For example, if very few STEM profesapplied to gender in the workplace. Male-­ sionals are women, there are going to be very few dominated organizations struggle to get qualified female role models for the next generation of sciwomen into their applicant pools. Courts have entists and mathematicians. Fewer identifiable endorsed the use of gender as a positive in jobs in role models results in it being less likely for the which there is gross underrepresentation. For underrepresented group to think of those jobs as instance, in Johnson v. Transportation Agency, possibilities for future careers. Having less than an

Affirmative Action

equal presence in any job tends to result in the automatic mental categorization of that job as a gendered job (e.g., nurses are female and surgeons are male). Humans internalize these patterns as they mature and deem them as normal and, accordingly, explore career paths that society points them toward. Supporters of affirmative action believe that without serious efforts to attract young adults to historically nontraditional careers for their gender and without energy being focused on breaking this cycle of restrictive gender roles and norms, every field with a gender minority will eventually have no minority students pursuing it. Because affirmative action can, by definition, vary in characteristics and scope, supporters have the ability to argue that certain programs are better than others. In 2014, Pew Research results showed that nearly two thirds of the general public are in favor of affirmative action. Of those two thirds, 63% support affirmative action because they believe that increasing diversity is important. Focused efforts to attract qualified applicants from different backgrounds, rather than the use of demographic quotas, is the most common form of affirmative action. Customers, shareholders, and activists are often pleased to hear that organizations are making concerted efforts to include all types of people on their teams. Organizational diversity also shows a concern for civil justice and encourages innovation. The simplest affirmative action efforts include using different methods of advertisement, like websites versus career expos, and advertising positions in different kinds of locations more likely to attract the projected groups. Using diverse methods can easily result in a more diverse applicant pool.

In Opposition to Affirmative Action Those in opposition to affirmative action argue that such policies only hurt society as a whole. The most common criticism is the conviction that giving any extra value to belonging to an underrepresented group raises the likelihood of selecting a less qualified candidate. Critics of affirmative action programs estimate that having a diverse set of employees is not beneficial enough to compensate for the cost of possibly selecting slightly lower performers, or it simply switches the beneficiary of biased hiring rather than eliminating the bias.

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Some critics of affirmative action claim that the disadvantages women and minorities face are due to their own life choices, which result in such groups being less skilled and exhibiting lower performance. The main argument against enacting affirmative action is the concern for overall fairness. Any sort of preferential treatment based on a demographic, whether it benefits majority or minority candidates, seems to some to be inherently unfair. In 1996, California banned affirmative action in public institutions, and Washington State followed in 1998. The next year, Florida banned affirmative action in government workplaces and college admissions. In the 21st century, Nebraska, ­Arizona, Oklahoma, and Michigan opted to ban affirmative action in college admissions. Because voters disapproved of preferential treatment, they chose to ban affirmative action altogether. Critics have argued that it would be unreasonable to disadvantage men and majority members for the injustices of the past. Those in opposition to affirmative action believe that one should avoid treating any group differently than another and that the applicants’ credentials should speak for themselves. Those who oppose affirmative action do so under the assumption that decisions can be made without discrimination. They argue that the past cannot be fixed, so it is best to move on with no preferential treatment toward any group of people. For example, the social sciences, which are female dominated, have lower salaries than maledominated fields, like physics. However, women freely “choose” the lower-paying fields. Thus, there is no necessity for an institutionalized handout, because the wage gap and underrepresentation are not due to discrimination. Although these arguments are steeped in issues of fairness, they do not address the issue of how to make it more likely that women will start choosing male-­dominated careers. In addition, most of the criticism is focused on preferential hiring systems, when most contemporary affirmative action plans are focused on increasing the numbers of qualified women applicants. Joel T. Nadler and Natalie S. Anderson See also Equal Employment Opportunity; Gender Bias in Hiring Practices; Gender Discrimination; Glass Ceiling; Sexism

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Ageism

Further Readings Gratz v. Bollinger, 539 U.S. 244 (2003). Holzer, H. J., Neumark, D., & Besharov, D. J. (2006). Affirmative action: What do we know? Journal of Policy Analysis and Management, 25(2), 463–490. Hopwood v. Texas, 78 F.3d 932 (5th Cir. 1996). Johnson v. Transportation Agency, Santa Clara County, 480 U.S. 616 (1987). Leslie, L. M., Mayer, D. M., & Kravitz, D. A. (2014). The stigma of affirmative action: A stereotyping-based theory and meta-analytic test of the consequences for performance. Academy of Management Journal, 57(4), 964–989. Orfield, G. (2013). Affirmative action hanging in the balance: Giving voice to the research community in the Supreme Court. Educational Researcher, 42(3), 179–181. Regents of the University of California v. Bakke, 438 U.S. 265 (1978). Rubio, P. F. (2001). A history of affirmative action, 1619–2000. Jackson: University Press of Mississippi. Williams, B. (2015). “You were the best qualified”: Business beyond the backlash against affirmative action. Journal of Policy History, 27(1), 61–92.

Ageism Ageism broadly is defined as prejudice, stereotyping, or discrimination against people based on perceptions about their age group. Most commonly, however, discussion of ageism centers around prejudice against those perceived as old. In contrast, evidence about older adults’ health and age-related changes belies many ageist stereotypes. Nevertheless, older adults often face ageism and other threats (e.g., sexism, heterosexism, racism, and classism) to their productivity, well-being, and adjustment in the aging process. With the growing numbers of diverse and aging people in the United States, there are increasing demands for more informed and effective psychological practice with older adults. Such practice requires an understanding of intersecting influences related to gender biases. This entry explains the incongruity of ageist bias with facts and the effect of ageism on older adults.

Ageism, Diversity, and Mental Health Scholars vary in defining the age range of older adults as those who are 40, 55, 60, or 65 years of age and above. In the United States, as people live longer and stay healthier, the percentage of older adults is increasing and projected to significantly grow, particularly among the baby boomer generation (born 1945–1965). Older adults are a richly diverse group. As women tend to outlive men, and the proportions of people of color also grow, these changes are increasingly reflected in the population of older adults. The prevalence of older adults in the workforce has increased due to longevity, continued productivity, and economic necessity. Evidence to date indicates that most older adults maintain high levels of functioning, performance, and resilience when afforded helpful support with environmental demands in their life, health, sociocultural, and employment contexts. However, the prevalence of ageism can hinder older people in successfully adjusting to the challenges of aging. Psychologists need to consider age and the intersection of age with other forms of diversity in their work toward promoting multicultural competencies and human rights and reducing prejudice, discrimination, and health disparities. As an example of how ageism operates to marginalize the mental health needs of older adults by gender and race, the suicide rate for older White men is among the highest of any age group, yet suicide prevention efforts typically overlook this group. As another example, ageism may exacerbate health disparities for people of color and for low-income individuals, furthering the effects of an accumulation of lifelong inequities. Ageism intersects with sexism in the disproportionately higher burden of caregiving assumed by more women than men for older adults with failing health. Women are more likely than men to be victims of elder abuse—including physical abuse or neglect, sexual assault, and financial exploitation. Older lesbians report experiences of discrimination against their age and sexual orientation in many contexts including health care, employment, housing, family relationships, social situations, and shopping or dining out. As another consequence of ageism in health care, a common problem is overmedication of older adults, including overreliance on unwarranted psychoactive medications with dangerous side effects.

Ageism

Ageism in the United States is a pervasive and institutionalized form of prejudice and discrimination that is often unintentional yet harmful. Theoretical explanations propose that from an early age the prevalence of ageist stereotypes in society is internalized and reinforced throughout the life span. There is evidence that older adults who endorse more ageist stereotypes about themselves are more prone to impaired performance in physical and memory abilities and shorter lives. In contrast, community-dwelling older women, who, despite experiences of ageism and sexism, endorse more flexible gender roles, have higher levels of well-being. Psychologists are not immune to the pervasive, ageist attitudes and beliefs that adversely bias the quality of care they provide older adults. For example, psychologists may set inappropriately lower expectations for therapeutic progress with older adults and misattribute cognitive difficulties and depression to normal aging. To provide effective assessment and intervention for older adults, psychologists need to distinguish between ageist biases and their clients’ particular needs.

Ageist Stereotypes and Scientific Evidence For older adults in the United States, a summary of research findings addresses each ageist stereotype listed, countering it and providing relevant information for mental health care needs in particular. Senility

The ageist stereotype is that older adults inevitably become severely impaired, mentally and physically. In contrast, evidence to date supports that for most Americans over the age of 65 years, declines in some intellectual abilities are not severe enough to cause problems in daily living. With normal aging, mild forms of slower cognitive processing occur, such that older adults may need more time and repetition to learn new information. Common physical changes with aging include mild or moderate hearing and visual impairment. Difficulties in sleeping commonly increase with age, particularly for those over the age of 80 years. Nevertheless, daily social and occupational functioning for most over the age of 65 years is not

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impaired. Furthermore, cognitive functioning in discernment and creativity often continues across the life span. Dementia and Alzheimer’s disease are not a normal part of aging but do afflict some older ­ adults. Dementia is the irreversible deterioration of intellectual abilities accompanied by emotional disturbance such as depression, anxiety, and paranoia. Alzheimer’s disease is marked by significant losses of many mental functions, and it is a progressive disease that eventually leaves one unable to form new memories. The prevalence of dementia and Alzheimer’s disease is projected to grow as the size and proportion of the U.S. population of people ages 65 years and older continue to increase. Depression and Mental Illness

This ageist stereotype is that older adults are commonly plagued with high rates of mental illness, particularly depression. With the exception of depression in men over 85 years of age, the overall prevalence of mental disorders in older Americans is less than in other age groups, and general life satisfaction among older adults is as good as or better than among younger age groups. Furthermore, depression among community-dwelling older adults (those not residing in institutions) is less prevalent than in younger adults. However, older adults have the highest suicide rate of any age group, primarily older White men living alone. Frail, Sick, Lonely, and Dependent

These ageist stereotypes are that older adults are frail, ill, and socially isolated and have limited capacity for self-care. In contrast, evidence overall supports that most older Americans live independently and maintain close relationships with friends and family. Nevertheless, the proportion of older adults needing assistance with daily activities increases with age, particularly for those over the age of 85 years. Another ageist stereotype is that older adults have no interest in sex or intimacy. The evidence suggests that while interest in sex or intimacy remains relatively intact, the incidence of sexual dysfunction increases with age for both men and women. Common developmental life span transition issues for older adults’ mental health care include coping with experiences of loss (e.g.,

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Ageism

deaths, health declines, financial insecurity); managing caregiving responsibilities (for older, ­ aging, or younger family members); planning for employment, retirement, long-term care, and end of life; and navigating experiences of prejudice and discrimination based on age, gender, and other marginalized identities.

other influences of overt and covert discrimination. By promoting their own and others’ more accurate knowledge about the rich diversity of older adults, psychologists may be better equipped to help reduce ageism and facilitate the healthy adjustment, productivity, and well-being of older adults. Margo A. Jackson

Inadequate Employees

Ageist stereotypes often held against older workers include beliefs that they are inferior to younger workers and are thus less energetic, flexible, adaptable, trainable, healthy, ambitious, productive, or creative. In contrast, research shows that older workers have significant life and work experience, from which they contribute many positive attributes, such as knowledge, productivity, work ethic, stability, honesty, dependability, and mentoring. Another ageist stereotype is that older people are inflexible and stubborn, becoming more difficult and rigid with advancing age. In contrast, research shows that most individuals’ personalities remain relatively stable throughout the life span. Despite substantial empirical evidence to the contrary, ageist stereotypes about older workers persist and continue to have negative consequences. Ageist biases of employers are associated with reduced opportunities for older workers in hiring, training, promotion, and retention. Furthermore, ageism against older workers may impair their health and performance. Challenges faced in confronting ageism may be compounded for older workers who are members of other social identity groups vulnerable to workplace discrimination (e.g., groups defined by gender, gender identity, sexual orientation, race, ethnicity, class, or disability status). For women in particular, ageism and sexism in the workplace put them in double jeopardy as they age. Beyond the workplace policies, practices, and stereotypes that disadvantage women as they grow older, women also tend to outlive men in the United States, are more likely to assume a disproportionate share of caring for ill and dying relations, are overrepresented among part-time workers, and thus are left more vulnerable to poverty in old age. To meet the increasing demands for more informed and effective psychological practice with older adults, psychologists must work to recognize and address ageist biases, gender biases, and

See also Gender Socialization in Aging; Lesbian, Gay, and Bisexual Experiences of Aging; Men and Aging; Stigma of Aging; Transgender Experiences of Aging; Women and Aging

Further Readings American Psychological Association. (2014). Guidelines for psychological practice with older adults. American Psychologist, 69(1), 34–65. doi:10.1037/a0035063 Anti-Ageism Taskforce. (2006). Ageism in America. New York, NY: International Longevity Center-USA. Averett, P., Yoon, I., & Jenkins, C. L. (2011). Older lesbians: Experiences of aging, discrimination and resilience. Journal of Women and Aging, 23(3), 216–232. doi:10.1080/08952841.2011.587742 Brownell, P., & Kelly, J. J. (Eds.). (2013). Ageism and mistreatment of older workers: Current reality, future solutions. New York, NY: Springer. Centers for Disease Control and Prevention. (2013). The state of aging and health in America 2013. Atlanta, GA: Author. Retrieved from http://www.cdc.gov/ features/agingandhealth/State_of_aging_and_health_ in_america_2013.pdf Keita, G. P. (2014). Speaking up against ageism. APA Monitor, 45(5), 61. Retrieved from http://www.apa .org/monitor/2014/05/itpi.aspx Nelson, T. D. (2005). Ageism: Prejudice against our feared future self. Journal of Social Issues, 61(2), 207–221. doi:10.1111/j.1540-4560.2005.00402.x Sterns, H. L., & Dawson, N. T. (2010). Emerging perspectives on resilience in adulthood and later life: Work, retirement, and resilience. Annual Review of Gerontology and Geriatrics, 32(1), 211–230. doi:10.1891/0198-8794.23.211 Tazeau, Y. N. (2013, October). Multicultural aging and mental health resource guide. Washington, DC: American Psychological Association. Retrieved from http://apa .org/pi/aging/resources/guides/multicultural.aspx

Websites Gerontological Society of America: http://www.geron.org/

Aging and Gender: Overview

Agender See Genderqueer

Aging

and

Gender: Overview

Just as gender affects and influences early human development, gender continues to be a critical aspect of development well into the later stages of life. As there is a rapidly growing number of Americans over the age of 65 years, expanding ­ one’s understanding of how gender influences the process and experience of aging for those in their later years becomes increasingly relevant to research. The terms gender and sex are distinct from each other in that gender is socially constructed and sex is biologically based. Although both of these constructs are important in relation to aging, as the effects of gender and sex are so often intertwined, competently differentiating between the influence of these social and biological factors on aging is beyond the scope of this review. This entry first identifies the changing demographics of individuals in their later years and then provides an overview of gender roles and ageism. The entry also explores the intersection of aging and gender in the context of biological, psychological, and social factors.

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in the racial and ethnic compositions of older Americans are also forecasted, as the number of older adults in all racial and ethnic groups is predicted to expand in the upcoming decades. The fastest-increasing group is expected to be Hispanic older adults. This rise in the number of those over the age of 65 years most likely is due to increased life expectancy as a result of improved health care services, sanitation, housing, and economic conditions. Life expectancy is defined as the average years of remaining life at any given age, holding death rates constant. General life expectancy has increased significantly over the past century from an average age of death of 47 years in 1900 to 77 years in 2000. Males in the United States have an average life expectancy at birth of 76.3 years, and women have an average life expectancy at birth of 81.1 years. Due to the relative mortality gap, wherein women live longer than men, much of the research on aging has focused on older women, a phenomenon often deemed the feminization of aging. However, this longevity gap appears to be closing, with a steady increase in the number of men over the age of 85 years. According to a 2009 estimate of life expectancy for 85-year-olds, women were expected to live an average of 7 additional years as compared with approximately 6 years for men. Overall, the number of U.S. adults over the age of 85 years is expected to increase from 5.5 million in 2010 to 19 million in 2050.

Changing Demographics

Gender Roles and Aging

In the 20 years after World War II, birth rates increased rapidly. These individuals, often referred to as the “baby boomers,” began entering older adulthood, defined as 65 years and older, in the year 2011. Those in their later years currently make up approximately 13% of the U.S. population (40 million). The majority of these older adults are female, with estimates showing that women account for approximately 57% of the population of ages 65 years and older and 67% of the population over the age of 85 years. Projections suggest a continuing increase of those over the age of 65 years, with predictions that older adults will account for 20% of the U.S. population (72 million) in the year 2030. Changes

Socialized gender roles often play a significant role in the experience of aging. For example, some theories suggest that women who value more traditional gender roles may experience postmenopause as a slight to their identity of “mother” as compared with women who embrace this time period as an opportunity for personal growth. The latter group seems to age more happily and productively. Women who interpret the aging process as a loss of their youthful beauty and sexual desirability also tend to experience more decreased well-being. Some researchers posit that older men may similarly experience gender role–related effects of aging, possibly resulting in a greater decrease in self-esteem and well-being than for their female counterparts.

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Aging and Gender: Overview

One explanation may be that men are typically socialized to appear strong and in control; therefore, a loss of physical prowess and independence may threaten their sense of masculinity. For example, throughout their lives, men are often encouraged to follow scripts such as “be strong and silent,” stressing the importance of being stoic and unemotional, and “be tough,” building on both the suppression of emotions and the use of physical prowess to address situations. The “give-’em-hell” script, conversely, downplays emotions and instead focuses on the importance of physical action or violence as a method of achieving goals. However, some men who easily accepted these scripts in their younger years find that continuing in these roles becomes increasingly difficult as they experience health or cognitive decline. In contrast, they find themselves in the role of a caregiver for an ailing spouse, or they become determined to be a grandfather who is emotionally available. Similarly, as men encounter situations such as forced retirement from work, or widowhood, they may struggle with the lack of control to a greater extent than older women, who have likely experienced many other social structures that are out of their personal agency. This experience may be related to the higher levels of depression in men over the age of 85 years and likely also results in hesitancy to seek help regarding mental health issues and more reluctance to engage in treatment when offered.

The Intersection of Ageism and Sexism Overt ageism operates openly within the system to suppress and dominate older adults of both genders through institutionalized discrimination, such as mandatory retirement, biased hiring, and discriminatory promoting practices. In contrast, covert ageism is often expressed under the guise of humor, such as “over the hill” birthday cards, unfavorable caricatures of older individuals in both movies and television shows, and jokes at the expense of older adults. Although all older adults likely experience the negative effects of ageism, it is often proposed that women experience additional discrimination due to the intersection of ageism and sexism. Some research has suggested that older women are more likely to be negatively rated along ageist stereotypes than

their male peers; however, other studies have exhibited an additional age effect wherein very old men (i.e., those over the age of 85 years) tend to be rated more negatively than very old women. Older women may also experience additional discrimination related to the tendency for women to be judged and valued according to perceived attractiveness. This is evident in the aging process, with some studies noting that women tend to be labeled as old at a younger age (55–59 years) as compared with men (60–64 years), and the lengths to which many women go to conceal their age and pursue a youthful appearance. On a systemic level, some theorists posit that older women are more frequently left out of discussions focusing on aging policy, a phenomenon that they insist must be addressed by policymakers, care providers, and researchers to effectively and equitably consider the experiences of older women.

Intersectionality Beyond Gender Much of the research on aging and gender has largely ignored the intersectionality of race/­ ethnicity, sexual orientation, and gender expression, with the majority of information focused on “generic” White, middle-class, cisgender, heterosexual, older women. The intersection and impact of multiple identities beyond this generic model can result in a “multifarious jeopardy,” in which older adults who identify with another marginalized group are at a greater disadvantage, compounding the stress of aging with the preexisting distress of discrimination. Additionally, an individual’s cultural background would likely influence his or her beliefs about aging. For example, an older male from a culture that greatly values the wisdom thought to come with advanced age may have a very different experience of his own aging process from that of an older man from a culture that does not typically value the role of an elder. Furthermore, men and women may be differentially socialized within different cultures, with learned gender roles continuing to affect the way in which they experience the later stages of development. In addition, older lesbian, gay, bisexual, and transgender individuals may experience additional discrimination, reduced access to services, and financial barriers. Older transgender adults are often considered an invisible population as they

Aging and Gender: Overview

are frequently ignored within the literature. However, growing efforts to represent these older adults have revealed that this population may have a unique experience of aging including specific health concerns, additional barriers to health care, difficulties with employment, and financial disadvantages. The ways in which these various identities interact and affect an individual’s experience of aging are complex and variable.

Biological Health Factors of Gender and Aging Although it is not inevitable with aging, there is often a decline of physical health, with an increase of chronic medical problems such as arthritis, high blood pressure, and late-onset diabetes. That is, although the majority of older adults report experiencing good health overall, many older individuals suffer from chronic health conditions. Sex differences may play a role in the prevalence of chronic conditions, with more women reporting conditions such as arthritis, asthma, and hypertension than men, who reported experiencing more fatal conditions such as diabetes, heart disease, and cancer. Although women live longer than men, they also tend to live many of those additional years coping with chronic disease and disability, a phenomenon often referred to as longevity versus health life expectancy. Women appear to experience higher levels of functional impairment than men, as indicated by their difficulty with daily self-care activities such as bathing, eating, dressing, getting in and out of chairs, and using the toilet. Women also report greater difficulties with physical functioning as compared with men, such as the ability to lift 10 pounds, walk two to three blocks, stoop/kneel, or reach up over one’s head. Some researchers have found that men are more likely to experience successful aging than their female counterparts, citing men’s higher education level, greater income, and increased likelihood of being married as potential explanations for this gender difference. However, other researchers posit that although men may be more successful in the objective component of successful aging, defined by functional capabilities, pain, and chronic health concerns, women are equally more successful in the subjective component of successful aging,

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which assesses an individual’s perception of the overall quality of his or her life.

Health Behaviors Poor health behaviors, including sedentary behaviors, obesity, smoking, and drinking are related to the physical complications of aging. Physical activity is a critical component of health at any age and can be particularly beneficial for older adults. In general, older women are less physically active and engage in less exercise, resulting in decreased mobility and increased dependence on others. However, only a small percentage of all older adults are following the recommended guidelines for exercise, which likely contributes to the growing obesity trends. Obesity rates have increased among the older adult population from 22% in 1988–1994 to 38% in 2009–2010. These trends may be affected by gender, with obesity rates leveling off for women, while the prevalence of obese older men continues to rise. Although smoking rates have significantly and steadily declined since 1965, a large percentage of older adults were former smokers, which makes them susceptible to smoking-related ailments such as lung cancer and chronic obstructive pulmonary disease. Men may be especially at risk given that about 53% of older men were former smokers, compared with approximately 29% of women who reported being smokers. Alcohol use and abuse are particularly concerning for older adults given their increased sensitivity to alcohol, difficulty metabolizing alcohol, and increased likelihood of having other medical conditions or medication regimens that increase the risk for the negative effects of alcohol. Older women tend to drink less than their male counterparts; older men are also more likely to exhibit alcohol dependence, which can negatively affect their general physiological health.

Health Care Unfortunately, many older adults often experience a number of barriers to medical health care and treatment. Those in their later years often struggle with health literacy, defined as the extent of capability to obtain, process, and understand healthrelated information in order to make informed

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Aging and Gender: Overview

health decisions. Research has indicated that older adults are less likely to have proficient health literacy skills than any other adult age group, although women tend to have a higher average health literacy than men. Older adults with a low comprehension of their health concerns and available treatment options are more likely to forgo preventative care and medical tests, require emergency room services, and exhibit more difficulty managing their chronic diseases. Additionally, some researchers argue that women’s chronic, nonlethal conditions may be underaddressed by both women and their physicians, citing that this may be the result of an underlying assumption that women are healthier than men. Conversely, other researchers posit that men believe that they are the stronger sex and, therefore, they may engage in risky health behaviors and forgo routine medical visits and preventative measures.

Psychological Factors of Gender and Aging Successful aging is a perception that emphasizes the positive outcomes of aging, highlighting mental health, spiritual connectedness, and a general sense of meaning and purpose. A positive sense of well-being bolsters resilience through the harmful effects of aging and strengthens the older adult’s psychological health. Well-being, defined as a combination of general life satisfaction, positive affect, personal growth, and autonomy, has been connected to physical health and mortality rates. Research indicates that well-being acts as a buffer against the negative effects of stress by promoting positive health behaviors and even reducing the levels of stress hormones. Mental Health

Although individuals entering older adulthood today are physically healthier than those in past generations, approximately 20% of older adults meet the diagnostic criteria for a mental disorder. The general prevalence of mental health disorders is consistent across middle age and old age, with a change in the most prevalent types of disorders occurring in later life. For example, older adults report lower levels of mood, anxiety, impulse control, and substance use disorders and higher rates

of dementia as compared with other age groups. However, there appears to be a significant comorbidity between cognitive impairments and psychological or mood disorders (e.g., depression, ­anxiety, and other behavioral disturbances). Depressive symptoms, such as feelings of hopelessness, withdrawal, anhedonia, and poor ­ self-concept, can be an important indicator of ­functioning among older adults. Elevated levels of depression are often related to higher rates of physical illness, functional impairment, and medical service utilization, and in some cases can be an early sign of dementia. There seems to be a consistent gender-related difference in the prevalence of reported mood-related symptoms, with older women more frequently reporting depressive symptoms than older men (approximately 16% compared with 11%, respectively). Similarly, anxiety often co-occurs with depression and is also more prevalent among older women as compared with older men. Although depressive symptoms are present in older age groups, the rates of clinical depression decline from middle age to older adulthood. This trend continues until about 85 years, with depression rates increasing for the oldest old. For example, almost 20% of men of the age of 85 years and over reported clinically significant depressive symptoms, approximately twice the rate for men in any other age group. In addition, White males over the age of 85 years have the highest rate of suicide completion. Women do not appear to follow this pattern, exhibiting little change in the prevalence of depression across age groups—65 years and older. Neurological and Cognitive Decline

The brains of males generally tend to contain more neurons, making them larger in volume. However, female brains tend to be more complex, specifically in the frontal and parietal lobes, which results in a greater surface area. There is some evidence that these structural differences and the typical neurological deterioration of the aging process result in different sex-related aging trajectories, but the research is inconclusive at this time. Research indicates that advanced age leads to  slower processing speed, difficulty learning new  information, deficits in memory processes, and challenges with executive functions (e.g.,

Aging and Gender: Overview

self-regulatory skills that affect planning, flexibility, generation of information, inhibition of impulses, attention, and working memory). Beyond the implications of these declines for general intellectual abilities, these cognitive difficulties can also affect social functioning, communication, and independent living skills. In general, women tend to perform better on perceptual speed and verbal fluency tasks, whereas men tend to perform better on visuospatial and mathematical tasks, with these trends holding true in the later years. Some studies also indicate that men experience greater age-related cognitive decline than women; however, these results are not consistent across the literature, with some studies generating the opposite results and yet others finding no gender effects related to the rate of cognitive deterioration. Dementia

Dementia is a term used to describe a general decline in mental ability and functioning beyond age-related loss, most frequently used to describe memory loss caused by damage to or death of an individual’s neurons, which leads to deterioration of memory, behavior, and overall cognitive functioning. Dementia is primarily a disease of older age, although some adults experience the onset of dementia before the age of 60 years. Alzheimer’s disease is the most prevalent type of dementia, with a recent report indicating that approximately 5 million older Americans have the disease. Approximately two thirds of individuals with Alzheimer’s disease are female, with some studies also indicating that the progression of Alzheimer’s disease is more severe for women than for men. There are several theories posited to explain these sex differences, including women’s longevity, genetic variations between men and women, estrogen deficiencies in postmenopausal women, and sex-related differences in brain structure. However, the research is ongoing and inconclusive. The second most common form of dementia is vascular dementia, which can occur when the vessels that supply blood to the brain become blocked or narrowed. This causes parts of the brain to be negatively affected because of lack of oxygen or nutrients, often due to a stroke. Although not

45

everyone with a stroke will develop vascular dementia, this type of dementia tends to be more prevalent among men than among women.

Social Factors of Gender and Aging Social networks and the extent of an individual’s social connectedness is a key factor in successful aging, with research connecting high levels of perceived social support to psychological health and well-being among older adults. Social networks can be diverse and include family, friends, community members, and acquaintances who offer the older adult support in instrumental means (e.g., household logistics and personal care) as well as emotional and social comforts. The proportion of time spent socializing and connecting with others tends to decline with age, with adults between the ages of 55 and 64 years spending approximately 11% of their leisure time socializing whereas adults over the age of 75 years spend approximately 8% of their ­leisure time socializing. Women in younger age groups tend to have larger social networks than men, with some research indicating that this gender difference persists into older adulthood. However, some studies indicate that both the size of the social network and the socialization gender gap appear to decrease with age. Unfortunately, isolated individuals may experience depression, discouragement, and decreased self-efficacy. The extent and type of social support may differentially affect men as compared with women. Limited social networks and high levels of instrumental support relate to functional decline for older men. Although the former may contribute to decline due to isolation, the latter type of support may be interpreted by older men as a sign that they are disabled and incapable of caring for themselves. Marriage and Widowhood

Marriage can be a primary form of social support for older adults; however, there may be a gender-related discrepancy regarding the evaluation and impact of marriage. For example, the majority of studies conducted on the subject indicate that women express lower levels of marital satisfaction than men, with wives frequently rating

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Aging and Gender: Overview

their marriages less favorably than husbands. In addition, marital appraisals tend to have a stronger effect on men’s well-being, health, and longevity. Poor marital quality appears to negatively affect physical health; given that women tend to report poorer marriage quality, the adverse impact of these marriages is greater for women than for men. However, some research indicates that the presence and magnitude of these gender differences may vary based on the type of marital factor observed. Given their longer average life span, older women often experience grief and loss more frequently than their male counterparts. Specifically, women are more likely to outlive their spouses and experience widowhood, leading much of the research in this area to focus on the experience of widows. Some gender differences in the difficulties of widowhood include greater financial strain for women and greater stress, depression, and loss of well-being for men. These differences likely affect the gender-related differential survival rates following the loss of one’s spouse, as men are more likely to perish within 6 months of the passing of their spouse. However, following an initial grieving period, many older adults return to preloss levels of well-being following the death of their spouse. Older Adults as Caregivers

As individuals age, there is often an increased need for caregiving, with the majority of these responsibilities and roles falling to women. Various studies have consistently found that between 60% and 70% of all informal caregivers are women. These responsibilities are often time-consuming and can result in decreased physical and mental health, strained relationships, loss of employment opportunities, and financial struggles. Although some men do fill caregiving roles, women are more likely to experience these negative effects of caregiver burden. This may be, in part, due to the greater likelihood of men to receive outside help for caregiving, such as social and respite support, and their greater sense of pride in caregiving as compared with female caregivers. The style of caregiving also appears to vary by gender, with women providing more personal care, such as bathing, feeding, and toileting, whereas men often provide more managerial or financial care. Women are also more likely to care for more than one

individual at a time and for longer durations. However, with the closing gender gap in life expectancy, the face of caregiving may change and see men taking on a larger chunk of the responsibility and burden of caring for their partners. Older adults are also increasingly moving into the caregiver role with the youngest generation, as approximately 2.7 million older adults in the United States are raising their grandchildren, with many of these grandparents serving as the primary caregiver. The majority (77%) of these grandparent caregivers are women, putting them more at risk for the negative consequences of these arrangements, including financial strain. The grandparent’s caregiving role has also been linked with poor health outcomes (e.g., diabetes, hypertension, coronary heart disease, and insomnia), negative mental health (e.g., depression, stress, and marital strain), and social isolation (e.g., not feeling like their peers can relate to their situation). It should be noted, however, that many older grandparents raising grandchildren also report experiencing joy, satisfaction, and finding a sense of purpose from providing this care. Religion and Spirituality

Religiousness and spirituality are often linked to well-being for those in their later years. Many older adults experience an increase in religiosity and spirituality as they age, with older adults reporting greater religious involvement than younger adults. Older women report higher levels of spirituality than their male counterparts. Research shows that older adults most likely benefit from the additional social engagement and emotional support that is often a key component of religious involvement. Furthermore, some research indicates that older men may reap more psychological benefits from organized religious involvement than their female counterparts, likely due to this additional social connectedness and support. However, regularly attending church has been shown to provide greater health benefits for marginalized populations, including women. Poverty

Between 1959 and 2010, the percentage of older adults living in poverty decreased from 35 to  9.

Aging and Mental Health

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Despite this positive trend, older women are much more likely to live under the poverty line than older men (e.g., 11% vs. 7%, respectively). Some explanations for this gender difference include workforce effects wherein older cohorts of women are less likely to have participated in the paid workforce and therefore have fewer investments and economic resources as they age as compared with older men. Older women may also be disproportionately affected by the financial cost of ­raising grandchildren, an experience that is increasingly prevalent. Advanced age is also related to poverty, with 8% of adults between the ages of 65 and 74 years living in poverty versus approximately 10% of adults 75 years of age and older.

Vacha-Haase, T., Wester, S. R., & Christianson, H. (2010). Psychotherapy with older men. New York, NY: Routledge. Whitbourne, S. K., & Bookwala, J. (2015). Gender and aging: Perspectives from clinical geropsychology. In P. A. Lichtenberg, B. T. Mast, B. D. Carpenter, & J. Loebach Wetherell (Eds.), APA handbook of clinical geropsychology: Vol. 1. History and status of the field and perspectives on aging (pp. 443–458). Washington, DC: American Psychological Association. doi:10.1037/14458-018

Tammi Vacha-Haase and Kirsten L. Graham

People of every age are vulnerable to a range of mental health issues, the nature and prevalence of which vary as a function of both age and gender. This entry examines common mental health disorders in late life using a gendered lens and discusses potential explanations for the greater prevalence of mood and anxiety disorders in older women than in older men. This entry notes that the prevalence of Alzheimer’s disease is greater among older women than among older men; however, the analysis of gender differences in predominant neurological disorders in late life, such as Alzheimer’s disease and other dementias, is beyond the scope of this review.

See also Ageism; Aging and Mental Health; Disability and Aging; Gender Socialization in Aging; Late Adulthood and Gender; Men and Aging; Sexuality and Aging; Women and Aging

Further Readings American Psychological Association. (2014). Guidelines for psychological practice with older adults. American Psychologist, 69(1), 34–65. doi:10.1037/a0035063 Calasanti, T. (2010). Gender relations and applied research on aging. Gerontologist, 50(6), 720–734. Carter, C. L., Resnick, E. M., Mallampalli, M., & Kalbarczyk, A. (2012). Sex and gender differences in Alzheimer’s disease: Recommendations for future research. Journal of Women’s Health, 21(10), 1018–1023. doi:10.1089/jwh.2012.3789 Centers for Disease Control and Prevention. (2013). The state of aging and health in America 2013. Atlanta, GA: Author. Federal Interagency Forum on Age-Related Statistics. (2012). Older Americans 2012: Key indicators of wellbeing. Washington, DC: Government Printing Office. Kemper, S. (2013). Gendering the psychology of aging. In M. K. Ryan & N. R. Branscombe (Eds.), The SAGE handbook of gender and psychology (pp. 148–162). Thousand Oaks, CA: Sage. Kryspin-Exner, I., Lamplmayr, E., & Felnhofer, A. (2011). Geropsychology: The gender gap in human aging: A mini-review. Gerontology, 57(6), 539–548. doi: 10.1159/000323154 Mühlbauer, V. (2014). Women and aging: An international, intersectional power perspective. New York, NY: Springer.

Aging

and

Mental Health

Age, Gender, and the Prevalence of Mental Disorders Most mental health problems begin in childhood or adolescence and are likely to continue into adulthood unless treated. In general, the earlier the onset and the more severe the disorder, the more likely that the problems will be chronic. Also of note is the likelihood that an individual who has one disorder will have another diagnosis as well; for example, a person with depression or an anxiety disorder may also have a substance use disorder. At every age, more women than men have diagnosable mental, emotional, or behavioral disorders. For example, in the 26 to 34 years age group, 18.6% of men and 26.8% of women have a diagnosable disorder, compared with 10.1% of men and 15.9% of women over the age of 65 years. As described below, however, these broad age and gender

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Aging and Mental Health

patterns mask interesting variations when specific mental problems are examined. Substance Use Disorders

At every age, women have lower rates of substance dependence and abuse than do men, although for both groups, incidence decreases over the life span. For example, among 18- to 25-yearolds, 22.7% of men and 15.1% of women had a substance use disorder in 2012, compared with 6.2% of men and 1.7% of women 50 years of age and older. The gender disparity in substance use disorders is evident with respect to all classes of drugs (alcohol, illicit drugs, and prescription drugs taken for nonmedical purposes), although older women are most likely to abuse prescription drugs and older men are most likely to abuse alcohol. Particular to alcohol abuse, although prevalence rates are lower in women at all ages relative to men, women are more likely than men to begin problem drinking after the age of 50 years, perhaps in response to late-life stressors such as widowhood, retirement, illness, and social isolation. Women also face more risks (physical, psychological, and social) than do men from high levels of alcohol consumption, due to their typically lower body weight and the ways in which women’s bodies metabolize alcohol. These vulnerabilities increase with age and are exacerbated when alcohol is consumed along with prescription drugs. Mood Disorders

Mood disorders are characterized by exaggerated, depressed, or elevated mood that interferes with daily functioning. The disorders that fall into this category are major depressive disorder (MDD), dysthymic disorder, and bipolar disorder, in decreasing order of frequency. Whereas the prevalence of dysthymic and bipolar disorders does not vary across the life span, those 50 years of age and older are half as likely as younger age groups (3.7% compared with 7.7%) to have experienced MDD in the past year. The rates of MDD in older adults are highest among those who also have medical problems or other risk factors, such as interpersonal loss, isolation, or caregiving challenges. This may explain why about half the older adults with MDD develop the disorder in the latter part of their life, when these challenges normatively occur. Depression in this age group also

increases the risk for substance abuse, disability, cognitive decline, and suicide. Although the prevalence of major depression is lower among those who are 50 years and older than among younger individuals, older women are significantly more likely to experience MDD or clinically relevant symptoms of depression than older men. Interestingly, the association of mood disorders with cognitive impairment, and particularly of depression, with lack of a partner in the household and low emotional social support appears stronger for older men than for older women. In terms of the onset of depression as well, social network variables (e.g., the availability of a partner in the household and small network size) have been found not to be salient for older women, but these variables have emerged as significant predictors for older men. Anxiety Disorders

Anxiety disorders, characterized by excessive fear or anxiety that interferes with daily functioning, affect about 5.7% of adults in any given year, with women being more than twice as likely as men to suffer from them. These fears can be specific (e.g., phobias, separation, and social anxiety), can be generalized (e.g., generalized anxiety disorder and agoraphobia), can develop in response to a trauma (e.g., posttraumatic stress disorder), or can involve panic attacks. The category also includes obsessive-compulsive disorders. The most common anxiety disorders are generalized anxiety disorder, specific phobias, panic disorder, and social anxiety disorder. Although the overall incidence of anxiety disorders does not vary significantly over the life span, individuals who are 50 years and older have lower rates of social phobias and generalized anxiety disorders than do adults between the ages of 26 and 49 years. Anxiety disorders and clinically relevant anxiety symptoms are more common in older women than in their male peers, and these conditions often co-occur with depression or clinically relevant depressive symptomatology. Such disorders in older adults are sometimes related to unique factors, such as visual and auditory changes, and incontinence. Eating Disorders

The prevalence of anorexia nervosa and bulimia nervosa in the general population is very low (less

Aging and Mental Health

than 0.1%), but they are most likely to be diagnosed in young women compared with young men and older populations. Nonetheless, women of every age can be at risk for an eating disorder given the emphasis on women’s conformity to the cultural ideal of extreme thinness, an ideal that becomes increasingly unattainable as one ages. Indeed, research suggests that subthreshold disordered eating behaviors occur among all age groups of women. Binge eating disorder, a more recent diagnosis, appears to be more common in older women than anorexia nervosa or bulimia nervosa. Psychotic Disorders

These disorders are considered severe and are characterized by disordered thinking, hallucinations, delusions, and/or emotional expression. The most common disorder in this category is schizophrenia, which affects about 1% of the population. Schizophrenia tends to be chronic, and for older women in particular, its effects are often exacerbated by conditions of neglect, low ­socioeconomic status, and limited social support. Unfortunately, the majority of older adults with schizophrenia do not receive any psychiatric treatment. Indeed, they are disproportionately ­ represented among the homeless. Although ­ approximately equal numbers of men and women suffer from schizophrenia and the typical age of onset is young adulthood, women tend to develop the disorder at later ages than do men. It appears that the onset of schizophrenia has two peaks in women: one in young adulthood, around the age of 30 years, and one around menopause; the incidence in men tends to be mostly in late adolescence and young adulthood, occurring typically between 15 and 25 years of age. In fact, in the small percentage of adults who develop the disorder after the age of 45 years, women are overrepresented. The occurrence of schizophrenia later in life, especially among women, may magnify other problems associated with aging, such as cognitive decline and physical health problems.

Potential Explanations A number of explanations have been forwarded for the greater prevalence of specific mental disorders, notably mood and anxiety disorders, among women than among men. These explanations are

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based on differences in women’s and men’s physical health; economic and financial resources; socialization, roles, and role transitions; and physiological development and changes. These genderspecific differences often start early in life, have a cumulative and enduring impact on women’s and men’s lives, and play an interactive role in gender disparities in mental health over the life span. It is well established that women on average live longer than do men; however, women’s longer lives generally are not healthier. Older women have been found to report worse physical health, including more falls, greater functional impairment, more chronic illnesses and disorders, and poorer health, than their male peers. Poorer physical health is a potent stressor that can undermine overall quality of life, especially in older adults. The financial burdens associated with health and health care also contribute to poorer mental health. The coupling for older women of more physical health problems and the accompanying financial challenges of coping with poor health may explain, in part, their poorer mental health relative to that of their male peers. Even disregarding gender disparities in physical health, older women are financially disadvantaged relative to older men. Women traditionally have had lower levels of education and held lower-­ paying jobs than men. These culminate in lower lifetime incomes, fewer financial resources before and after retirement, and a higher prevalence of poverty in late life. Lower financial resources among older women also stem from a greater likelihood of widowhood relative to their male peers and more physical health challenges concomitant with their longer life expectancy. A lifetime of managing with poorer financial resources and the ensuing life struggles that are likely to peak in old age offer another potential mechanism for explaining women’s poorer mental health than men’s during the late life years. Women’s lives also differ from the lives of their male peers in terms of the responsibilities and roles that characterize their lives. Women are more likely to report experiencing role conflicts related to balancing work and family demands, to occupy the informal caregiver role for a frail or impaired parent or parent-in-law, and to assume full-time responsibility for raising a grandchild when such a need arises. Stressors and demands that emerge from the differential role responsibilities borne by women compared with men are, in turn, linked to

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Aging and Mental Health

greater psychological distress (and poorer physical health) among women. Women also experience more stressors related to sexual violence, intimate partner violence, and sexism and discrimination in the workplace and society at large over their lifetime relative to men. They experience a greater number of relationship stressors (i.e., stressors involving significant others in their lives) and are more likely than men to be characterized by unmitigated communion, an unhealthy focus on others to the exclusion of the self, which can lead to selfneglect. Women also are more likely than men to appraise stressors as more severe and to use most forms of coping behaviors, even those associated with unsuccessful outcomes. These stress appraisal and coping differences may emerge from differences in women’s and men’s socialization, life experiences, and gender role expectations. Regardless of the underlying reasons, it is plausible that women use more coping strategies because they are more distressed by stressors than are men. Recently, researchers have argued that specific gene-by-environment interactions render women especially at risk for specific mental disorders. For example, women with specific alleles (e.g., those with one or both short [“s”] alleles of the serotonin transporter gene 5-HTT) are at greater risk for depression and/or anxiety if they have experienced high levels of early or adult life stress. Postmenopausal changes also may partially explain the higher prevalence of specific disorders among older women. Changing levels of sex hormones result in sizable changes in the hypothalamic-­ pituitary-adrenal system and stress response in women. These changes interact with life stressors that characterize the lives of older postmenopausal women (e.g., poor finances, social isolation, physical illness, and disability) to increase the occurrence of serious alterations or disorders related to moods. Premenopausal availability of estrogen also may be a factor in delaying the onset of schizophrenia in women relative to men. It would be remiss not to consider some methodological reasons for the gender differences in mental health with age. These differences may reflect cohort rather than age effects. Gender differences in education and income have been declining in more recent cohorts, and future cohorts of older women may be less vulnerable to financial hardship and subsequent distress. Thus,

the narrowing gap in the prevalence of mental disorders, already evident at older ages relative to younger ages, may become narrower still in the future. Gender also may serve as a proxy variable in explaining the differences in late-life mental health as it is correlated with education, income, and marital status, at least in the current cohort of older adults. Differences in mental illness that are attributed to gender may be just as attributable to these factors and other sociodemographic factors or their interaction. The gender differences described above also may reflect a reporting bias, with women generally more amenable to reporting symptoms of depression or anxiety than their male peers. As a result, mood and anxiety disorders may go undetected in older men. Finally, clinician biases may exist in diagnosing mental ­ disorders, with, for example, physicians more readily diagnosing depression symptoms in women than in men. What remains undeniable is that there exists considerable variability in the mental health experiences of women as they age. The greater prevalence of mental disorders in older women than in older men notwithstanding, millions of women age successfully and report high well-being despite experiencing health challenges, financial difficulties, and the loss of significant others in their social network. Indeed, some studies show that women score higher on indices of successful aging than do men. Access to personal, social, and community resources appears to be key to building resilience and fostering better mental health in women. Research shows that those with higher levels of optimism are at especially lower risk for poor mental health. Older women who successfully thwart threats to their identity from ageist attitudes and stereotypes are characterized by higher self-esteem. Compared with older men, older women cope with and adapt to interpersonal stressors, such as the loss of a spouse, better. Women’s greater use of effective coping strategies, such as seeking and securing social support, engaging in positive appraisal, and using positive self-talk, also may promote resilience. Successful aging in women can be viewed as a testament to a lifetime of building resilience and enhancing coping skills. Indeed, gender appears to become less relevant as an explanatory factor in mental health with age. Older women fare relatively well compared with

Agoraphobia and Gender

their younger counterparts in the rate of mental disorders. They have lower rates of all mental disorders, especially substance abuse disorders, MDD, generalized anxiety disorders, social phobias, and eating disorders. These lower rates with age may reflect a decline in some stressors (e.g., child care and work-family role conflicts) as well as increased resilience developed from lengthy experiences dealing with sociocultural stressors related to gender role ideologies, sexism, and ageism. Thus, it is inaccurate to conclude that aging and poor mental health are inevitably and inexorably linked. Jamila Bookwala and Susan Basow See also Aging and Gender: Overview; Biological Sex and Mental Health Outcomes; Depression and Gender; Gender Roles: Overview; Gender Socialization in Aging; Mental Health and Gender: Overview; Women and Aging

Further Readings Antonucci, T. C., Blieszner, R., & Denmark, F. L. (2010). Psychological perspectives on older women. In H. Landrine & N. Felipe Russo (Eds.), Handbook of diversity in feminist psychology (pp. 233–256). New York, NY: Springer. Brandsma, L. (2007). Eating disorders across the life span. Journal of Women & Aging, 19, 155–172. Dickerson, F. (2007). Women, aging, and schizophrenia. Journal of Women & Aging, 19, 49–61. Epstein, E., Fischer-Elber, K., & Al-Otaiba, Z. (2007). Women, aging, and alcohol use disorders. Journal of Women & Aging, 19, 31–48. Goldstein, R., & Gruenberg, A. (2007). Major depressive disorder in the older adult: Implications for women. Journal of Women & Aging, 19, 63–78. Helgeson, V. S. (2012). Gender and health: A social psychological perspective. In A. Baum & T. A. Revenson (Eds.), Handbook of health psychology (2nd ed., pp. 519–537). New York, NY: Taylor & Francis. Karg, R. S., Bose, J., Batts, K. R., Forman-Hoffman, V. L., Liao, D., Hirsch, E., . . . Hedden, S. L. (2014, October). Past year mental disorders among adults in the United States: Results from the 2008–2012 Mental Health Surveillance Study (CBHSQ Data Review). Rockville, MD: SAMHSA, Center for Behavioral Health Statistics and Quality. Retrieved from http:// www.samhsa.gov/data/sites/default/files/NSDUH-DRN2MentalDis-2014-1/Web/NSDUH-DR-N2Mental Dis-2014.pdf

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Kryspin-Exner, I., Lamplmayr, E., & Felnhofer, A. (2011). Geropsychology: The gender gap in human aging: A mini review. Gerontology, 57, 539–548. Pinquart, M., & Sorensen, S. (2001). Gender differences in self-concept and psychological well-being in old age: A meta-analysis. Journal of Gerontology: Psychological Sciences, 56B, P195–P213. Substance Abuse and Mental Health Services Administration. (2014). Results from the 2012 National Survey on Drug Use and Health: Mental health findings and detailed tables. Rockville, MD: Author. Retrieved from http://media.samhsa.gov/data/ NSDUH/2k12MH_FindingsandDetTables/Index.aspx Tamres, L. K., Janicki, D., & Helgeson, V. S. (2002). Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 6, 2–30. Weissman, J., & Levine, S. (2007). Anxiety disorders and older women. Journal of Women & Aging, 19, 79–101. Whitbourne, S. K., & Bookwala, J. (2015). Gender and aging: Perspectives from geropsychology. In P. A. Lichtenberg & B. T. Mast (Eds.), APA handbook of clinical geropsychology (pp. 443–458). Washington, DC: American Psychological Association.

Agoraphobia

and

Gender

Agoraphobia (AG) is characterized by intense fear of places or situations where escape might be ­difficult or where help in the case of panic-like symptoms may not be available. Typical feared situations are varied, ranging from crowded areas or enclosed spaces, like stores or theaters, to open spaces, such as bridges or parking lots, to forms of transportation, including cars, subways, and planes. Consistent with other anxiety disorders, significantly more women than men are affected by AG. This entry examines the possible origins of the discrepancies in prevalence rates across sex, the differences in the presentation and impact of AG between men and women, and the influence of cultural differences on the relationship between gender and AG. In addition, the entry investigates how agoraphobic features are influenced not only by biological sex but also through one’s identification with feminine and masculine characteristics. Finally, differences in treatment outcome between men and women are assessed, highlighting future

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directions for transgender and gender nonconforming people.

Prevalence Approximately 2.5% of the population will develop AG at some point in their lives. As with other anxiety disorders, women are significantly more likely to develop AG than men. Disease studies report that the ratio of women to men affected by any anxiety disorder ranges from 1.5:1 to 3:1, and for AG specifically, this ratio varies between 1.8:1 and 3.1:1. The most recent estimate in the United States reported that approximately 3.2% of women and 1.8% of men will suffer from AG in their lifetime, with a similar number reported in an epidemiological study in Europe. Given that the discrepancy in rates of AG between men and women is similar to that for all anxiety disorders, it is difficult to discern the extent to which sex differences in AG are a result of broad factors relevant to all anxiety disorders versus the interaction between sex and AG specifically. For example, research suggests that the heritability of the nonspecific vulnerability factors underlying anxiety disorders such as neuroticism, as well as specific phobias and fears, is significantly greater for women than for men. Women have also been shown to be more vulnerable to being conditioned to fear responses, to report higher levels of traits like anxiety sensitivity and negative affectivity, and to have greater hormonal fluctuations as a result of the menstrual cycle, each of which is a risk factor for the development of anxiety disorders. Perhaps most important, gender role expectations reinforce characteristics among men such as instrumentality, assertiveness, and dominance, which may serve as a buffer against the development of anxious psychopathology, whereas traits such as interdependence, emotional expressivity, and expectations of protection, which are reinforced among women, likely lead to increased susceptibility to anxiety. One aspect of male and female gender roles that may influence the divergent prevalence rates in AG specifically is the differing expectations between men and women related to staying at home versus leaving the house. For one, certain public places are in fact more dangerous for women, which could lead to greater initial avoidance of certain

situations by women and reinforce fears about difficulty of escape. Furthermore, the woman’s ­ traditional role as a homemaker makes it more acceptable for women to avoid feared situations in the outside world by simply staying at home, which can reinforce agoraphobic fears. Men, on the other hand, are expected to leave the home for employment purposes and thus may be encouraged to confront feared situations. As societal expectations regarding women in the workforce are changing, however, this explanation may have increasingly less relevance. Furthermore, research directly testing the link between expectations of employment among men and women and AG is lacking, and at this point, such an explanation should be considered speculative.

Developmental Considerations The age of onset of AG is typically late adolescence or early adulthood. However, there are several characteristics of a child or adolescent’s upbringing that increase the risk of developing AG and may differentially affect men and women. For example, individuals with AG are more likely to come from a family that strongly supports traditional values. For women, this may result from reinforcement of traditionally socialized feminine characteristics such as interdependence as well as imposition of stricter limits and discouragement of exploring the environment outside the home. Moreover, signs of an anxious temperament frequently seen in children who develop AG as adults, such as behavioral inhibition, avoidance behaviors, or separation anxiety, are inconsistent with the male gender role and may therefore be less tolerated in boys by parents or other adult figures. Consistent with this idea is evidence that child school refusal and parental protectiveness, which are higher for girls than for boys, appear to be a risk factor for developing AG. An additional developmental consideration is that the age of onset for AG frequently corresponds with a time characterized by separation from the familiar home environment and the fulfillment of new roles (e.g., moving away for school or beginning one’s first job). Given that women tend to be more interpersonally oriented and are not encouraged to develop autonomy and selfefficacy to the extent that men are, adjustment to

Agoraphobia and Gender

unfamiliar environments and separation from safe, homelike situations may be particularly challenging. Such stereotypically female characteristics could lead to greater dependence on safe environments, like the home, or attachment figures among those already disposed to anxiety, and increased discomfort with and avoidance of situations in which escape could be difficult.

Nature and Impact Beyond differences in prevalence rates and the factors underlying the development of AG, some ­differences seem to exist between genders in the presentation and impact of the disorder. For instance, women report more fear of being alone in the street, or in crowded stores, whereas men report relatively more fear of having a heart attack, suffering from a physical illness, or losing control as a result of their agoraphobic symptoms. Women with AG have also been found to exhibit more avoidance of feared situations when alone but not when accompanied. This is consistent with evidence that women rate higher on measures of interdependence. Similarly, consistent with a greater interpersonal orientation among women, research has shown that women with AG score higher on measures of embarrassability and fear of negative evaluation, which is particularly relevant to AG given that embarrassment caused by extreme anxiety in situations that are difficult to escape from is a commonly feared outcome. There is conflicting evidence regarding discrepancies in the experience of catastrophic thoughts among agoraphobics. Some data have shown that women suffer more from fears of going insane, passing out, or suffocating from confronting feared situations, while other research has not found any sex differences in expectations of catastrophic consequences. However, women with AG report more physical sensations when anxious and judge them as more frightening, which could also contribute to the greater levels of avoidance among women discussed previously. AG also has been shown to have varying impacts on men and women’s lives. More men with AG are unmarried or single compared with women, and married men with AG report less severe agoraphobic symptoms. These findings likely reflect the greater societal acceptance of interdependence and

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emotional expressivity in women. Women with AG may be better able to find a male partner who would accommodate their symptoms. Male gender role expectations, on the other hand, may cause men with more severe AG to be less attractive to potential spouses or may create pressure for already married men to confront the feared situations and overcome their symptoms. Regarding comorbid anxiety disorders specifically, up to 79% of women and 53% of men with AG have at least one other anxiety disorder. Women with AG are more likely to experience comorbid panic disorder, social anxiety disorder, posttraumatic stress disorder, and specific phobia, while men are more frequently diagnosed with hypochondriasis and alcohol abuse or dependency. The greater rates of alcohol use disorders among men with AG mirror the trend seen in the general population. In addition, it appears that men with AG are more likely than women to use alcohol to deal with anxiety in agoraphobic situations and to find it more effective. One study found that greater alcohol use was associated with less avoidance of feared situations among men but not among women. It should be noted, however, that in the long term the use of safety behaviors such as alcohol consumption tends to exacerbate anxiety, and thus it is not an adaptive coping strategy. Gender Role Identification

In addition to an individual’s biological sex, an individual’s identification with socialized gender roles can have an impact on the development and severity of AG. Research has shown that men and women diagnosed with AG rate lower on measures of stereotypically masculine traits (e.g., assertiveness, instrumentality, autonomy) than healthy controls. In addition, high levels of stereotypically masculine traits are associated with lower pathology among both men and women, whereas the level of stereotypically feminine traits (e.g., dependent and emotional behavior) has no impact on AG severity. In fact, one study found that when controlling for stereotypically masculine factors, the relationship between sex and AG severity disappears, though this has not been replicated in recent years. Of note, such associations between masculine traits and AG mirror those found with other forms of psychopathology, and thus the

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Agoraphobia and Gender

impact of masculine traits on symptom severity is likely not specific to AG. Given this logic, it is important to note that there are no known studies on experiences of AG with transgender and gender conforming populations. Future research can examine if gender role identification and traits with transgender and gender conforming people may also affect AG diagnoses. Cultural Differences

Because gender role expectations are embedded within a particular cultural context, it is also important to consider the impact of cultural differences in the relationship between gender and AG. In many Eastern and Arab cultures, for example, there are greater expectations that women’s activities will be restrained to those of a traditional housewife and women will only leave the home for very circumscribed reasons or if accompanied by a male. Interestingly, some research indicates that compared with Western countries, AG is less common among women in countries with such traditional gender expectations. A study in India, for example, found that 85% of individuals with AG were male. Although expectations that women stay at home could lead to greater agoraphobic fears due to lack of exposure to places away from the home, such discomfort may not cause clinically significant distress or impairment because of the clearly defined expectations that women do not leave the home unaccompanied. Given such a cultural context, AG would be a more relevant manifestation of psychological distress for men. In contrast to such findings, research comparing the rigidity of gender roles across countries found that stricter gender role expectations in a given country were associated with higher levels of AG among the individuals sampled from that country. However, this study did not directly compare AG between men and women; it only sampled university students and primarily examined highly Westernized countries. Thus, more research is needed on the impact of culture on the relationship between gender and AG.

Treatment of Agoraphobia Women are more likely to present for treatment for AG, which is consistent with the notion that it is more socially and culturally acceptable for women to show anxiety and to ask for help. Once

in treatment, research generally shows that men and women with AG experience comparable rates of symptom improvement. Following symptom remission, however, women appear to have a greater likelihood of relapse and recurrence. One study found that during a 3-year period after remission, the probability for symptom recurrence was 0.75 for women and 0.47 for men. Women with AG have also been found to be more likely to utilize medical services and rely on a companion to confront feared situations following treatment. Reasons for the differences in long-term outcomes are unclear, but it is possible that the factors that led to the greater prevalence of AG in women ­initially, such as gender role expectations that discourage assertiveness and independence among women, continue to play a role. Accordingly, it may be beneficial in the context of treatment of AG to acknowledge the social and cultural factors that may encourage women in particular to rely on a companion or altogether avoid situations related to their AG. Teresa M. Bolzenkötter, Joseph K. Carpenter, and Stefan G. Hofmann See also Anxiety Disorders and Gender; Cultural Gender Role Norms; Gender Roles: Overview; Gender Socialization in Women; Panic Disorder and Gender

Further Readings Bekker, M. H. J. (1996). Agoraphobia and gender: A review. Clinical Psychology Review, 16(2), 129–146. doi:10.1016/0272-7358(96)00012-8 Chambless, D. L., & Mason, J. (1986). Sex, sex-role stereotyping and agoraphobia. Behavior Research and Therapy, 24(2), 231–235. doi:10.1016/0005-7967(86)90098-7 Goodwin, R. D., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R., & Wittchen, H. U. (2005). The epidemiology of panic disorder and agoraphobia in Europe. European Neuropsychopharmacology, 15(4), 435–443. doi:10.1016/j.euroneuro.2005.04.006 McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity, and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. doi:10.1016/j.jpsychires.2011.03.006 Starcevic, V., Latas, M., Kolar, D., & Berle, D. (2007). Are there gender differences in catastrophic appraisals in

Alcoholism and Gender panic disorder with agoraphobia? Depression and Anxiety, 24(8), 545–552. doi:10.1002/da.20245 Turgeon, L., Marchand, A., & Dupuis, G. (1998). Clinical features in panic disorder with agoraphobia: A comparison of men and women. Journal of Anxiety Disorders, 12(6), 539–553. doi:10.1016/S08876185(98)00031-0

Alcoholism

and

Gender

Heavy drinking among college students is a serious public health concern as it can increase the likelihood of negative alcohol-related consequences. While many researchers have investigated the factors that place particular students at risk for heavy drinking, only a few studies have considered how gender norms, or the expectations, beliefs, and attitudes associated with being a man or a woman, influence alcohol use. This entry examines how adherence to particular masculine and feminine norms may affect the drinking behaviors of ­college-age men and women by either increasing or decreasing the risk.

Prevalence Rates Heavy drinking is generally most common in college settings, with prevalence rates of alcohol consumption substantially higher for young adult college students than for non-college-attending peers. Approximately 80% of college students drink, with half of these students engaging in heavy episodic drinking, defined as five or more drinks in a 2-hour session for males and four or more drinks for females. Nearly 54% of undergraduate drinkers report getting drunk at least once weekly. Importantly, problematic drinking has been linked to severe outcomes, including poor academic and career achievement, and elevated risk for engagement in other health-compromising behaviors, including illicit substance use, unsafe sex, violence, and physical, sexual, and emotional abuse. Given the high prevalence of heavy drinking among college students, it is essential to understand the factors associated with alcohol use. Specifically, research has shown associations between drinking behavior and gender, highlighting an important factor to explore when understanding heavy drinking.

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Gender and Alcohol Use Research suggests that men consume significantly higher amounts of alcohol and report higher frequencies of intoxication, alcohol abuse, and dependency than do women. Moreover, men are more likely to report increased incidences of binge drinking and tend to score higher on scales of desire to seek sensation, poor behavioral self-­ control, and impulsivity. These traits have been consistently associated with alcohol use and ­alcohol-related problems. However, evidence suggests that the drinking rates of underage college women (18–19 years) are converging with those of men. This is concerning because women who drink at rates similar to those of men are at increased risk of being victims of physical and sexual assault, as well as of developing health problems, including heart disease, breast cancer, and reduced brain volume, even when their overall consumption quantities are lower. Given the differential impacts of alcohol use on both men’s and women’s health, it is imperative to understand the sociocultural factors that might better explain why certain men and women drink more than others and why certain individuals experience more alcohol-related consequences. Biological factors alone cannot explain the differences in men’s and women’s drinking rates; it is therefore critical to identify the gender factors that heighten risk for heavy episodic drinking. One promising gender factor that may explain the differences in drinking patterns and consequences within groups of men and women is the role of gender norms. Adherence to gender norms may heighten or lower risk for heavy alcohol use as drinking may represent a way of conforming to traditional gender expectations or a way of coping with unrealistic pressures to fit into these traditional gender molds. The following section will review the role of two distinct sets of gender norms, masculine and feminine, and will highlight how these norms affect alcohol use and related problems for men and women, respectively.

Masculine Norms and Alcohol Use Masculine norms are the socially constructed beliefs, values, and expectations of what it means to be a man, and they vary greatly across social contexts. The Westernized notion of masculinity often reinforces adherence to traditional masculine

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Alcoholism and Gender

ideologies and behaviors, such as sexual prowess, emotional restraint, and assertiveness. However, these masculine norms are theorized to increase the risk for health-harming behaviors. In an effort to assert their masculinity, men may conform to socially sanctioned behaviors, including engaging in heavy alcohol use, while resisting or avoiding prohealth behaviors, including seeking help. Two prominent gender theorists, James Mahalik and Derek Iwamoto, suggest that distinct masculine norms influence heavy drinking behavior, since individuals report feeling relaxed, more powerful, and more attractive when drinking. Drinking is often considered a prescribed masculine behavior, as men are typically rewarded for their risky drinking exploits. Moreover, male-specific subcultures, including fraternities, often endorse more permissive drinking attitudes as an expression of masculinity. Endorsement of specific masculine norms, such as a willingness to take risks, and valuing power and stamina, can escalate risk for drinking to intoxication, as they reflect a man’s perceived ability to tolerate increasing amounts of alcohol. Men who are unable to consume large amounts of alcohol are often deemed feminine, weak, or even homosexual, all of which collectively suggest that a man’s masculinity will be threatened if he cannot drink up to this standard. Numerous studies confirm that distinct masculine norms (e.g., desiring multiple sex partners, enjoying risk-taking activities, striving to win at all costs) are significantly associated with drinking to intoxication, even while controlling for factors that generally predispose risk, including fraternity status and perceived estimates of how much other peers drink. Adherence to specific masculine norms can also increase men’s susceptibility to peer pressure and general conformity, which, in turn, can heighten risk for alcohol use. Another theorist, James O’Neil, discusses how adherence to socialized and often restrictive gender roles can intensify stress and strain and result in a devaluation of oneself. Research suggests that high levels of gender role conflict are associated with alcohol use intensity and drinking-related problems, which can perhaps explain men’s desire to drink as a means of coping with the negative emotions they may feel in failing to conform to unrealistic masculine expectations. Theoretical models also suggest that adherence to particular masculine norms can protect men

from engaging in harmful drinking behaviors. Masculine norms including self-reliance and emotional control may discourage heavy drinking patterns because these norms are associated with qualities that could regulate alcohol intake, such as self-discipline, restraint, and self-control. Two masculine norms that may demonstrate these protective effects are primacy of work and heterosexual presentation. Men who endorse primacy of work may be less likely to engage in heavy episodic drinking for fear that it will jeopardize their academic or work performance, while men who engage in heterosexual posturing, who are particularly concerned with others’ perceptions, may be less likely to engage in drinking behavior that makes them appear unstable, sloppy, or irresponsible. Accordingly, studies in this area clearly elucidate the salient and distinct role masculine norms have on heavy drinking behaviors among men.

Feminine Norms and Alcohol Use Similar to masculine norms, feminine norms are associated with the attributes, behaviors, roles, and expectations of what it means to be a woman. Through ongoing modeling and reinforcement, feminine norms encourage women to perform and construct their femininity in accordance with cultural definitions that often reflect traditional Western values, such as being passive or emotional. Recent empirical investigations suggest that the conflict associated with navigating restrictive gender ideals can either heighten or attenuate risk for alcohol use. While there is less empirical evidence examining the associations between feminine norms and alcohol use, the few prominent studies that do exist underscore the complexity and variability of feminine norms in influencing alcohol consumption. Several studies have found that adherence to feminine norms can increase risk for heavy episodic drinking and alcohol-related problems, perhaps as a means of coping with the tension of navigating restrictive gender expectations that may be demeaning, limiting, and unattainable. Moreover, college women who endorse appearance norms and investment in personal relationships are more likely to report heavy episodic drinking, perhaps as a means of self-validation. Results from a qualitative study mirror these findings, such that women who were

Alcoholism and Gender

more frequent drinkers tended to be more social, thinner, and highly invested in maintaining an attractive appearance. It is likely that women who are more focused on their appearance and relationships may be more likely to socialize in alcohol environments, such as bars, as a way of securing men’s attention or pursuing social relationships, or they may drink more heavily because they believe that being drunk will facilitate social connection, especially with male peers. Several other studies have also emphasized the protective role of feminine norms in diminishing alcohol use. Samples of Spanish college students who desired to maintain sexual fidelity and who valued romantic relationships were less likely to consume alcohol frequently. Lower levels of affective femininity among Mexican American young adults were also associated with more desirable drinking behaviors, including less binge drinking, less recent use of alcohol, and less normative approval of substance use. Identification with traditional feminine ideologies was also associated with perceptions of lower peer approval of excessive drinking; these women may then refrain from heavy drinking to avoid social disapproval. Collectively, these studies highlight that women who adhere to particular feminine norms and beliefs may discourage or minimize heavy drinking as these behaviors challenge normative femininity expression and may make them appear improper or immodest.

Discussion and Implications Masculinity and femininity, as broad gender-­ relevant constructs, have variable and often complex relationships with heavy alcohol use. While some masculine and feminine norms may increase the risk for heavy drinking and alcohol-related problems, possibly as a way of coping with genderrelated stress or unattainable gender expectations, other gender beliefs serve as protective factors, perhaps because heavy alcohol consumption is incongruent with some traditional gender norms. Further research is needed to clarify these intricate and dynamic associations, as a more nuanced understanding can encourage the development of preventative interventions. Given that a majority of the femininity studies examining alcohol use are conducted internationally and the majority of national studies on

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masculinity and femininity sample predominantly White, middle-class, heterosexual young adults, there is a very limited understanding of how ethnic differences intersect with gender expression to influence alcohol use patterns. Most studies use cross-sectional data and stereotypic masculinity and femininity measures, which may be antiquated compared with modern notions of gender. These limitations make it difficult to establish that gender norms really cause changes in alcohol use. These limitations also fail to capture the fluidity and malleability of gender constructs across time and contexts. Future studies should use multidimensional measures, sample ethnically diverse men and women, sample transgender and gender ­nonconforming people, and examine how gender identity interacts with other salient identities to influence alcohol use. By expanding conceptualizations of masculinity and femininity and utilizing longitudinal research designs, treatment facilities and college campuses can adapt gender beliefs so that men and women can develop more flexible and adaptive cognitions that are advantageous to their health. Jennifer Brady and Derek Kenji Iwamoto See also Gender Role Behavior; Gender Role Conflict; Substance Use and Gender

Further Readings Barrett, A. E., & White, H. R. (2002). Trajectories of gender role orientations in adolescence and early adulthood: A prospective study of the mental health effects of masculinity and femininity. Journal of Health and Social Behavior, 43, 451–468. Iwamoto, D. K., Cheng, A., Lee, C. S., Takamatsu, S., & Gordon, D. (2011). “Man-ing” up and getting drunk: The roles of masculine norms, alcohol intoxication and alcohol-related problems among college men. Addictive Behaviors, 36, 906–911. Mahalik, J. R., Morray, E. B., Coonerty-Femiano, A., Ludlow, L. H., Slattery, S. M., & Smiler, A. (2005). Development of the conformity to feminine norms inventory. Sex Roles, 52, 417–435. doi:10.1007/ s11199-005-3709-7 O’Neil, J. M. (2008). Summarizing 25 years of research on men’s gender role conflict using the Gender Role Conflict Scale: New research paradigms and clinical implications. The Counseling Psychologist, 36, 358–445.

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Alexithymia

Smiler, A. P., & Epstein, M. (2010). Measuring gender: Options and issues. In J. C. Chrisler & D. R. McCreary (Eds.), Handbook of gender research in psychology: Gender research in general and experimental psychology (pp. 133–157). New York, NY: Springer.

Alexithymia Alexithymia is a dimensional personality trait characterized by three core features. First, persons with elevated alexithymia have difficulty identifying emotional experiences as discrete, subjective feelings that are distinct from physiological experiences. Second, they have trouble communicating their emotions, needs, and motivations to those around them. Last, as a likely result of their difficulties in emotion processing and communication, such persons tend to present with a concrete, utilitarian style of thinking, which focuses on external factors (i.e., facts or spoken words) over internal experiences (i.e., feelings or motivations). As a result of these features, individuals with elevated alexithymia tend to face more interpersonal conflict, greater emotion regulation difficulties, and higher rates of psychological and medical disorders than do the general population. Although both males and females struggle with alexithymia and its associated consequences, alexithymia is commonly viewed as a stereotypically male trait. Furthermore, some evidence suggests that gender socialization and identification with traditional masculine ideology may contribute to higher rates of alexithymia in men than in women. This entry first reviews the observed rates and presentations of alexithymia across genders. It then discusses the ways in which gender socialization may influence alexithymic trait development. The entry concludes with a brief discussion of the implications of this gender-alexithymia interaction for clinical contexts and mental health outcomes.

Alexithymia Prevalence Across Genders Alexithymia is relatively common, with clinical (i.e., functionally impairing) levels affecting approximately 10% to 20% of the general population and 30% to 60% of psychiatric samples. Although the construct of alexithymia largely

resembles male stereotypes of stoicism, low emotionality, and inability to emotionally communicate, results of meta-analytic studies suggest that alexithymia levels are only slightly elevated in male (compared with female) samples. These elevations are due in large part to men’s tendency to adopt an externally oriented style of thinking (i.e., focusing on external factors over internal experiences) rather than to difficulties in identifying or communicating feelings. As of 2015, no research has examined the presentation of alexithymia in transgender or gender nonconforming samples.

Gender Socialization and Alexithymia In the early 1990s, the theory of normative male alexithymia outlined the role of gender socialization in the development of subclinical alexithymic symptoms commonly observed in men seeking psychotherapy. Based largely on the gender role strain paradigm and clinical observations, normative male alexithymia suggests that male children are socialized to restrict expression of vulnerable emotions, such as love and fear, while they are simultaneously encouraged to express socially dominant emotions, such as anger and sexuality. This restriction of the expression of vulnerable emotions is theorized to limit the development of awareness and vocabulary for such experiences— skills necessary for self-understanding, self-care, emotional empathy, and interpersonal interactions. Furthermore, because the expression of vulnerable and caring emotions by men is often socially punished, boys and men are more likely to express such emotions through behaviors deemed more gender acceptable (i.e., aggression and nonrelational sexuality). Consistent with the theory of normative male alexithymia, empirical research suggests that persons with elevated alexithymia are more likely to adhere to traditional masculine norms and ideologies, such as restriction of emotional expression, avoidance of stereotypical feminine traits and behaviors, and emphasis on achievement and status. However, these associations between alexithymia and masculine norms are not restricted to men; they are noted across genders and cultural backgrounds and tend to be strongest in White males and ethnic minority females. Although such findings corroborate the assertions of normative male alexithymia theory regarding the relation

Allies

between masculine ideology and alexithymic trait development, the strong associations in females and comparable prevalence rates across genders have caused some critics to question the centrality of gender socialization in alexithymia.

Implications for Clinical Contexts Some research suggests that gender may moderate the influence of alexithymia on mental health outcomes. For example, although alexithymia increases emotional overeating in both males and females, this risk is exceptionally pronounced in male samples. Similarly, although elevated prevalence rates of alexithymia are commonly noted in male substance abusers, such rates fall to nonsignificant levels in mixed-gender substance-abusing samples. Some evidence also suggests that the tendency for those with elevated alexithymia to adopt maladaptive coping styles when faced with depression (e.g., avoiding treatment seeking, remaining socially isolated) may be exceptionally salient in male samples. Notably, although research on the clinical implications of alexithymia has been generally confined to male samples, elevated alexithymia is also commonly noted in predominantly female samples, such as those with eating disorders, body dissatisfaction, borderline personality disorder, and/or a history of sexual abuse. However, as of 2015, the potential moderating role of gender in the association of alexithymia to these disorders has not been examined. Emily R. Edwards and Peggilee Wupperman See also Children’s Social-Emotional Development; Emotions in Adolescence and Gender; Gender Role Strain Paradigm; Gender Socialization in Men; Masculinity Gender Norms; Masculinity Ideology and Norms

Further Readings Levant, R. F. (2001). Desperately seeking language: Understanding, assessing, and treating normative male alexithymia. In G. R. Brooks & G. E. Good (Eds.), The new handbook of psychotherapy and counseling with men: A comprehensive guide to settings, problems, and treatment approaches (pp. 424–443). San Francisco, CA: Jossey-Bass.

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Levant, R. F., Hall, R. J., Williams, C. M., & Hasan, N. T. (2009). Gender differences in alexithymia. Psychology of Men & Masculinity, 10(3), 190–203. Levant, R. F., Richmond, K., Majors, R. G., Inclan, J. E., Rossello, J. M., Heesacker, M., . . . Sellers, A. (2008). A multicultural investigation of masculine ideology and alexithymia. Psychology of Men and Masculinity, 4(2), 91–99. Taylor, G. J., & Bagby, R. M. (2013). Psychoanalysis and empirical research: The example of alexithymia. Journal of the American Psychoanalytic Association, 61, 99–133.

Allies Allies, generally speaking, are people who help and support people from another group and who unite with them for a common purpose. With regard to gender, allies are people from a societally advantaged group who support those from a societally disadvantaged group, such as men who help and support women in the common cause of gender equality and cisgender people who advocate for transgender rights. Male allies recognize gender disparities and the role that sexism plays in creating obstacles for women’s success. They offer their help and support for women to reduce this inequality, not only by working to recognize and control their own gender biases but also by helping others recognize sexism and take action to reduce it. Similarly, cisgender allies advocate for transgender issues, particularly when there is less visibility of, or support for, transgender people in particular sectors of society. Research suggests that men and cisgender people can be especially effective allies in confronting others’ biases, but they must first improve their skills at recognizing gender bias and inequality and be motivated to take action. This entry discusses the effectiveness of allies in the struggle for gender equality and briefly explores three strategies that allies can use to combat sexism: (1) self-regulation of prejudice, (2) interpersonal prejudice confrontation, and (3) collective action.

The Need for Allies Despite advances in gender equality as a function of the passage of Title IX—U.S. legislation requiring gender equity in federally funded educational

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Allies

programs—in 1972, gender disparities continue to exist. For example, although Fortune 500 companies have seen increased gender parity, women constitute a small percentage of their top leadership. Research demonstrates the contribution of gender stereotypes in causing such disparities. Stereotypically, women are expected to be warmer but less competent than men. Thus, when women exhibit competence and agency, they are penalized for a perceived lack of warmth and are considered less fit for promotion. In addition to these more obvious forms of gender inequality, women are also more likely than men to be targets of harassment and incivility. Daily diary studies suggest that, on average, women report experiencing one or two incidents a week that they perceive as gender bias, such as unwanted sexual attention and gender-stereotypic jokes and remarks. Such daily hassles are associated with mental and physical distress. Although women can and do challenge gender bias by reporting harassment to authorities and confronting sexist perpetrators directly, social change movements have always included allies. Moreover, a growing body of evidence indicates that allies who speak out against injustice toward stigmatized targets are actually seen as more persuasive and are met with less resistance than targets who make claims of discrimination. Indeed, targets are often viewed as being hypersensitive when they advocate for themselves. Collectively, evidence suggests that women and other stigmatized targets need allies to help communicate to others the gravity of social inequality and injustice.

Self-Regulation of Prejudice As a first step toward becoming allies for women or transgender people, men or cisgender people work to become more adept at recognizing gender bias, including their own. Because gender stereotypes are culturally widespread and are often activated without conscious awareness, even men who are highly internally motivated to avoid sexism and transphobia sometimes have gender-­ stereotypic thoughts or misogynist feelings or behave in paternalistic ways that limit women or normalize the gender binary. However, by attempting to take the perspectives of historically marginalized groups

(e.g., imagining a day in a woman’s life), allies can become more sensitive to their own and others’ biases. When members of dominant groups recognize their own biases, they can learn to self-­regulate; that is, they can take in cues from the environment in which they exhibited bias and, in subsequent similar situations, respond with greater thought and care so as to avoid exhibiting bias again. Social science research demonstrates that, with practice, people can improve their self-­regulation skills and change their gender-stereotypic associations. In summary, people from privileged identity groups who are motivated to do so can learn to gain control over their own gender biases.

Interpersonal Prejudice Confrontation Through interpersonal prejudice confrontation, allies can help others recognize and change their gender biases as well. Confrontation involves communicating one’s disapproval of prejudice directly to the person responsible, whether verbally (e.g., saying “That sounds unfair”) or nonverbally (e.g., shaking one’s head at the perpetrator of a sexist or transphobic remark). Laboratory experiments clearly demonstrate that confrontation is effective in reducing perpetrators’ use of stereotypes and endorsement of prejudiced attitudes as well as increasing their compensatory behavior toward the offended target. Furthermore, confrontation establishes a zero-tolerance norm regarding interpersonal mistreatment that appears to spread throughout people’s social networks. Additionally, allies are crucial because individuals from historically privileged groups (e.g., men, cisgender people) experience less backlash than individuals from targeted groups (e.g., women, transgender people) when they confront discrimination or prejudice. Finally, allies are important for societal progress because sexist or transphobic behavior often occurs in the absence of women or transgender people.

Collective Action Some allies may wish to effect more large-scale change than can be achieved by recognizing and regulating their own biases or confronting others’ biases. Collective action is one means by which they can do so. Collective action is any group (as opposed to individual) behavior done in the service

Ambivalent Sexism

of improving conditions for a disadvantaged group. For example, social protests and petitions are examples of collective action. Collective action is similar to confrontation in that it shines light on the injustices a group experiences. However, some scholars argue that collective action is purely on behalf of an in-group; thus, only to the extent that men see themselves as sharing an identity with women would they be able to engage in collective action to advance women’s rights. In that vein, some men identify as feminists and would be able to engage in collective action for their in-group, in  alliance with female feminists. By engaging in ­collective action, allies can become activists. Leslie Ashburn-Nardo See also Feminism and Men; Gender Discrimination; Gender Equality; Gender Stereotypes; Sexism

Further Readings Czopp, A. M., & Ashburn-Nardo, L. (2012). Interpersonal confrontations of prejudice. In D. W. Russell & C. A. Russell (Eds.), The psychology of prejudice: Interdisciplinary perspectives on contemporary issues (pp. 175–201). Hauppauge, NY: Nova Science. Drury, B. J., & Kaiser, C. R. (2014). Allies against sexism: The role of men in confronting sexism. Journal of Social Issues, 70(4), 637–652. doi:10.1111/josi.12083 Monteith, M. J., Parker, L. R., & Burns, M. D. (2016). The self-regulation of prejudice. In T. D. Nelson (Ed.), Handbook of prejudice, stereotyping, and discrimination (2nd ed., pp. 409–432). New York, NY: Psychology Press. Wright, S. C., & Lubensky, M. E. (2009). The struggle for social equality: Collective action versus prejudice reduction. In S. Demoulin, J. P. Leyens, & J. F. Dovidio (Eds.), Intergroup misunderstandings: Impact of divergent social realities (pp. 291–310). New York, NY: Psychology Press.

Ambivalent Sexism In an attempt to understand more fully the nuances of gender-based prejudices, Peter Glick and Susan Fiske developed the idea of ambivalent sexism in the late 1990s. Although sexism has been the

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subject of academic interest for more than 100 years, Glick and Fiske sought to examine these attitudes in a more nuanced way, looking at the possibility of complex sexist attitudes that may entail both positive and negative attitudes toward women. To understand ambivalent sexism, one must first understand its components: paternal and caring attitudes, or benevolent sexism, and aggressive and mistrusting attitudes, or hostile sexism. Together, these two attitudes are known as ambivalent sexism, as they imply attitudes that are seemingly both positive and negative.

Benevolent Sexism Benevolent sexism is best thought of as a set of attitudes toward or beliefs about women that categorize them as fair, innocent, caring, pure, and fragile. Rather than being overtly misogynistic, these attitudes are often characterized by a desire to protect and preserve women. In many situations, these attitudes may be casually referred to as chivalry or traditional values. However, despite their seemingly positive characteristics, the attitudes that constitute benevolent sexism are often dangerous and damaging to women’s rights and even their safety.

Hostile Sexism Hostile sexism is much more openly misogynistic than benevolent sexism. A hostile sexist is likely to think of women as manipulative, angry, and seeking to control men through seduction. Hostile sexism often views gender equality as an attack on masculinity or traditional values and seeks to suppress movements such as feminism. Hostile sexism often represents a significant danger to women.

Ambivalent Sexism At first, hostile and benevolent sexism seem to be incompatible. It may seem impossible for individuals to simultaneously believe that women are both pure and fragile and also manipulative and angry. However, ambivalent sexism may be understood in light of sexism more broadly. Particularly within Western societies, sexism is largely based on traditional gender norms, which place men in positions

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of authority in the home, the community, and government. In the majority of cultures, women are expected to submit to male dominance. Until relatively recently (the late 19th century until the present), this system of male dominance was largely unchallenged in the Western world. However, women’s liberation, universal suffrage, and the modern feminist movement have gained much power over the past century and a half, and traditional gender norms have progressively become less and less universal. In keeping with these changing societal norms, there have been increasing numbers of women who do not conform to traditional, male-dominated gender norms. Herein lies the basis for ambivalent sexism. Women who conform to gender norms by respecting and submitting to a largely patriarchal (male dominated) society are often the target of benevolent sexism. More simply, women who conform to expectations are viewed as pure, innocent, and gentle. By contrast, women who do not conform to patriarchal norms are viewed as deserving hostile sexism, in that they are perceived as manipulative, angry, and seeking to control men.

Impacts of Ambivalent Sexism The impacts of ambivalent sexism are multifaceted. Individuals who endorse high levels of hostile sexism are more likely to tolerate and even engage in sexual harassment of women in a variety of settings. Individuals who endorse such attitudes are also more likely to accept and perpetrate violence toward their intimate partners. Finally, individuals who are high in hostile sexism are more likely to engage in or excuse sexual violence, such as rape, against women. While benevolent sexism may not appear to be as overtly dangerous an attitude as hostile sexism, there are many consequences. At its core, benevolent sexism is still based on the assumption that women are somehow weaker than and inferior to men. Women may be seen as pure and caring, but they are also seen as fragile and needing protection. Although benevolent sexism is largely associated with positive emotions toward women, it still places men in a position of authority over the perceived weaker sex. Men who are high in benevolent sexism tend to express discomfort ­ with  women in leadership positions, to support

male-dominated political systems, and to believe that a woman’s place is in the home. Importantly, these associations often are above and beyond the associations between hostile sexism and the relevant outcome. Benevolent sexism predicts—­ ­ perhaps even causes—inequalities between men and women in a way similar to hostile sexism. Adding more concern is the notion that while hostile sexism predicts violence against women, benevolent sexism tends to predict victim blaming in the context of that violence. Although a benevolently sexist man may object to violence against women, he is also more likely to find the woman partially at fault for the violence she has experienced. Finally, benevolent sexism also affects how women view themselves. Women who are exposed to benevolently sexist statements are often less likely to disagree with such statements than they would with hostile sexist statements, less likely to organize against sexist inequalities, and less likely to challenge patriarchal norms. In short, benevolent sexism functions as a subtle, yet effective, means of perpetuating traditional gender norms.

Sexism in Women Ambivalent sexism may extend beyond simple dichotomies between men and women. Although women are typically the target of sexist attitudes and behaviors, men are not the only perpetrators of such attitudes. Women can be prejudiced too, in both hostile and benevolent ways. At first, the notion of women endorsing sexist values and behaviors seems absurd. After all, if sexism is inevitably damaging to women, then it makes little sense that women would endorse such attitudes. However, there is precedence for the notion that victims of discrimination and prejudice might internalize some of the views that have victimized them. As a by-product of living in a patriarchal society, both men and women are raised in an environment that subtly as well as openly enforces sexist ideals. In turn, women often internalize these ideals. In the face of rampant inequality, women are forced to either challenge the inequality by embracing more egalitarian and feminist values or accept the inequality by embracing sexist attitudes. Women are less likely than men to endorse hostile sexism, but they are often just as likely as men

Androcentrism

to endorse benevolently sexist values. This is likely due to a variety of reasons. Given that conforming to traditional gender roles often acts as a buffer against hostile sexism, women may endorse benevolently sexist attitudes as a means of avoiding being the target of hostile sexism. In some sense then, women endorsing attitudes of benevolent sexism may be a means of self-preservation via choosing the lesser of the two evils. Finally, benevolent sexism may appeal to a sense of entitlement among some women. Taken at face value, benevolent sexism seems to be devoted to the well-being and protection of women, which may seem like good things. However, given the impact that benevolent sexism has in discouraging women from engaging in activism against gender-based inequalities, women’s endorsement of benevolent sexism may be considered in some ways more subversive to gender equality than hostile sexism. Joshua B. Grubbs See also Equal Pay for Equal Work; Feminism: Overview; Gender Equality; Gender Socialization in Men; Gender-Based Violence; Gendered Stereotyped Behaviors in Men; Gendered Stereotyped Behaviors in Women; Microaggressions; Rape Culture

Further Readings Becker, J. C., & Wright, S. C. (2011). Yet another dark side of chivalry: Benevolent sexism undermines and hostile sexism motivates collective action for social change. Journal of Personality and Social Psychology, 101(1), 62–77. Begany, J. J., & Milburn, M. A. (2002). Psychological predictors of sexual harassment: Authoritarianism, hostile sexism, and rape myths. Psychology of Men & Masculinity, 3, 119–126. Glick, P., & Fiske, S. T. (1996). The Ambivalent Sexism Inventory: Differentiating hostile and benevolent sexism. Journal of Personality and Social Psychology, 70, 491–512. Glick, P., & Fiske, S. T. (2001). An ambivalent alliance: Hostile and benevolent sexism as complementary justifications of gender inequality. American Psychologist, 56, 109–118. Glick, P., Fiske, S. T., Mladinic, A., Saiz, J. L., Abrams, D., Masser, B., . . . López López, W. (2000). Beyond prejudice as simple antipathy: Hostile and benevolent sexism across cultures. Journal of Personality and Social Psychology, 79, 763–775.

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Grubbs, J. B., Exline, J. J., & Twenge, J. M. (2014). Psychological entitlement and ambivalent sexism: Understanding the role of entitlement in predicting two forms of sexism. Sex Roles, 70(5/6), 209–220.

Androcentrism Androcentrism translates literally to male centeredness. The term refers to beliefs and associated practices that center males and male experiences as the norm for humanity. These beliefs and practices became hegemonic, influencing all facets of social life. This is particularly relevant for the field of psychology, since the privileging of male experiences and perspectives influences language, culture, science, medicine, and social institutions. This entry explores these aspects of androcentrism, focusing on the United States.

Language and Culture Androcentrism, first articulated in 1911 in Charlotte Perkins Gilman’s The Man-Made World or Our Androcentric Culture, may be regarded as a fundamental component of sexism. An androcentric culture not only supports and maintains patriarchy by privileging males, it also devalues females and gender liminal people as other, different, and/ or deviant. Androcentrism shapes and is shaped by language. Language structures human understanding and knowledge, framing and constructing reality through specific cultural norms and ideologies, which are shaped by those in power. Thus, language serves as a way to reinforce existing power structures. The power of androcentric language can be understood through three linguistic practices. The first practice centers male as equivalent to human through pronouns, words, and expressions. Although initially the pronoun “he” referred to males, scholars in the 1800s, attempting to move away from “they” as a singular pronoun, enacted the use of “he” to be generic and include females. This universal form was generally accepted and employed; however, generic “he” was sometimes interpreted to not include females, thus blocking women’s entrance into certain spheres (e.g., physician membership).

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Androcentrism

Conversely, some words initially referencing humankind became masculinized (e.g., man or mankind). Even when man is posited to mean human, people associate it with masculinity (e.g., policeman and fireman reinforce these professions as masculine). The second practice marks nonmale groups as other. This occurs when qualifiers are added to professions or activities marking them as variations from the norm (woman doctor, women’s soccer); the qualifier reinforces the unmarked norm (that doctors are men). This gendered marking occurs through other visual cues. Many children’s toys are masculinized through unmarking (e.g., Legos or a doctor’s kit), since girls’ versions exist (Lego Friends or a pink doctor’s kit). The final linguistic practice consists of devaluing femininity. This includes utilizing language to infantilize women (e.g., calling adult women “girls” but not referring to adult men as “boys,” particularly in professional settings), sexualizing women (describing their looks), or relegating women to lower positions (e.g., assuming that a heterosexual married woman would become Mrs. John Doe). The devaluing of femininity also occurs by men and boys policing hegemonic masculinity through expressions such as “You throw/run/play like a girl” or negatively describing men/boys as effeminate or feminine, which reinforces femininity as undesirable. Androcentric language, ideologies, and practices profoundly affect people who cross or bridge cultural gender boundaries. This may be in terms of people disrupting cultural scripts ascribed to their gender (e.g., entering professions or participating in activities perceived as suited for the “opposite” gender) or the discrimination experienced by transgender individuals.

Science and Medicine In 1974, the American Psychological Association proposed and later adopted a policy prohibiting the use of the generic “he.” While psychology publications comply with this and have expanded their language to include female participants, research continues to position males as the norm and females or gender liminal individuals as the exception.

Androcentrism is also pervasive in medical research and education. Until the 1980s, most research participants were White men, yet findings were generalized to all people. In the 21st century, an idealized male body serves as a model in most biomechanical engineering and medical textbooks. The 40th edition of Gray’s Anatomy, published in 2007 and used worldwide, predominately utilizes White, cisgender male figures to depict the human body, whereas the female form is primarily depicted in relation to reproduction. Finally, since male bodies, experiences, and behaviors are the norm, women, marginalized men, intersex people, and transgender people are often studied as variations or along lines of difference. For instance, female bodies are pathologized in terms of menstruation, pregnancy, and menopause. Originating in medicine and then shifting to cultural norms, women expressing more emotion than men are defined as “hysterical.” Androcentric research and medical practices continue to inform policies, including norms for health care and insurance, definitions of disability (e.g., pregnancy), and standards of who is considered rational and capable of holding certain positions.

Social Institutions Social institutions too are shaped by language and cultural practices. Rigid gender roles continue to be perpetuated through ideologies of a nuclear family, which is not in a statistical majority; rather, in the West, it is a cultural model supporting White normative heteropatriarchy by relegating separate gender spheres. Even in the 21st century, despite the movement of White, middle-class women into the workforce, women continue to engage in the majority of housework, food preparation, and child care—work that is unpaid and devalued. Researchers examine the link between this work and women-dominated professions that often entail care work (e.g., nursing, teaching). Even within these lower-paid fields, White men’s salaries are higher than women’s. White normative masculine behaviors and traits tend to be valued by employers. This is apparent in the American political system, where White women and people of color are described in the news as

Androgyny

“different” from White, heterosexual cismen. It is also apparent in workplace norms (e.g., language, hours, and commitment) that stem from men’s roles in the ideal White, heterosexual, middle-class nuclear family. The universalizing of male experiences, bodies, and behaviors shapes people’s knowledge and understanding of social environments and themselves. Androcentrism is not just a belief or ideology; it is a practice, one that enables patriarchy and pervades all aspects of social life. Kylan Mattias de Vries See also Cultural Gender Role Norms; Gender Bias in Research; Gender Stereotypes; Male Privilege; Patriarchy; Sexism

Further Readings American Psychological Association Publication Manual Taskforce. (1977). Guidelines for non-sexist language in APA journals: Publication Manual Change Sheet 2. American Psychologist, 32, 487–494. Bem, S. L. (1993). The lenses of gender: Transforming the debate on sexual inequality. New Haven, CT: Yale University Press. Hegarty, P., & Buechel, C. (2006). Androcentric reporting of gender differences in APA journals: 1965–2004. Review of General Psychology, 10(4), 377–389.

Androgyny Androgyny refers to having both masculine and feminine personality characteristics and gender traits or gender expressions. Scholarly writings on this topic have encompassed three main areas, which are reviewed in this entry: (1) psychological androgyny, (2) androgyny related to gender expression, and (3) androgyny related to the gender identity of androgyne.

Psychological Androgyny Historically, masculinity and femininity were thought to exist on bipolar extremes of a single continuum, meaning that individuals who had characteristics of both masculinity and femininity

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were not recognized in theory or research. During the 1970s, the study of androgyny became more common, especially due to the work of Sandra Bem, who created the Bem Sex Role Inventory (BSRI), which measured psychological androgyny (in addition to femininity and masculinity). The BSRI was one of the early scales to differentiate femininity and masculinity into separate domains, with individuals who display both traits being characterized as androgynous. Work with the BSRI also further established that individuals who are low on both femininity and masculinity are a group distinct from androgynous individuals, which Bem called “undifferentiated,” even though they often are conflated with androgynous individuals. The study of androgyny marked a significant shift in research and theory on gender/sex roles. Prior to this, it had been thought that individuals who manifested gender traits that were typically associated with their sex assigned at birth (e.g., a woman who has a feminine gender role and gender expression) were the healthiest and most adaptive. However, much of the research that focuses on androgyny has revealed more positive outcomes associated with having both masculine and feminine traits as opposed to being more heavily aligned psychologically with one type of gender traits. For example, androgynous individuals have been shown to be more adaptive in stereotypically gendered situations, have more life satisfaction, and have better mental health and well-being than individuals who are gender typed as masculine or feminine. Although there have been advancements in the study of gender as a result of early work on androgyny that measured femininity and masculinity as distinct continuums, the scales measuring androgyny have been criticized for measuring stereotypical notions of femininity and masculinity— likely because these concepts are dated and the field is in need of more updated measures. For example, the BSRI was created by having women and men rate the desirability of different traits. Arguably, the desirability of these traits (e.g., that women are gullible or childlike) has shifted over the past 40 years, and conceptions of the meaning of masculinity and femininity in research are in need of revision.

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Gender Expression While most research has focused on the concept of psychological androgyny, which is more in line with how strongly someone adheres to gender roles in terms of personality, androgyny also can refer to someone’s gender expression and physical traits, behaviors, or mannerisms that are socially constructed to denote masculinity and femininity. Androgynous gender expressions have been particularly common in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities, especially for sexual minority women. It was during the late 1960s and 1970s that androgynous gender expression gained visibility within lesbian communities in the United States. This shift was in marked contrast to the two prior decades, which had emphasized butch and femme gender identities. It was related to the rise of feminist views, in which the push for egalitarianism was associated with the goal of minimizing gender difference. An ethic developed, especially in university-based feminist communities, around constricting the expression of masculinity or femininity as a way to reduce sexism and gender disparities. This trend changed again in the late 1980s as butch and femme identities reemerged and transgender movements fostered the acceptance of a wide range of gender identities. The study of androgynous gender expression in research similarly has tended to focus on LGBTQ samples. For example, some research has shown that individuals who are more androgynous in their appearance are assumed by others to be sexual minorities. In addition, individuals who are androgynous in their gender expression have been shown to encounter more experiences of social marginalization, likely associated with the conflation of gender nonconformity and sexual minority status. Sexual minority women who are androgynous have been shown to experience similar rates of discrimination as butch women, although both groups experience greater discrimination than femme women.

Gender Identity When referring to their gender identity, some androgynous individuals, but not all, may identify as androgyne. Similarly, some people also may identify as genderqueer—an umbrella term used to

describe gender identities that are nonbinary. Androgyne as a gender identity is relatively marginalized within both mainstream society and LGBTQ populations. Research in this area is again limited but has shown that sexual minority women who identify as androgynous when discussing their gender identity have more masculine characteristics (including gender expression, physical appearance, and gender roles) than women who are femme identified, but less so than butch identified women. Sexual minority women who identify as androgynous also report higher rates of experiencing stigma than women who are femme identified. Androgyny can signify and be related to many different experiences—including personality traits, gender expression, and gender identity. On the whole, research on psychological androgyny has been the most advanced, but it has methodological and measurement issues. The examination of androgynous gender expressions and identities, on the other hand, has been more limited, and future work is needed in these areas. Jae A. Puckett and Heidi M. Levitt See also Bem Sex Role Inventory; Bi-Gender; Gender Fluidity; Gender Nonconforming People; Genderqueer; Lesbians and Gender Roles; Trans*; Two-Spirited People

Further Readings Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42, 155–162. Bem, S. L. (1975). Sex role adaptability: One consequence of psychological androgyny. Journal of Personality and Social Psychology, 31, 634–643. Bem, S. L. (1977). On the utility of alternative procedures for assessing psychological androgyny. Journal of Consulting and Clinical Psychology, 45, 196–205. Constantinople, A. (1973). Masculinity-femininity: An exception to a famous dictum? Psychological Bulletin, 80, 389–407. Cook, E. P. (1987). Psychological androgyny: A review of the research. The Counseling Psychologist, 15, 471–513. Lehavot, K., King, K. M., & Simoni, J. M. (2011). Development and validation of a gender expression measure among sexual minority women. Psychology of Women Quarterly, 35, 381–400.

Anorexia and Gender Levitt, H. M., & Horne, S. G. (2002). Explorations of lesbian-queer genders: Butch, femme, androgynous or “other.” Journal of Lesbian Studies, 6, 25–39.

Anorexia

and

Gender

Eating disorders affect close to 1% of the population worldwide. Of that number, almost 90% of cases occur in women. Anorexia nervosa is the most deadly mental health disorder according to the National Eating Disorder Association. Up to 20% of those diagnosed with anorexia will die as a result of the disorder. Despite the numbers that show this as a female disorder, more men are developing anorexia, and there are distinct patterns that influence the presentation of anorexia in men and women. Gender dynamics, such as transsexualism, femininity, and sports involvement, have all influenced who develops this disorder. For men, there are considerations of sexuality and abuse that contribute to the disorder, as well as changing pressures for body type. For women, there is a long history of body image distortion, superwomen complexes, abuse, and social pressures that lead to a diagnosis. These gender differences account for some of the discrepancies in the diagnosis of anorexia nervosa. This entry covers the signs and symptoms of anorexia, and the cycle of dieting, and the factors that contribute to its presence in men and women. Considerations for the future are also discussed.

Anorexia Nervosa In early history, people with anorexia were described as ascetic: giving up food as part of a devotion to a higher power. For this reason, women with this condition were revered for their self-control and dedication to a higher power. In cases of anorexia today, some of this reverence for control and power over food still exists. Anorexia nervosa, as described today, is characterized by these primary symptoms: preoccupation with losing weight or feeling fat, failure to maintain adequate body mass index or weight for a person’s build, body image distortion, and amenorrhea (in women with menstruation). There are two different subtypes of anorexia: (1) bingeing-purging and (2) restricting. In the

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bingeing-purging subtype, individuals with anorexia will restrict calories and alternatively have episodes of bingeing (eating large quantities of food) and purging (some method of ridding the body of the calories or weight, e.g., diuretics, laxatives, or vomiting). The restricting subtype involves an extreme restriction in caloric intake. Other symptoms may include obsessions about food, collecting food or recipes, or chewing and spitting food. There can also be fatigue or more serious medical complications such as electrolyte imbalance or heart problems. Many people with anorexia do not get help right away because the thin ideal is supported in many Western cultures. In previous versions of the Diagnostic and ­Statistical Manual of Mental Disorders (DSM), only women could formally meet the diagnostic criteria of anorexia, as one of the main features of the diagnosis was amenorrhea, or the loss of the menstrual cycle for at least 3 months. This was removed as one of the main symptoms from the fifth edition of the DSM (DSM-5) to allow for more recognition of the disorder in men. One precursor to this disorder that seems to affect both men and women is dieting.

Dieting Dieting is an important part of understanding the diagnosis of anorexia as it relates to both genders. The diet industry in the United States is highly lucrative, and it heavily disseminates messages about losing weight and its importance. Both male and female celebrities endorse various diet plans and insist that anyone can lose weight. At a time in our history when many people are overweight and obese, dieting is a common solution to maintain a thinner body type. The cycle of dieting can very often become a starting point or trigger for a more serious disorder such as anorexia. The person who begins a diet and has some initial success receives a great deal of positive reinforcement for that weight loss. “What are you doing to lose weight?” or “You look great!” are common responses. This positive reinforcement starts a cycle of continuing the diet and trying to lose more weight. The person who is successful in losing more significant weight will continue to receive the positive reinforcement. The person who does not experience success could try more drastic means to feel the positive reinforcement. This can

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Anorexia and Gender

start a cycle of losing weight and gaining weight, which is considered unhealthy. At its worst, dieting can continue to the point of developing disordered eating, such as anorexia. Anorexia was long ignored in men because the symptoms seem to reflect a societal pressure that women in our culture feel to be thin. This Western ideal for body type was typically reflective of a White, middle-class culture as well. This is changing as more women and men of different racial and ethnic backgrounds imbibe the White cultural norms for dieting and thinness. Men and women today, regardless of race, are susceptible to the pressure to be thin. However, there are many more complex issues to consider in diagnoses based on gender.

Sexuality Issues and Men With Anorexia There have been several studies to suggest that there is a link between anorexia and sexuality issues in men identifying as gay and/or bisexual. Men still experience discrimination in coming out as gay, and some may be hiding their sexual preferences or still be considering their sexuality. This can lead to men feeling a need for control, and food is one aspect that can reflect that control. Another theory suggests that men with nonheterosexual orientations experience more pressure to be thin or fit in order to find a partner. This increased pressure on body image may also lead to a dieting cycle that causes anorexia. This constant focus on outward appearance or the body can lead to negative self-image or body image, which are symptoms of anorexia. One study found that male-to-female transsexuals may also be important to consider when looking at sexual issues in males that are linked to anorexia. One male-to-female transsexual who was studied was found to be struggling with gender identity and sexual identity, which led to restriction of diet to the extreme. In this case, the need to control something when other parts of life feel out of control could explain why men with sexual identity concerns or transitions develop anorexia.

Abuse Histories and Men With Anorexia Men who have experienced sexual or physical abuse sometimes develop symptoms of disordered eating later in life. The experience of abuse feels

out of control, and one thing that they can take back and control in their life is food intake. Other theorists have suggested that abuse histories lead to difficulty eating and enjoying food (or anything) orally and this contributes to a diagnosis of anorexia as well.

Men in Sports Participation in activities that place emphasis on the body, such as dancing, swimming, or cheerleading, leads to a higher rate of anorexia in women. Men also participate in sports with an emphasis on weight, if not on the body, such as horse racing and wrestling. In sports such as wrestling, men engage in dangerous dieting regimens such as extreme calorie restriction and excessive exercise. Before weigh-ins in wrestling, individuals sometimes run or engage in cardio exercise with many layers of clothing to shed water weight. Jockeys also use sauna or other hot techniques to shed water weight. Men placed in a situation where weight loss is critical to their success can develop disordered eating and sometimes anorexia nervosa. Though there are many factors that contribute to eating disorders in men, the fact remains that the majority of patients with anorexia are women.

Superwoman Complex The superwoman complex was first introduced in the 1980s to describe women who wanted to have it all and do it all, including motherhood, job success, and a perfect body ideal. In the 1990s, some studies found that the superwoman complex was strong in women who experienced disordered eating and that the perfectionism involved in having it all was a contributing factor. To achieve the superwoman ideal, women feel pressured to focus on control in every aspect of their lives, even when it involves controlling other people, such as their partners and children. The way to achieve total control is through perfectionism. If you exhibit control over your work life, you will appear to have the perfect job or the perfect level of success. If you control your partner and your children, you will appear to have the perfect family. If you control your eating and your body, you will look perfect. The response to this level of control can spill over into disordered eating as a way to cope with the stress of perfectionism and as

Anorexia and Gender

a way of achieving perfectionism in the form of the perfect body. More recent studies of the superwoman complex have shown that there are two other features that may contribute to anorexia in women. The first is social isolation. Women who adhere to the superwoman ideal are less likely to seek out social support from other women. Therefore, their quest for perfection in body image is also met with constant comparison with other women, with no way of knowing how those other women feel. Often, these women do not have anyone to share their feelings of struggle with. This social isolation can lead to women feeling the pressure even more to be thin; they perceive that other women are feeling the same way. In addition, women with a superwoman complex are more likely to engage in self-harm behaviors, more specifically self-harm behaviors around dieting and eating. Women report abusing laxatives and diuretics as well as not eating when hungry. An area related to the superwoman complex that affects women is objectification theory.

Objectification of Women In the technology age, people are bombarded with advertising messages daily. There is a wealth of research studies that show that women are portrayed differently than men in advertising. Women are most often portrayed as exposing parts of their body: legs, arms, stomach, and breasts. The media uses images of specific female body parts, and the whole person is left out. Men are more likely to be portrayed as a whole person or with emphasis on their face. This constant focus on women’s bodies and body parts leads to the objectification of women. This means that women are constantly evaluated based on parts of their body, which leads them in turn to judge themselves based on their bodies and, more important, on parts of their bodies. In a vicious cycle, women who endorse the superwoman complex are also more likely to feel the pressure to be perfect after viewing in advertisements or the media images of women who exhibit the superwoman qualities. Currently, there are fewer than 1% of American women who can achieve the level of thinness that supermodels portray. Moreover, with modern technology, the images of models and even actors and actresses are digitally altered in the media, which

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leads to an even more unattainable ideal that women struggle to achieve.

Sexualization of Women Women in advertising are highly sexualized in comparison with men, which increases the pressure to be thin as well. Women’s body parts, such as breasts, are used to sell a variety of products, like clothing, food, and luxury items. Although many women with anorexia self-harm out of a desire to maintain their sexual appeal, women with anorexia often lose traits associated with a sexualized human body, such as a “curvy” silhouette. This led some theorists to suggest that women with anorexia are in fact rejecting sexuality when they develop the disorder.

Body Image Concerns The superwoman complex and the objectification and sexualization of women can lead to body image concerns. Women with eating disorders, including anorexia, predominantly have body image distortion. They experience their body as being bigger than it really is, even when confronted with evidence to the contrary. Therapists can use several techniques, including having these women draw themselves as they perceive themselves, to determine body image distortion. Body image distortion makes an eating disorder difficult to treat because the women will never achieve the level of thinness they desire. Even when they can see the bones protruding on their bodies, they still perceive it as being fat. The continued objectification of women in the media and the societal pressure for women to have it all contribute to the ongoing prevalence of body image distortion.

Abuse Histories Women who have experienced sexual and physical abuse can be susceptible to eating disorders. In such cases, the disorder may manifest as a denial of their own sexuality by maintaining the undeveloped body of a little girl. They may also be taking control over their bodies by controlling what they eat. There is a strong connection between experiencing abuse and developing an eating disorder later in life.

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Anti-Feminist Backlash

Anorexia in Older Women Anorexia is typically diagnosed in late childhood or early adolescence. Over the past few decades, however, women are developing the disorder after having children. One reason for this development is the superwoman complex; women may feel increased pressure for perfectionism once they have children. Another reason is the lack of control over one’s body during the pregnancy and delivery process. Many women feel the need to take control back and lose weight rapidly in order to get back to their previous body or weight. A third reason why women may experience anorexia later in life is feeling a lack of control over their children, leading to restriction of diet and body image concerns as a way to experience control. Anorexia in older women is an area of disordered eating that needs to be studied further and supported by research. It is very difficult to treat this disorder in older populations, and most insurance companies do not recognize the disorder, similar to how researchers historically overlooked the disorder in men.

Further Research on Anorexia and Gender The DSM-5 has provided the most inclusive diagnosis of anorexia nervosa for both genders to date. The removal of amenorrhea as a main symptom of the disorder may have an impact on research concerning men with the disorder. However, the features that generally contribute to the disorder, such as dieting and body image issues, affect women more than men. More research is needed on men with anorexia nervosa to determine if there are more specific symptoms or features that are unique to men. Both men and women possess the potential for developing an eating disorder when engaging in a cycle of dieting, restricting, and bingeing, or from stressors in life such as abuse histories or sexual identity concerns. Sara Martino See also Body Image Issues and Men; Body Image Issues and Women; Body Objectification; Gender Role Behavior; Gender Role Conflict; Gender Role Socialization; Gender Socialization in Women

Further Readings Everett, J., & Martino, S. (2014). Superwoman on the big screen: How media portrayals affect female viewers. Journal of Behavioral Health, 3(3), 145–148. Ewan, L., Middleman, A., & Feldmann, J. (2014). Treatment of anorexia nervosa in the context of transsexuality: A case report. International Journal of Eating Disorders, 47, 112–115. Gies, J., & Martino, S. (2014). Uncovering ED: A qualitative analysis of personal blogs managed by individuals with eating disorders. The Qualitative Report, 19(57), 1–15. Holman, M. J., Johnson, J., & Lucier, M.-K. (2013). Sticks and stones: The multifarious effects of bodybased harassment on young girls’ healthy lifestyle choices. Sport, Education and Society, 18(4), 527–549. Januszek, K. (2007). Some aspects of sexual identity of girls suffering from anorexia nervosa. Archives of Psychiatry and Psychotherapy, 3, 53–62. Martino, S., & Lauriano, S. (2013). The relationship between feminist identity development and the superwoman ideal. Journal of Behavioral Health, 2(2), 167–172.

Anti-Feminist Backlash Anti-feminist backlash is the overt and covert opposition to the ideology that men and women should have equal opportunity and treatment. Feminism as a movement gained traction in the 19th century. Some of the Western privileges that women benefit from today as a result of the feminist movement are the right to vote, greater opportunities to participate in the workforce, variations in the division of household duties, and more diverse educational opportunities. Although the feminist movement has narrowed many of the gaps between male and female opportunities, these opportunities and the notion of equality between genders have been met with resistance in the form of various backlash or counterattack systems, which have been established and regenerated over time. After a brief overview of feminism, a major part of the entry explores the resulting backlash that is occurring in the West at the current moment. Backlash of anti-feminism is discussed in the context of several arenas: media (e.g., television, print and social media), law/policies, household duties,

Anti-Feminist Backlash

education, business, and health. The implications of anti-feminism backlash are explored, including a brief discussion of anti-feminism backlash across the world.

Media Media has several components—including film, television, print media, and social media outlets. In Western programming, women have been able to assume lead roles as the strong, assertive “heroine,” as well as a wide range of other roles. However, many women in the media have reported that their professions are still male dominated, with women having a substantially smaller number of roles open to them compared with male actors. Although the variety of characters that women have been able to depict has increased, anti-­feminist backlash continues to manifest in the disparate number of female roles versus male roles. Furthering the inequity, the portrayal of women in film and television implies that to be a leader, a woman must maintain societal standards of beauty (e.g., being fashionable, wearing makeup), while still maintaining gender roles (e.g., being a wife or mother). Relatedly, women leaders in the media must navigate dichotomous gender role expectations (e.g., being assertive without being aggressive, being intelligent but not more intelligent than men, or being warm without being too emotional). When female characters do not meet these ­expectations, shows are often not successful or characters are critiqued as being too strong or too flawed. Female politicians face the same sexist standards, particularly when they are running for office. For instance, during the 2016 election, when Hillary Clinton eventually became the first woman to win the presidential nomination of a major political party in the United States, media outlets held different standards for her than for her opponents (e.g., commenting on her appearance, voice, or likeability). Donald Trump and other political commentators also accused her of playing the “woman card”—stating that people would vote for her only because of her gender and not because of her qualifications. Women who speak out regarding gender inequality are met with attacks on their personal character. Because societal norms still imply that women should be feminine, submissive, quiet, or

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inferior to men, some women are criticized with a number of stereotypes, like “angry feminist” or “man hater.” Many female public figures have been criticized for expressing or demonstrating behaviors that are deemed unacceptable for women but are accepted or celebrated in men. For instance, Danica Patrick, a female race car driver who competes with men, has been called vulgar names for communicating her confidence in winning upcoming races. Similarly, Ronda Rousey, a mixed martial artist and the first female to win an Olympic medal in judo, has been criticized for being too masculine or too vocal about a number of issues (e.g., her pride in her physical strength, her criticisms of media portrayals of body image, or her ridicule of men who are intimidated by women).

Law and Policies The anti-feminist backlash surmises that if equality between genders is to exist, it should be more congruous across the board. For instance, women are treated as equal to men by the criminal justice system regardless of the nature or provocation of the offense. Men, in turn, are treated as equal to women or as more victimized than women, as in many cases of rape allegations where the man’s reputation is valued at a higher premium than the woman’s safety. In such instances and others, this effort toward consistency translates to adverse results. As a result of the redirection of victimization, services established to protect women are losing funding, constructing a new form of vulnerability for women. Increasingly, the targets of criminal justice sanctions tend to be women in poverty and/or of color, and victims of domestic violence and sexual abuse—groups already facing massive barriers to equality. Stephanie J. Wong and Amekia Sims See also Feminism: Overview; Violence Against Women Act

Further Readings Laidler, K. (2008). Anti-feminist backlash and genderrelevant crime initiatives in the global context. Feminist Criminology, 3(2), 79–81. van Wormer, K. (2008). Anti-feminist backlash and violence against women worldwide. Social Work & Society, 6(2), 324–337.

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Antisocial Personality Disorder and Gender

Antisocial Personality Disorder  and Gender Personality disorders are set ways of thinking and behaving that are considered to be inflexible and that could potentially impair interpersonal relationships. Antisocial personality disorder (APD) is considered to be one of the most common types of personality disorders, with a prevalence rate of 2% to 3% in the general population. People with APD tend to routinely violate the rights of others without remorse. They may be habitual criminals or may engage in potentially criminal behaviors. Furthermore, they may hurt and manipulate others in a manner that despite being noncriminal may nevertheless be socially unacceptable, irresponsible, unethical, or immoral. Individuals with APD are fairly likely to be charismatic and may often evoke the sympathy of others, often by portraying themselves as the victim. Thus, APD is characterized by a constant disregard for and violation of the rights of others, beginning in childhood and continuing through adolescence and the adult years. APD has been associated with abuse and neglect during childhood, victimization, and an increased risk for additional personality, substance abuse, and psychiatric disorders. Historically, APD is more commonly diagnosed in men, perhaps reflecting the culturally stereotyped male tendency toward aggressive and impulsive behaviors. However, research is now ­ beginning to focus on women and APD as well, by considering the underlying personality traits associated with antisocial personality disorder as well as the developmental trajectory of the disorder in both males and females. This entry explores the personality traits of APD as they relate to gender, and how gender differences in problem behaviors may lead to the manifestation of APD.

Gender Differences in Underlying Personality Traits and Phenotypic Manifestations Comprehensive epidemiologic investigations have reported that more than 80% of those meeting the diagnostic criteria for APD are men. These gender differences could reflect trait profiles. One of the  primary traits reported to underlie APD is ­impulsive aggression, a characteristic that is more

commonly found in men. The diagnostic criteria for APD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classification also make it more likely to be diagnosed in men. The DSM-5 classification criteria for APD include the requirement of a childhood history of conduct disorder, which is a pattern of criminal behavior, overt aggressiveness, and irresponsibility (behavioral traits that are far more common in men than in women). This diagnostic requirement of childhood symptoms of conduct disorder may account for an underrepresentation in prevalence rates of antisocial personality disorder in women. For instance, conduct disorder’s emphasis on overt physical aggression in adolescence as opposed to other expressions of adult behavior (e.g., sexual activity or substance abuse) may bias prevalence rates toward men. As a result, men may be seven times more likely to meet the diagnostic criteria for APD than women. Thus, research suggests that the lower prevalence rates for APD diagnosis in women could be due to APD’s reliance on explicit behavioral indicators of antisocial disorder. For instance, research indicates that men with APD are more likely to be involved in illegal, harmful, and violent behaviors while women with APD are more likely to commit more passive disagreeable behaviors (e.g., miss work or school). This passive nature of the behavioral manifestations endorsed by women with APD may lead to misdiagnosis or underrepresentation of APD in women in clinical settings. Some researchers have hypothesized that men and women may actually possess the same fundamental personality features of psychopathy but may differ in their explicit behavioral expressions. Ellison Cale and Scott Lilienfeld posited that since distinct phenotypic or behavioral expressions/ demonstrations may reflect the same fundamental tendencies, an individual’s biological sex might shape the personality dispositions of psychopathy into different overt conditions. This possibility is especially pertinent to gain a better understanding of psychopathy and APD, as several researchers have speculated that some personality disorders such as histrionic personality disorder and possibly borderline personality disorder could be considered as predominantly female manifestations of underlying psychopathic tendencies whereas APD may be a predominantly male manifestation of such ­tendencies. Although these personality disorders are seemingly different from none other, such

Antisocial Personality Disorder and Gender

differences may cover essential similarities in their etiologies. Thus, one line of research suggests that it is plausible that males and females differ in their manifestations of antisocial behaviors rather than in the core affective and interpersonal features of psychopathy. It has also been suggested that the differential socialization experienced by boys and girls could contribute to some of these differences. Research suggests that these differences continue into adulthood, leading to a male predominance in adult externalizing disorders (most notably, APD and substance abuse) and a female predominance in adult internalizing disorders (e.g., mood and anxiety disorders). Some research has focused on the links between the interpersonal, familial context and women’s personality disorders, with most research supporting the threshold of risk/sex paradox hypothesis, which states that women who develop APD have a higher threshold of risk than males and are therefore more severely afflicted. The female threshold is presumably raised by the gender role socialization of women, whereby they often face sanctions for engaging in physically aggressive behaviors. Some researchers suggest that the push over this threshold could stem from psychobiological or developmental factors at the individual level. This higher threshold for women could potentially help explain the lower prevalence of APD among women as well as the apparently greater impairment in women with APD. Thus, while APD is relatively uncommon in women, when it does exist, it might pose a higher risk for violence than it does for men. Examination of neurobiological abnormalities and the interaction of genetic influences and risk and protective factors in men and women over time may help clarify sex differences in the pathways to APD and can aid in the development of sex-specific prevention strategies.

Gender Differences in Developmental Trajectories: Childhood Antisocial Behavior The DSM-5 requires a childhood history of conduct disorder for an APD diagnosis in adulthood. Thus, it is important to glean a better understanding of the developmental trajectories related to conduct disorder as it is often a precursor to adult APD. Before the age of 18 years, individuals with

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conduct disorder characteristically exhibit a pattern of behaviors that includes the violation of others’ rights, actual or threat of harm to others, stealing or destroying property, deceitfulness, and similar severe rule violations. Although over the years, the prevalence of conduct disorders has been increasing in girls, data indicate that boys continue to report higher cases of conduct disorders. Some research suggests, however, that the gender ratio for conduct disorders decreases in adolescence. Persephanie Silverthorn and Paul Frick reviewed this literature and determined that while there are no gender differences in the rates of conduct disorders until the age of 5 years, after this age, girls report fewer conduct problems than boys, but by the adolescent years, both boys and girls report an increase in the manifestation of symptoms related to conduct disorder. These adolescent sample research findings are especially relevant to the diagnosis of APD since a number of individuals with late-onset conduct disorder might display adult APD symptoms but may not be diagnosed with APD as they do not exhibit conduct disorder symptoms before the age of 15. For example, in a longitudinal study of adolescents, Michael Windle examined gender differences in antisocial behaviors in early (i.e., between 14 and 15 years) and late (i.e., between 18 and 19 years) adolescence and found that although boys committed more property and violent crimes and were more likely to engage in substance use than girls, there was no gender difference in running away from home. This study also found that while antisocial behaviors were linked with substance use among earlyadolescent males, most other associations were not significantly different across sex. Some researchers suggest that gender differences in problem behaviors from infancy to school age may be indicative of early problem behaviors being channeled into predominantly externalizing disorders for boys and internalizing disorders for girls. Thus, extant research has established that there exist gender differences in early externalization behaviors, which have been associated with adult APD. Nicki Crick and colleagues have distinguished between overt physical aggression (which is more common in boys) and manipulative relational aggression (more common in girls) in samples of children and young adults. Crick reported that preadolescent children who engaged in gender nonnormative forms of aggression (i.e., overt

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physical aggression in girls and relational aggression in boys) were more maladjusted than children who engaged in gender normative behavior. Research suggests that these gender differences may be artifacts of gender-biased conduct disorder criteria. Silverthorn and Frick have suggested that the traditional conceptualization of conduct disorder development (i.e., childhood onset and adolescence onset) may not apply to girls, and they proposed a female “delayed-onset” developmental APD pathway. This conceptualization notes that although girls do not tend to manifest antisocial behaviors until adolescence, they might show many of the same pathogenic mechanisms that are associated with the childhood-onset pathway in boys. Since girls tend to have later onset of conduct disorder as compared with boys, girls with earlyonset conduct disorder may be especially antisocial even through adulthood. Furthermore, females with APD who meet the criteria for conduct disorder tend to be atypical and more deviant than other antisocial (i.e., adult-only APD) females and males with conduct disorder (which is in line with the threshold of risk/sex paradox hypothesis discussed earlier). It is also interesting to note that in the general population, female children have been traditionally at greater risk of experiencing childhood maltreatment as compared with male children. Similar gender differences have been noted in APD samples as well. For instance, a study of a large, nationally representative sample of the general population reported that women with APD had experienced more incidents of adverse events, including emotional neglect and sexual abuse, and parent-related adverse events during childhood and adulthood. Similarly, research in this area has also found a strong association between familial dysfunction and antisocial deviance, and between early victimization and substance use disorders in females (as compared with males).

Future Directions One of the most consistent findings in APD research is its male preponderance, with APD prevalence rates being significantly higher for men than for women. Furthermore, the research also suggests a gender difference in the developmental

course of APD. However, research is still uncertain about the extent of these gender differences and the degree to which these differences could vary across samples (e.g., in clinical/substance abuse settings or incarceration samples). Furthermore, the extant research has predominantly focused on a primarily Caucasian American sample, and it would be beneficial to study cultural variations in the manifestation of antisocial behaviors across racial and ethnic samples. Madhavi Menon and Meenakshi Menon See also Behavioral Disorders and Gender; Borderline Personality Disorder and Gender; Criminal Justice System and Gender; Histrionic Personality Disorder and Gender; Narcissistic Personality Disorder and Gender; Personality Disorders and Gender Bias

Further Readings Alegria, A. A., Petry, N. M., Liu, S.-M., Blanco, C., Skodol, A. E., Grant, B., & Hasin, D. (2013). Sex differences in antisocial personality disorder: Results from the national epidemiological survey on alcohol and related conditions. Personality Disorders, 4(3), 214–222. doi:10.1037/a0031681 Cale, E. M., & Lilienfeld, S. O. (2002). Sex differences in psychopathy and antisocial personality disorder: A review and integration. Clinical Psychology Review, 22, 1179–1207. Crick, N. R. (1997). Engagement in gender normative versus nonnormative forms of aggression: Links to social–psychological adjustment. Developmental Psychology, 33, 610–617. Paris, J. (2004). Gender differences in personality traits and disorders. Current Psychiatry Reports, 6, 71–74. Rogstad, J. E., & Rogers, R. (2008). Gender differences in contributions of emotion to psychopathy and antisocial personality disorder. Clinical Psychology Review, 28, 1472–1484. Silverthorn, P., & Frick, P. J. (1999). Developmental pathways to antisocial behavior: The delayed-onset pathway in girls. Development and Psychopathology, 11, 101–126. Windle, M. (1990). A longitudinal study of antisocial behaviors in early adolescence as predictors of late adolescent substance use: Gender and ethic group differences. Journal of Abnormal Psychology, 99, 86–91. Yang, M., & Coid, J. (2007). Gender differences in psychiatric morbidity and violent behavior among a

Anti-Trans Bias in the DSM household population in Great Britain. Social Psychiatry and Psychiatric Epidemiology, 42, 599–605.

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Evolution of the DSM

Although the 10th edition of the International Classification of Diseases (ICD-10) is used more broadly outside the United States (and includes both physical and mental health), the DSM mainAnti-Trans Bias in the DSM tains extensive international influence on classification and treatment. The DSM-5 was released in Anti-trans bias, or transphobia, refers to an irratioMay 2013 and is meant to replace the DSM-IV-TR nal fear or hatred of transgender people and, more (text revision), which was published in 2000. The broadly, of gender nonconformity. It can also refer DSM-5 differs from the previous edition in several to the tendency of individuals and systems to notable ways, though much of the content remains recognize the gender identity and/or expression ­ unchanged. Changes to the nomenclature and clasassociated with birth-assigned gender as the only sification of certain forms of gender diversity are legitimate gender identity and/or expression an among the content changes between the two ediindividual may possess. While transphobia differs tions of the DSM. from homophobia in that it refers to the dislike of First published in 1952, each edition of the DSM gender nonconformity more broadly, many argue has included mental health diagnoses that involve that the two inherently coexist, since homosexualthe pathologization of various nonheteronormative ity itself is a form of gender nonconformity (e.g., sexual behaviors and gender presentations or men are “supposed” to feel sexually attracted expressions. To the extent that DSM diagnostic exclusively to women, and vice versa). Nonethecategories are a reflection of the dominant societal less, most agree that transgender people experience norms and values of the time period, characterizatypes of bias and discrimination that their cisgentions of “deviant” sexual orientations and gender der lesbian, gay, and bisexual counterparts do not. identities, including the symptoms, nomenclatures, Examples of anti-trans bias include overt mistreatand diagnostic categories of these “disorders,” have ment of transgender individuals, such as violence, shifted with each edition of the DSM. For example, employment discrimination, bullying, and sexual in 1973, the diagnosis of homosexuality was harassment. More covert or systemic examples removed from the DSM-III, while gender identity include the barriers to legal gender change, the disorder (GID) was added. Since that time, diagnoexistence of only two legal genders, the difficulties ses pertaining to gender identity have remained in faced by trans people navigating non-gender-­ the DSM in various forms. neutral public restrooms, and the widespread Between the DSM-IV-TR and the DSM-5, sevabuse of incarcerated transgender people. eral changes were made to the gender-related diagAnother type of anti-trans bias relates to how noses listed in the manual. While some of the transgender people’s gender identities are viewed changes represent attempts to decrease pathologior classified. The Diagnostic and Statistical Manzation and stigma, critics have argued that some ual of Mental Disorders, Fifth Edition (DSM-5) is changes actually broaden the types of gendered the primary tool for diagnosis and classification behaviors that could be included in the diagnosis, used by mental health practitioners in the United thus increasing the pathologization and potentially States. Given its importance, how the DSM-5 clasleading to greater stigma. Perhaps the most visible sifies gender identity, including transgender idenchange in the DSM-5 is renaming the diagnosis tity, can shape how the transgender community is previously labeled gender identity disorder in the treated and viewed. This entry provides a brief DSM-IV to gender dysphoria (GD). Along with historical review of the evolution of the DSM and this change, this diagnosis was removed from the explores the areas in the DSM-5 in which this bias chapter on paraphilias and given its own chapter. is still reflected. The entry concludes with the Many transgender individuals and allies believe implications of this bias and recommendations for that these changes represent a progressive shift future changes to help ameliorate the harm that away from pathologization. Another gendercan stem from such bias. related diagnosis within the DSM-IV-TR was

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transvestic fetishism. This diagnosis also remains in the DSM-5, though it was renamed transvestic disorder (TD). As with GD and its predecessor, GID, much of the content remains the same. Despite these changes, the DSM-5 has drawn criticism from many transgender people and allies who believe that transphobic bias is still evident in the manner in which gender diversity is addressed. Critics argue that transphobic bias in the DSM-5 can be observed in the use of language, the behaviors that are deemed nonnormative, the symptoms listed, the medicalization of distress, and other realities of the human condition. More broadly, transphobic bias exists in the listing of transgender experience in a taxonomy of mental disorders. Although evidence of bias that privileges heterosexuality and identification with birth-assigned gender as ideal can be found throughout the manual, many believe that transphobic bias is most visible in the diagnoses of GD and TD.

Gender Dysphoria The DSM-5 distinguishes between GD in children and GD in adults and adolescents, though both are defined by an incongruity in the gender experienced and the gender assigned at birth. Children must meet six out of eight criteria for 6 months or longer to be given the diagnosis. Adults and adolescents must meet two out of six criteria for 6 months or longer. In addition, to receive a diagnosis, the individual must also experience either distress or impairment as a result of the incongruity. The diagnosis includes specifiers indicating whether the individual also has a disorder of sex development (e.g., hormonal or chromosomal condition) and a specifier for whether the individual is posttransition. The chapter continues describing diagnostic features (e.g., whether an individual enjoys toys, clothing, or other stereotypical activities of their assigned gender), development, and course. The section also includes a discussion on early versus late onset, the degree of anatomic ­dysphoria, and sexual orientation. Present throughout the text of these diagnoses is language that could be characterized as both transphobic and sexist. With regard to transphobia, the view of gender nonconformity as pathology is reinforced throughout the criteria, despite the name change of the diagnosis itself. A new section

in the DSM-5 that was not included in the DSM-IV’s GID diagnosis is the section “Risk and Prognostic Factors.” This section is meant to refer to supposed predisposing factors, genetic or otherwise. The term risk has clear negative connotations (e.g., risk factors for cancer, for depression, for relapse or criminal recidivism). In discussions of the implications and predisposing factors of psychological phenomena viewed as either neutral or positive, such language would not likely be used (e.g., risk factors for high IQ [intelligence quotient]). Thus, despite the change in nomenclature of the diagnostic label, language peppered throughout the description is arguably more pathologizing and stigmatizing than in the DSM-IV-TR. Consistent with previous versions, the DSM-5 also maintains anachronistic (and arguably sexist) language to describe deviations from normative gendered behaviors. This is most apparent in the GD in children diagnosis, which names avoidance of gender stereotyped play (e.g., rough-and-tumble play for boys and interest in dolls for girls) as evidence of such deviation. Inherent in these descriptions is also the labeling of children as their assigned birth sex, which privileges the genitals over other markers of gender (e.g., identity) and fails to recognize any possibility that the birthassigned gender is not correct, as asserted by many transgender children and adults. Another example of the focus on body parts and behaviors or verbalized self-identity is the addition of a “posttransition” specifier in the DSM-5, which was absent in the DSM-IV-TR. It describes posttransition as living full-time in the desired gender and having undergone at least one “cross-sex” medical procedure. The addition of this specifier presents two problems. First, it places additional focus on the physical body, even as transgender advocates have been working to emphasize the right to self-identify as existing independently from transition-related behaviors (e.g., people opt to transition or not for a variety of reasons, including access, health care status, safety, etc.). A cisgender patient seeking psychological services would, for example, not likely be labeled with a gender specifier spotlighting gendered elements of their body (e.g. “a female patient who had a hysterectomy” or “a male patient on depo-testosterone.”). Most cisgender patients would likely view this as an invasion of privacy,

Anti-Trans Bias in the DSM

and most mental health practitioners would feel that this has little clinical utility as a diagnostic specifier, even in cases in which it could have mental health implications. Last, the posttransition specifier contradicts the American Psychiatric Association’s (APA) own Position Statement on Access to Care for Transgender and Gender Variant Individuals, released in 2012, which argues that “appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments” (p. 1). The posttransition specifier continues to pathologize individuals who may no longer feel any GD. In addition, an assumption embedded in this specifier is that all transgender and gender nonconforming people desire or can attain both social and medical transition. Related to the specifier critique is the inclusion of the desire for transition as a symptom in its own right, which makes the diagnosis tautological and arguably lends support to conversion therapies designed to encourage individuals to adhere to their birth-assigned gender (already deemed unethical by the APA and the World Professional Association for Transgender Health), rather than to physical transition as the desired manner of resolving the dysphoria. There is no other diagnosis in the DSM-5 in which the desire for the stated treatment is itself a symptom. A correlate would be if a depressed person’s desire to alleviate his or her depression (e.g., feelings of excessive guilt, sadness, and anhedonia) was considered a symptom of depression itself. Given the APA’s statement affirming the utility of physical transition for those who desire it, it seems contradictory to label a phenomenon as a mental disorder when the recommended treatment is corporeal. For example, a cisgender man with gynecomastia (i.e., the growth of breast tissue in males) would not be viewed as having a mental disorder just because he feels distress about the presence of breasts and thus desires surgery. Similarly, a sexually active heterosexual cisgender woman who feels distress at the possibility of becoming pregnant would not be given a psychiatric diagnosis nor be required to undergo a psychiatric evaluation in order to be prescribed oral contraceptives. The only difference is that the man’s gender confirming chest surgery and the woman’s hormone prescription are viewed by

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society as “gender congruent,” whereas for transgender people, their desire for a physical transition is viewed as contradicting what society says they should want. Stated in the introduction of the DSM is the notion that conflicts between the individual and society are not inherently disorders. Thus, critics have argued that the DSM’s differing treatment of transgender bodies and associated feelings versus those of cispeople represents a significant degree of transphobic bias. Perhaps as a consequence of the overemphasis on bodies and behavior, the DSM-5 downplays the developmental elements and internal psychological processes involved in gender identity development. As with sexual and racial identity development, there is research that describes gender identity development, models, and stages for transgender people and cispeople alike. Rather than being viewed by these researchers as pathology, identity conflicts and questions around gender are seen as elements of the human condition. In many identity development models focused on marginalized individuals, distress is frequently framed as stemming from societal inequities (e.g., stigma, racism, homophobia), not as arising from pathology within the individual. Nonetheless, the DSM fails to reflect developmental models that highlight the influence of sociocultural and contextual factors. One notable change from the previous DSM is the removal of a sexual orientation specifier. Although many advocates believe that removing the “sexual orientation subtype” is consistent with the depathologization of nonheterosexual orientations, the current version includes a discussion on which conditions (e.g., early vs. late onset of GD) result in a trans person being either “androphilic” (attracted to natal males) or “gynephilic” (attracted to natal females). Critics argue that the use of these terms to describe the sexual orientations of transgender individuals sounds pathologizing and they are rarely, if ever, used to describe the sexual orientations of cisgender people, perhaps with the exception of the conditions noted in the paraphilias, such as TD.

Transvestic Disorder TD is included in the DSM-5 in the chapter on paraphilic disorders, along with seven other diagnoses: (1) exhibitionistic disorder, (2) fetishistic disorder,

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(3) frotteuristic disorder, (4) pedophilic disorder, (5) sexual masochism disorder, (6) sexual sadism ­disorder, and (7) voyeuristic disorder. TD identifies cisgender (generally heterosexual) men who are sexually aroused by dressing in women’s clothing and who experience significant distress or impairment in their lives—socially or occupationally—as a result. Several of these diagnoses include behaviors that involve nonconsensual sexual activity and thus involve the psychological distress and/or physical injury of another, unwilling person. The inclusion of TD in this class of disorders presents several concerns, only some of which involve transphobic bias. Critics have noted that gender diversity takes many forms and that classifications within the DSM fail to capture these many variations. For example, not all gender nonconforming people have a gender identity that differs from the gender assigned at birth, and not all seek to make physical changes to their bodies. Many individuals, including cisgender women (a  group not addressed in this entry), opt to don the clothing of a different gender for a variety of reasons, most of them nonsexual. Critics argue that this diagnosis serves to sexualize nonsexual cross-dressing and stigmatize both sexual and nonsexual cross-dressing. In addition, the diagnosis itself, as well as its placement in a chapter that includes disorders that cause harm to others, may contribute to an individual’s confusion and selfloathing (i.e., distress) about the desire to crossdress, whether or not it has sexual components. Another example of transphobic bias in this diagnosis is the name itself. As with GD, the name of this diagnosis was changed from transvestic fetishism in the DSM-IV to TD in the DSM-5. While this was meant to decrease the stigma (attempting to create a distinction between disordered and nondisordered cross-dressing), it still incorporates the term transvestite, which is experienced as pejorative by many transgender and cross-dressing people and is often used as a slur to degrade and demean them. To be diagnosed with any of the victimless paraphilias (i.e., fetishistic disorder, sexual masochism disorder, sexual sadism disorder, and TD), a person must report distress about their sexual interest itself, not merely distress resulting from societal condemnation of the desire. This suggests that atypical sexual behavior and any sign of distress

automatically qualify one for a mental health diagnosis. The challenge here, however, is that it is not always possible to isolate a single source of distress or rule out societal disapproval as a cause. The manual gives examples of relationship distress stemming from conflicts in the relationship due to the individual’s partner not sharing the same sexual interests (e.g., a heterosexual man’s wife not wanting him to cross-dress). The implication here is that if relationship distress ensues, it is a matter of dysfunction in the individual rather than a matter of mismatched sexual interests. This would also mean, for example, that if a heterosexual woman does not like missionary heterosexual intercourse with a male partner, she has a paraphilia, since heterosexual missionary sex is a societal standard for a normative sexual practice. Indeed, some clinicians might argue that she does have a disorder (see the DSM-5 chapter titled “Sexual Dysfunctions”), though this is arguably sexist and ­outdated. A more modern perspective might understand this as a relationship issue whereby the partners have diverging sexual interests. Given that the nature of what is considered normative sexual behavior varies by culture, time, and other variables, it is perhaps not useful for the APA to set a universal standard.

Implications Many believe that the changes to gender-related diagnoses in the DSM-5 represent a step forward, but they still contain a considerable amount of transphobic bias. Controversy surrounding the classification of gender nonconformity as a mental disorder continues, with many arguing that the GD diagnosis is stigmatizing, has little clinical utility, and mislabels a healthy process of identity development as disordered. Still many others, including the APA, argue that the inclusion of GD creates a pathway to treatment (e.g., hormone therapy, surgery) and without it these treatments would become less available and insurance companies would no longer provide coverage. Indeed, many insurance companies already argue that such medical care is “cosmetic” despite its classification as a disorder. The same arguments cannot be used to support the continued inclusion of TD, however, as no such medical treatment recommendations are tied to this diagnosis.

Anti-Trans Bias in the DSM

Despite the classification of GD as a mental disorder, professional associations such as the World Professional Association for Transgender Health and the APA itself support physical transition as an acceptable treatment to alleviate dysphoria for those who desire this form of health care. Given that the treatment is physical, the implication is that if GD is a disorder at all, it does not belong in a classification of mental disorders but should instead be listed only in ICD-11 as a physical, rather than a mental, condition. Recently, there have been proposals for the GD diagnosis to be removed from the mental disorders section of the ICD-11 and moved to the chapter titled “Condition Related to Sexual Health.” The DSM continues to draw erroneous distinctions between distress that is located in the social environment and distress that is intrinsic. For example, prior to 1987, homosexuality could still be labeled as a disorder if the individual felt distress about their sexual orientation. However, this diagnosis was removed in the DSM-IV as it was argued that lesbian, gay, and bisexual people often feel distress on the initial realization of their sexual orientation because of societal homophobia. It seems contradictory to not apply this same logic to GD, as well as to TD, and all the victimless paraphilias. Concerns about the continued pathologization and treatment of distress still persist as well. Without a clear understanding of the root or meanings of this distress, the DSM resorts to pathologizing “atypical” sexual behavior purely because it is nonnormative. Still other critiques about transphobic bias stem from the pathologization of behavior in trans people and cross-dressers that is considered ordinary for cisgender people (e.g., wearing gendered clothing, seeking genderrelated health care, wanting to be referred to by the gender with which they self-identify). Alongside this is the notion that the resolution of identity conflicts belongs only to the “other” (e.g., marginalized group), as there are no descriptions in the DSM-5 of disorders that stem from the refusal of cisgender people to question gender identity based on birth-assigned gender. Advocates of depathologizing gender diversity tend to agree, however, that pathways to transspecific health care ought to remain in place if and when these diagnoses are removed from the DSM. Models of mandated health care coverage for

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nondisorders already exist. Pregnancy, for example, is a human experience that requires specific health care and support, as do infancy and other life stages. This is provided to these individuals without labeling them as having a disorder. The same paradigm could be adapted for gender transition, which is another developmental process that many transgender people speak of as a rebirth. Overall, sex/gender assignments today in the United States are still made at birth by individuals who are strangers to the infant. Feeling that this is limiting later in life need not be seen as pathology. Instead, perhaps questioning and exploring one’s gender identity may one day be viewed as one of many aspects of child identity development that is healthy, regardless of whether or not the individual settles on agreement with the gender assigned at birth. Avy Skolnik and Sand C. Chang See also Gender Bias in the DSM; Gender Development, Theories of; Gender Dysphoria; Heterosexist Bias in the DSM; Pathologizing Gender Identity; Personality Disorders and Gender Bias; Sexual Orientation Identity Development; Transgender Research, Bias in; Transmisogyny; Transphobia

Further Readings American Psychiatric Association. (2012). Position statement on access to care for transgender and gender variant individuals. Retrieved July 7, 2015, from http://www.psychiatry.org/File%20Library/Learn/ Archives/Position-2012-Transgender-Gender-VariantAccess-Care.pdf American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. American Psychological Association Task Force on Gender Identity and Gender Variance. (2009). Report of the Task Force on Gender Identity and Gender Variance. Washington, DC: Author. Retrieved July 7, 2015, from http://www.apa.org/pi/lgbc/policy/ transgender.html Chang, S. (2015, July 9). Slam dunk? No thank you [Weblog comment]. Retrieved July 11, 2015, from http://sandchang.com/2015/07/09/slam-dunk-nothank-you/ Coleman, E., Bockting, W., & Botzer, M. (2012). The World Professional Association for Transgender Health (WPATH) standards of care for the health of

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transsexual, transgender, and gender nonconforming people (7th ed). Minneapolis, MN: World Professional Association for Transgender Health. Retrieved May 3, 2015, from http://www.wpath.org/site_page.cfm?pk_ association_webpage_menu=1351 Lev, A. I. (2006). Disordering gender identity: Gender identity disorder in the DSM-IV-TR. Journal of Psychology & Human Sexuality, 17(3/4), 35–69. National Gay and Lesbian Task Force. (2012). Task force questions critical appointments to APA’s Committee on Sexual and Gender Identity Disorders. Retrieved July 7, 2015, from http://thetaskforce.org/press/ releases/PR_052808 Skolnik, A. A. (2011). Diagnosing gender entitlement disorder: Instructions for activists in the homophile political subculture. In P. Lundberg-Love, K. L. Nadal, & M. Paludi (Eds.), Women and mental disorders (pp. 117–138). Santa Barbara, CA: ABC-CLIO. Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice (6th ed.). Hoboken, NJ: Wiley. Winters, K. (2011, May 26). Transvestic disorder: The overlooked anti-trans diagnosis in the DSM-5 [Weblog comment]. Retrieved July 7, 2015, from https:// gidreform.wordpress.com/?s=transvestic+disorder Winters, K. (2013, June 13). GID reforming the DSM-5 and ICD-11: A status update [Weblog comment]. Retrieved July 7, 2015, from https://gidreform .wordpress.com/category/dsm-5-2/

Anxiety Disorders

and

Gender

Anxiety can be broadly defined as the expectation of encountering a threatening object, situation, or sensation. Anxiety often elicits an emotional reaction known as fear and can be triggered by either an external event (e.g., going to a party, encountering a bear in the forest) or an internal event (e.g., a memory, thought, prediction, or physical sensation). Anxiety disorders include some of the most prevalent mental health disorders around the world (e.g., specific phobia, social anxiety disorder, panic disorder, generalized anxiety disorder) and can cause a significant decrease in quality of life and impairment in functioning. Anxiety disorders can interfere in many aspects of an individual’s life, including academics, employment, and social functioning. The costs associated with anxiety ­disorders (e.g., psychotherapy, medication, hospitalization, work absences) are sizable and continue to grow.

Gender is a sociodemographic variable that has been repeatedly linked to anxiety disorders, most notably in relation to a higher prevalence of anxiety disorders among women. This entry reviews the similarities and differences based on gender in the diagnosis, prevalence, presentation, and treatment of anxiety disorders and reviews theories and explanations for gender differences in the prevalence of anxiety disorders.

Diagnosing Anxiety Disorders Anxiety disorders are often diagnosed by psychiatrists, psychologists, or physicians from information obtained through a clinical interview and by using the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases. The clinical interview may include a diagnostic interview scale, such as the Composite International Diagnostic Interview or the Structured Clinical Interview for the fifth edition of the DSM (DSM-5). According to the criteria listed in the DSM-5, when anxiety/fear is persistent and excessive and interferes with an individual’s functioning, it is considered an anxiety disorder. Different anxiety disorders are diagnosed based on the symptoms reported (e.g., unexpected panic attacks, anxiety in social situations, excessive worry). The criteria for diagnosing anxiety disorders are the same for men, women, and other gender identities. Self-report scales may also be used to inform a diagnosis of an anxiety disorder through the use of cutoff scores or clinical ranges. Commonly used self-report measures of anxiety symptoms include the Beck Anxiety Inventory, the Depression Anxiety Stress Scales, and the Hospital Anxiety and Depression Scale. There are also scales that are used to measure the symptoms of specific anxiety disorders (e.g., Social Interaction Anxiety Scale, Penn State Worry Questionnaire). Most of these scales use the same cutoff scores and clinical ranges for all genders.

Prevalence of Anxiety Disorders Women are more likely than men to receive a diagnosis of an anxiety disorder across the life span. Many research studies have indicated that women are approximately twice as likely to experience an anxiety disorder as men, although prevalence rates vary by type of anxiety disorder. For example,

Anxiety Disorders and Gender

women are more likely to be diagnosed with generalized anxiety disorder compared with men but have similar prevalence rates as men for social anxiety disorder. Individuals who identify as transgender often experience even greater levels of distress than nontransgender men and women and have a higher prevalence of anxiety disorders compared with the general population. Certain demographic characteristics may vary based on gender in individuals with anxiety disorders. For example, some research indicates that men with social anxiety disorder are more likely to be single and live alone whereas women with social anxiety disorder are more likely to have been in a relationship (e.g., widowed, divorced) and to be single parents. Men with social anxiety disorder are also more likely to be employed compared with women with social anxiety disorder.

Clinical Presentation Anxiety disorders may develop in childhood, adolescence, or adulthood. There is no consistent evidence that there are differences in age of onset of an anxiety disorder based on gender. There is evidence to suggest that women diagnosed with anxiety disorders experience more severe symptoms of anxiety and are more likely to experience impairment in their daily lives compared with men. Women with panic disorder are also more likely to experience panic attacks and breathingrelated difficulties during panic attacks compared with men. Women with social anxiety disorder tend to have more severe social fears compared with men, and the types of situations that elicit greater fear may also vary by gender (e.g., talking to people in authority vs. using a public washroom). Many individuals with anxiety disorders also meet the criteria for other mental health disorders. Women are more likely than men to have an additional diagnosis of major depression, bulimia, or another anxiety disorder. Men are more likely than women to have an additional diagnosis of a substance use disorder, attention-deficit/hyperactivity disorder, or intermittent explosive disorder. Some research suggests that there are no differences based on gender in the chronicity or remission of anxiety disorders; however, there is some evidence that relapse rates may be higher for women with panic disorder compared with men.

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Theories and Explanations for Gender Differences in Prevalence There are many different theories and explanations that have been proposed to account for the gender differences in the prevalence of anxiety disorders. Although many of the theories and explanations have some research support, there is no consensus as to which theory or explanation best accounts for the gender differences in prevalence. As the etiology of anxiety disorders has been linked to multiple factors (e.g., genetics, the environment, stressors), it is likely that multiple factors may be involved in the gender differences in prevalence as well. Biological Differences

There are genetic, physiological/hormonal, and neurological differences based on sex (male vs. female), which extend to theories on gender differences in anxiety. Genetic studies have found that some genetic markers and mutations are related to anxiety in both men and women, and studies based on female twins have found that vulnerability to anxiety disorders in women may be strongly related to genetic factors. As females have different levels of hormones (e.g., estrogen, progesterone) compared with men and experience reproductive cycles, it has been suggested that both these factors may play a role in anxiety. Estrogen and progesterone have been shown to affect certain neurotransmitters that can have an impact on mood and/or anxiety in women (serotonin, dopamine, glutamate, and GABA [gamma-aminobutryic acid]). As these hormones fluctuate in women during reproductive cycles, the mood-altering effects of the hormones may also fluctuate and influence the etiology and/or course of an anxiety disorder. Finally, studies using magnetic resonance imaging have found both similarities and differences by sex in the volume of certain brain structures that are connected to anxiety-related personality traits. Exposure to Stressors or Trauma

Exposure to stress or trauma has been consistently linked to the development of anxiety disorders in both men and women. As women are more likely to experience chronic stress (e.g., poverty) and certain types of traumatic events (e.g., domestic violence, childhood sexual abuse, sexual assault)

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compared with men, this may account for the gender differences in anxiety disorder prevalence. There is also research that indicates that women respond differently to trauma compared with men, which may make women more vulnerable to developing anxiety. Gender Roles and Traits

Some theories explaining the gender differences in anxiety focus on gender role socialization, particularly the differential reinforcement of certain traits based on gender. Traditional gender role traits for women include expressivity (e.g., showing greater expression and understanding of emotions) and interdependence (e.g., seeking social support/aid from others). Traditional gender role traits for men include instrumentality (e.g., assertiveness, self-confidence) and mastery (i.e., sense of self-efficacy). In many cultures, men are discouraged from expressing fear and encouraged to manage stress on their own, whereas women are encouraged to be more expressive and to avoid feared objects. Both instrumentality and mastery have been found to be negatively related to anxiety. Compared with men, women report less instrumentality and mastery, which indicates that they may experience a greater psychological sense of a lack of control. Women may also develop an expectation of being unable to handle novel or unpredictable events (i.e., learned helplessness) and interpret these events as threatening. Instrumentality and mastery have been found to fully mediate the relation between gender and anxiety. Methodological Issues

Many studies investigating the gender differences in anxiety rely on self-reported symptoms of anxiety. Based on gender norms, it is more acceptable for women to be anxious or openly display anxious feelings. In contrast, men are often discouraged from displaying fear and anxiety. It is therefore possible that men underreport anxiety symptoms. There is evidence, however, that underreporting cannot fully explain the gender differences in the prevalence of anxiety disorders. Using multiple methods of assessing anxiety symptoms (e.g., self-report, physiological measures, observational measures) can help control for the possibility of underreporting.

Gender Nonconformity

A link has been found between gender atypical traits (i.e., gender nonconformity) and anxiety. There is evidence that gender nonconformity in childhood is related to anxiety in men, regardless of sexual orientation. There is less evidence indicating that gender nonconformity is related to anxiety in women. Individuals who display gender atypical traits are often stigmatized by others for contravening social norms. Although many people display gender nonconformity during their l­ ifetime, individuals who identify with a nonheterosexual orientation are more likely to display gender ­atypical traits. These individuals also have a higher prevalence of anxiety disorders compared with the general population. Emotion Regulation Strategies

Gender differences in emotion regulation strategies could potentially explain the gender differences in the prevalence of anxiety disorders. Some emotion regulation strategies are considered adaptive (e.g., problem solving, positive attributions), while others are considered maladaptive (e.g., rumination, avoidance). Research has indicated that rumination and suppression or avoidance of emotion are related to anxiety in both men and women. Women report engaging more often in rumination and suppression compared with men. Rumination has been found to partially mediate the relation between gender and self-reported anxiety. Women also report engaging in more adaptive emotional regulation strategies compared with men (e.g., reappraisal, problem solving, acceptance, distraction, seeking social support). Although no direct relationship has been found between adaptive emotion regulation strategies and psychopathology, these strategies appear to offset the negative effects of maladaptive emotion regulation strategies in women but not in men. The only emotion regulation strategy that men report using more often than women is drinking alcohol to cope, which in turn is related to greater substance misuse in men. It is suggested that men may utilize emotion regulation strategies that are not considered traditional emotion regulation strategies (e.g., engaging in activities with friends) or that are more unconscious in nature and hence cannot be ­ measured through self-report.

Anxiety Disorders and Gender

Anxiety Sensitivity

Anxiety sensitivity is the fear of sensations that are associated with anxiety and can include physical sensations (e.g., chest pain), cognitive symptoms (e.g., racing thoughts), and social concerns (e.g., embarrassment). Anxiety sensitivity has been shown to predict the development of anxiety symptoms. There is evidence that women score higher on measures of anxiety sensitivity than men and that anxiety sensitivity mediates the relationship between gender and symptoms of anxiety. More in-depth analyses have indicated that both physical and social concerns mediate the relationship between gender and anxiety symptoms. Based on the concept of anxiety sensitivity, it is possible that men and women experience similar anxietyrelated sensations but interpret or react differently to these sensations.

Impact of Anxiety on Quality of Life Quality of life is considered to be an individual’s subjective sense of well-being and life satisfaction. Research consistently indicates that individuals with anxiety disorders report a poorer quality of life compared with individuals without an anxiety disorder. Although there is evidence that women report more severe symptoms of anxiety and experience more impairment/disability due to anxiety, there is no consistent evidence of any differences in quality of life based on gender. No consistent differences have been found in overall quality of life based on anxiety disorder diagnosis; however, certain quality-of-life domains (e.g., physical mobility, social relationships, employment) may be affected more or less based on the type of anxiety disorder.

Impact of Anxiety on Physical Health The fight-or-flight response is repeatedly activated in individuals with anxiety disorders, which causes the body to release a number of hormones including cortisol. Cortisol increases blood pressure and blood sugar and suppresses the immune system. This response is very helpful in threatening or dangerous situations as it provides the body with more energy to flee or fight. However, constant activation of this system can have a negative impact on an individual’s physical health. There is

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evidence that anxiety disorders may be linked to coronary heart disease (CHD). CHD is one of the leading causes of death among both men and women. Anxiety has been shown to be a risk factor for CHD, and for those who already have CHD, it increases their chances of having a heart attack or stroke. Generalized anxiety disorder, in particular, has been linked to heart disease. CHD presents differently based on gender and often develops at different life stages for men and women.

Treatment Some evidence suggests that women who have an anxiety disorder are more likely to visit a primary care health facility compared with men with an anxiety disorder, but that this difference does not necessarily extend to visits to mental health professionals. Although differences have been noted in the prevalence and presentation of anxiety disorders by gender, many treatment approaches for anxiety disorders are not tailored by gender. There is strong evidence to support the use of cognitivebehavioral therapy to treat anxiety disorders and exposure therapy to treat specific phobias. Although these are gender neutral treatments, there is evidence that both men and women benefit from cognitive-behavioral therapy and exposure therapy. There is also some evidence that mindfulness based strategies can improve anxiety symptoms, particularly in individuals with generalized anxiety disorder. There is a lack of research investigating whether there are differences in therapeutic effectiveness based on gender, as well as a lack of research on the effects of gender (client and therapist) on therapeutic outcome regardless of type of therapy. Antianxiety medications and antidepressants are often prescribed as a treatment for anxiety disorders, either alone or in combination with therapy. Women are more likely than men to be prescribed psychotropic medication. There is also evidence that these medications are processed differently by men and women. For example, benzodiazepines and tricyclic antidepressants are absorbed more quickly by women compared with men, and psychotropic medications are eliminated more slowly by women than by men. The rate of distribution of a medication may also vary by gender as it is affected by many factors,

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Arab Americans and Gender

including body size, percentage of body fat, and blood flow. Karen E. Roberts See also Agoraphobia and Gender; Femininity; Gender Nonconforming Behaviors; Masculinity Gender Norms; Mental Health and Gender: Overview; Panic Disorder and Gender; Social Anxiety Disorder and Gender

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychological Medicine, 43, 897–910. doi:10.1017/ S003329171200147X Bekker, M. H. J., & van Mens-Verhulst, J. (2007). Anxiety disorders: Sex differences in prevalence, degree, and background, but gender-neutral treatment. Gender Medicine, 4(Suppl. B), S178–S193. McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45, 1027–1035. doi:10.1016/j.jpsychires.2011.03.006 Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187. doi:10.1146/ annurev-clinpsy-032511-143109 Norr, A. M., Albanese, B. J., Allan, N. P., & Schmidt, N. B. (2015). Anxiety sensitivity as a mechanism for gender discrepancies in anxiety and mood symptoms. Journal of Psychiatric Research, 62, 101–107. doi:10.1016/j.jpsychires.2015.01.014 Pigott, T. A. (1999). Gender differences in the epidemiology and treatment of anxiety disorders. Journal of Clinical Psychiatry, 60(Suppl. 18), 4–15. Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005). Quality of life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162, 1171–1178. doi:10.1176/appi.ajp.162.6.1171 Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010). Anxiety and risk of incident coronary heart disease: A meta-analysis. Journal of the American College of Cardiology, 56(1), 38–46. doi:10.1016/ j.jacc.2010.03.034 Zalta, A. K., & Chambless, D. L. (2012). Understanding gender differences in anxiety: The mediating effects of

instrumentality and mastery. Psychology of Women Quarterly, 36, 488–499. doi:10.1177/ 0361684312450004

Arab Americans

and

Gender

Arab Americans have a rich and diverse cultural heritage. Despite Arab migration to the United States dating from the late 19th century, social scientists only began to conduct research involving this population in the aftermath of the September 11, 2001, terrorist attacks. This entry examines the small but growing body of literature on ethnic and cultural identity and norms, family processes, ­differential experiences based on gender, and the effects of post-9/11 discrimination on Arab American psychological well-being. Implications ­ for practice and research are discussed.

Who Are Arab Americans? Arab Americans are individuals in the United States whose country of origin or ancestry is one of the 22 member nations of the Arab League in the Middle East and North Africa (i.e., Algeria, Bahrain, Comoro Islands, Djibouti, Egypt, Iraq, ­ Jordan, Kuwait, Lebanon, Libya, Mauritania, ­ Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab ­Emirates, and Yemen). It is estimated that 63% of Arab Americans are Christian, 24% are Muslim, and 13% are of other religious affiliations. These proportions differ from those in the Arab nations, whose populations tend to be predominantly Muslim. Arab Americans of different national identities tend to share cultural norms, beliefs, and practices that include speaking Arabic, family values, gender roles, music, entertainment, and cuisine. They also share an Arab identity that has been shaped by the sociopolitical history of the Middle East and North Africa, as well as experiences with mainstream American culture before and after 9/11. Arab Migration to the United States

Arab immigration to the United States can be categorized into three waves. The first wave of immigration occurred during the late 19th century.

Arab Americans and Gender

Most immigrants were poor Christians from the Syrian and Lebanese regions of the Middle East who arrived in the United States to become laborers and farmers. The descendants of the first wave have largely assimilated into mainstream American culture. The second wave of immigration occurred shortly after World War II in the 1950s. Political turmoil in the Middle East led many Christians and Muslims to leave Palestine, Egypt, Iraq, Yemen, Syria, and Lebanon and seek asylum and a new life in the United States. The second wave of immigration occurred during a time of increased Arab nationalism and a resurgence of traditional Arab cultural and religious norms in the Middle East, motivating families to retain their cultural and religious heritage through subsequent generations born in the United States. The third wave of immigration occurred between 1965 and 2001, when increased U.S. involvement in the area combined with policy reforms permitted an influx of immigrants from the Middle East, who sought to escape the continued political turmoil. Similar to the second wave, these immigrants were of mixed Christian and Muslim religious affiliation and sought to retain their cultural and religious heritage in the United States. Arab Americans Today

The Arab American Institute estimates that 3.7 million people of Arab descent live in the United States today. The majority of Arab Americans live in metropolitan areas such as Los Angeles, New York City, Detroit, Chicago, and Washington, D.C. Arab American families tend to be middle class, with an estimated median household income of $54,749 in 2009; the national median household income is estimated at $50,221. However, 15% of Arab American families live in poverty, compared with 10.5% of American families as a whole. Income among Arab Americans varies by national origin and gender, with Lebanese and Syrian men in the United States earning significantly more than Iraqi and Jordanian men in the United States. In contrast, Egyptian women tend to have the highest income among Arab women in the United States, and Moroccan women tend to have the lowest. The reasons for these discrepancies are unclear.

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Similar to immigrants of other ethnic and national origins, Arab Americans tend to differ in their adherence to Arab cultural norms and identification with their ethnic group based on generational status, time spent in the United States, gender, the ethnic composition of the neighbor­ hood, and experiences with mainstream American culture. In general, new and first-generation immigrants, women, and individuals living in neighborhoods with a high concentration of Arabs are expected to adhere to Arab cultural norms more than subsequent generations, men, and Arabs ­living in culturally heterogeneous neighborhoods.

Cultural Norms Arab Americans have both maintained the cultural norms of their countries of origin and adapted the norms of American culture. Many of the heritage countries’ cultural norms involve clear gender roles and expectations for educational attainment for men and women, which have been explored in the sociological and psychological literature. While there are some differences in cultural norms by religion, adherence to Arab and American cultural norms most clearly differs by generational status. Gender Roles

A 2003 survey of 500 Arab American women found that Arab Muslim women scored higher on measures of religiosity, were more likely to marry an Arab Muslim man, and were more likely to endorse traditional gender roles for women (e.g., staying at home and raising children, depending on one’s husband, etc.) than Arab Christian women. However, when generational status and length of time spent in the United States were accounted for, the effect of religion-based gender norms disappeared. The cultural heterogeneity of neighborhoods has also been found to affect gender roles among Arab American adolescents. For example, Arab youth raised in an ethnic enclave in the United States reported feeling isolated and being subjected to teasing by second- and third-­generation Arab peers, who were described as being less observant of gender roles and expectations. In a second study, young Arab women described the persistent scrutiny and double standards experienced by Arab Muslim adolescents who covered their hair with a hijab. They noted that Arab and

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non-Arab peers would scrutinize the behavior of young women wearing a hijab (i.e., swearing, gossiping) more closely than those who did not wear a hijab. In addition, these young women felt that family and Arab American peers enforced cultural and religious norms more strictly for females.

less willing to disclose their Arab ethnicity to others. A 2010 study of 177 Arab American men and women found that Arab Muslims reported more frequent discrimination than Arab Christians; 77% of the participants experienced at least one form of discrimination because of their Arab ethnicity, regardless of religious affiliation.

Education

Education is highly valued by Arab American men and women of diverse religious affiliations. Approximately 48% of Arab American men and 42% of Arab American women hold a bachelor’s degree or higher, compared with 27% of men and 28% of women in the general U.S. population. Arab American women’s labor force participation and career pursuits, however, do not conform to U.S. patterns, in which educational attainment and labor force participation typically share a strong positive relationship. Approximately 66% of Arab American women participate in the labor force regardless of religious affiliation—a percentage considerably lower than those of women from nearly all U.S. racial and ethnic groups. These findings suggest that Arab American women who stay at home and raise children are not likely forced into these roles but may aspire to both educational pursuits and traditional gender roles, in which they choose to focus on raising children.

Post-9/11 Experiences While the Federal Bureau of Investigation’s annual hate crime statistics report does not include a category on hate crimes against Arabs, statistics about crimes against Muslims and post-9/11 surveys provide insight into the discrimination experiences of Arabs of all religious affiliations. In the 9 weeks following 9/11, more than 700 hate crime incidents against Muslims (including Arab Muslims) and people perceived as Muslim were recorded by the Federal Bureau of Investigation—in stark contrast to only 28 hate crime incidents against ­Muslims recorded in the previous year. Incidents remained high in subsequent years, with approximately 150 hate crime incidents against Arab Americans reported annually from 2002 to 2013. A 2001–2002 survey of 1,500 Arab American adults conducted by the Arab American Institute found that 78% of respondents reported increased profiling due to their Arab ethnicity and 40% were

Discrimination

When considering the discrimination experiences of Arab men and women, it is important to recognize that Arabs have varying degrees of visibility in American society. This includes variation in skin color, use of traditional clothing, English proficiency, and the wearing of cultural and religious clothing, which may lead them to experience discrimination in different forms and settings. For example, an Arab Muslim woman who covers her hair with a hijab in public is immediately visible as an outsider and may experience more discrimination than a woman who does not adopt traditional forms of dress. The majority of studies of Arab American adolescents and adults have found that the frequency of discrimination does not differ by gender; however, some studies have found that Arab women experience discrimination at nearly twice the rate of Arab men. A 2009 study of Arab American adults found that in the majority of incidents reported by Arab Muslim participants, a woman wearing a hijab was present. In these instances, the participants reported being subjected to slurs, threats, spitting, and other hateful actions by strangers. Several studies that have highlighted the experiences of Arab American men and women in a variety of settings are discussed in the following sections. Employment Arab American men and women have consistently reported employment discrimination experiences post-9/11. The number of workplace ­discrimination and harassment claims due to religion, ethnicity, national origin, citizenship, and immigration status increased from approximately 8,600 in 2000 to 11,000 annual claims in the 5 years after 9/11. Court decisions between 2001 and 2014 highlight some gender-specific forms of discrimination experienced by Arab Americans. In several cases, Arab Muslim women were instructed

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to remove their hijab at work when performing tasks that required interaction with clients and customers. In addition, Arab Americans may be less likely to be hired for positions for which they qualify. In a 2011 study, 250 résumés with identical qualifications and either an Arab man or nonArab man’s name were sent to job postings online. Résumés with a non-Arab man’s name were twice as likely to receive an invitation to the interview. Schools Post-9/11 studies have reported that Arab American youth experience discrimination from peers and teachers in school settings. Arab female youth are more likely than non-Arab peers to be stigmatized by peers as oppressed individuals lacking autonomy in their life choices. Arab Muslim girls report disproportionate targeting by classmates and teachers in schools. In one study, several Arab Muslim girls reported having their hijab pulled off their head by classmates. A focus group study of Arab adolescents found that these young women were frequently criticized for their choices regarding clothing, religious expression, use of foul language, and career paths—regardless of what these choices were. Arab male youth more frequently report verbal harassment and physical assaults in schools. In one study, a participant reported witnessing a male Arab student beaten unconscious on school grounds for defending his religion and ethnicity. Additionally, male youth in several studies reported being called “terrorists” and that their behavior is often interpreted as violent and threatening to peers and teachers. These frequent experiences of discrimination among male and female youth negatively relate to academic performance and perceptions of academic competence.

Psychological Well-Being Post-9/11 studies have yielded concerning findings about the psychological well-being of Arab Americans of all ages. One study of 600 Arab ­ American adults found that 50% of participants scored above the clinical cutoff on a widely used measure of depressive symptoms; approximately 20% of nonclinical samples are expected to meet this cutoff. In addition, 25% of the participants in this study exceeded the cutoff for mild to moderate

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symptoms of an anxiety disorder. A second study of 350 Arab American adults found a similar frequency of depressive symptoms as well as a prevalence of mild to moderate posttraumatic stress disorder (PTSD). Rates of depressive, anxiety, and PTSD symptoms did not differ by age, gender, religious affiliation, generational status, or country of origin in both study samples. A study of Arab American adolescents found even higher rates of anxiety and depressive symptoms than studies of Arab American adults that did not differ by gender, religious affiliation, or generational status. Discrimination frequency predicted higher severity of anxiety and depressive symptoms for all participants. At the same time, ethnic identity and religious community support predicted decreased anxiety and depressive symptoms, although the effect was stronger for female participants. This may indicate that cultural norms, which have stricter expectations of women, also serve as a protective factor against the negative impacts of discrimination on psychological well-being.

Recommendations for Practice Three recommendations are made for mental health practitioners when engaging with Arab American clients or patients. First, practitioners should consider that Arab Americans are diverse in terms of religion, appearance, generational status, acculturation experiences, ethnic identity, values, and goals. These differences will likely influence an individual’s experiences with their ethnic group and mainstream American society. While there are some common patterns of experiences among Arab Americans, they do not necessarily represent the experiences of an individual client/patient. Second, considerable evidence has shown that stereotypes of Arab American men and families as oppressive of women are false and based on a limited view of Arab culture. Many Arab American women pursue a college education and subsequently choose to stay at home and raise their children. Many Arab Muslim women who cover their hair with a hijab do so by choice. Practitioners should not assume that Arab American women are oppressed by male family members; doing so may damage the relationship with clients/patients and distract from their reasons for seeking mental health care.

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Third, Arab Americans have experienced continuous negative life events post-9/11 (e.g., increased profiling, discrimination, stereotyping, etc.), which may lead them to be less trusting of practitioners than Americans who have not been a victim of these ethnic prejudices. Arab Americans may therefore be less inclined to seek mental health care than the American population as a whole. This is an important concern considering the elevated rates of depression, anxiety, and PTSD in this population. Arab Americans who do seek care may be initially distrustful of mental health care professionals. It is crucial for practitioners to understand how these experiences shape the worldview of their clients/patients. At the same time, it is also important to remember that not every patient’s experiences and concerns are a result of their Arab American group membership. Establishing a trusting relationship in which the practitioner respects the individuality of the client/patient is an important step toward encouraging Arab Americans in need of mental health care to seek necessary treatment.

Research Directions Research with Arab American adolescents has yielded key findings, but considerable gaps in the literature remain. Three recommendations are made based on the growing body of literature on Arab Americans. First, there is a clear need to examine the long-term mental and physical health effects on Arab Americans of continued overt discrimination and microaggressions perpetuated due to post-9/11 societal prejudices. At the same time, research is needed to identify those aspects of cultural identification, family support, and positive school, work, and neighborhood environments that serve as a protective factor against ethnic discrimination and that promote psychological well-being. Second, little psychological research has examined cultural practices in Arab American families, especially members of the Arab Muslim community. Findings regarding Arab American women’s choices to assume traditional gender roles are largely drawn from publicly available demographic characteristics of this population and from sociological research. The dearth of research on the diversity of cultural socialization within families

and on the positive and negative influences on youth development and adult mental health may contribute to the one-dimensional perceptions of Arab American families and Arab American women in particular. An examination of parental ethnic and cultural socialization processes, activity settings, parent-child relationships, and relationships between parents may provide important insight for researchers and practitioners in addressing the needs of Arab American communities. Third, an emerging body of interdisciplinary work has begun to examine the experiences of gender and sexual minorities in Arab American communities. The needs, concerns, and experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) Arab Americans—especially youth—are largely absent in scholarly work. LGBTQ individuals are generally considered to be at high risk for poor psychological well-being—a risk multiplied by the high prevalence of anxiety, depressive symptoms, and PTSD among Arab Americans. Psychological research with this potentially high-risk group will provide a valuable contribution to understanding the challenges of Arab American LGBTQ youth and emerging adults as they attempt to engage in the exploration of two intersecting and potentially conflicting identities. Mona A. Khalil and Celia B. Fisher See also Arab Americans and Sexual Orientation; Arab Americans and Transgender Identity; Cultural Gender Role Norms; Immigration and Gender; Islam and Gender; Minority Stress

Further Readings Abu-Ras, W., & Abu-Bader, S. H. (2009). Risk factors for depression and posttraumatic stress disorder (PTSD): The case of Arab and Muslim Americans post-9/11. Journal of Immigrant & Refugee Studies, 7(4), 393–418. Ahmed, S. R., Kia-Keating, M., & Tsai, K. H. (2011). A structural model of racial discrimination, acculturative stress, and cultural resources among Arab American adolescents. American Journal of Community Psychology, 48(3/4), 181–192. Amer, M. M., & Hovey, J. D. (2012). Anxiety and depression in a post-September 11 sample of Arabs in the USA. Social Psychiatry and Psychiatric Epidemiology, 47, 409–418.

Arab Americans and Sexual Orientation Arab American Institute Foundation. (2012). National Arab American demographics. Washington, DC: Author. Retrieved from http://b.3cdn.net/ aai/44b17815d8b386bf16_v0m6iv4b5.pdf Awad, G. H. (2010). The impact of acculturation and religious identification on perceived discrimination for Arab/Middle Eastern Americans. Cultural Diversity & Ethnic Minority Psychology, 16(1), 59–67. Kumar, R., Seay, N., & Karabenick, S. A., (2014). Immigrant Arab adolescents in ethnic enclaves: Physical and phenomenological contexts of identity negotiation. Cultural Diversity & Ethnic Minority Psychology, 21(2), 201–212. Nassar-McMillan, S. C., Ajrouch, K. J., & Hakim-Larson, J. (2014). Biopsychosocial perspectives on Arab Americans: Culture, development and health. New York, NY: Springer. Read, G. (2003). The source of gender role attitudes among Christian and Muslims Arab American women. Sociology of Religion, 64(2), 207–222. Tabbah, R., Miranda, A. H., & Wheaton, J. E. (2012). Self-concept in Arab American adolescents: Implications of social support and experiences in the schools. Journal of Adolescence, 49(9), 817–827. Widner, D., & Chicoine, S. (2011). It’s all in the name: Employment discrimination against Arab Americans. Sociological Forum, 26(4), 806–823.

Arab Americans and Sexual Orientation Arab Americans are an ethnic minority group in the United States who identify themselves as various races and have diverse religious affiliations. There has been some debate among experts regarding whether or not Arab Americans should have their own racial/ethnic group category on official documents. Arab Americans have encountered increased discrimination since the attacks of ­September 11, 2001 (9/11). Arab Americans are often mistakenly conflated with Islam or Muslim; ­however, the majority of Arab Americans are actually Christians, while many others identify as agnostic, atheist, Buddhist, Jewish, or from many other religions. As ethnic minorities from a socially conservative culture, Arab American sexual minorities (i.e., people who are nonheterosexual) face many

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challenges in understanding themselves and how they fit in with the dominant U.S. society as well as with their own ethnic community. The term sexual identity is used throughout this entry to refer to the aspect of someone’s identity that has to do with their sexual orientation. The terms sexual identity and sexual minority are used intentionally instead of LGBQ, which is commonly used in U.S. mainstream society, to be inclusive of nonheterosexual Arab Americans who may not choose to use lesbian, gay, bisexual, or queer labels, which are often associated with White American or Western culture. This subpopulation of Arab Americans has been rendered invisible historically in mainstream media and in psychological research. However, there has been growing attention to this group in both of these spheres between 2010 and 2015. Issues of identity are an integral part of psychology, related to how we see ourselves, how we are perceived by others, and our position in society. This entry explores the issues related to Arab Americans’ struggle to balance their ethnic and sexual minority identities. The reception that Arab American sexual minorities receive from family members is also discussed, as is the sexual ­orientation–based discrimination they experience. Finally, some Arab-related organizations for sexual minorities in the United States are listed.

Identity Development and Related Issues As individuals with multiple minority statuses, Arab American sexual minorities must find ways to navigate the unique experiences of holding an ambiguous ethnic minority identity, which has received increasingly more media attention since the early 2000s, and a sexual identity that is influenced by their own ethnic community as well as the dominant culture, both of which are heteronormative. Many Arab American sexual minorities take steps toward ethnic identity development by learning Arabic, enrolling in relevant courses in school, and/or joining Middle Eastern Arab (MEA) groups and organizations. However, for some Arab American sexual minorities, concerns about being outed for their sexual identity status or rejected because of it leads them to halt their engagement with MEA groups and organizations, which in turn impedes their ethnic identity development.

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The issues related to ethnic identity development alone for this population are complicated by a lack of agreement about how best to classify Arab Americans as an ethnic group in the United States. Officially, neither the U.S. Census Bureau nor the Office of Management and Budget recognizes Arab as an ethnic minority, despite some Arab organizations’ efforts to have it added. Arab Americans are officially classified as White, and some Arab individuals and organizations have argued that such a designation underestimates Arab Americans’ marginalization based on their ethnic background. Consistent with arguments for and against the inclusion of Arab and Middle Eastern ethnic identity categories, many Arab ­American sexual minorities have discussed the confusion or ambivalence around whether they are best classified as White or as persons of color and hiding their MEA background to pass as White. In very broad terms, same-sex attraction and behavior is frowned on in Arab culture; however, Arab Americans may be more comfortable with it as LGBQ attitudes in the United States become increasingly more commonplace. As such, sexual identity development among Arab American sexual minorities can mirror that of individuals from other ethnic backgrounds in which early stages are often characterized by questioning and feelings of shame, and internalized heterosexism/homophobia. The later stages of sexual identity development may be characterized by identifying the self based on sexual attractions (i.e., adopting labels such as gay, lesbian, bisexual, or queer) and negotiating various relationships and spaces with respect to how and if they choose to disclose their sexual identities.

Multiple Identities The intersection of Arab American and sexual minority identities can serve as a source of strength and resilience. For instance, some Arab American sexual minorities find that developing a clear sense of ethnic identity first helps pave the way for the development of sexual identity, while for others development of sexual identity may facilitate ethnic identity development. This phenomenon is explained in part by cultivating experience of and increased ability to cope with adversity (e.g., feelings of not belonging, discrimination) with respect to one identity and then applying the coping skills

learned to experiences of adversity associated with the other identity. On a similar note, these two minority identities are often conceptualized as separate and independent processes by the individuals who hold them. This is important to note as psychologists and other scholars emphasize the importance of conceptualizing multiple identities through an intersectional perspective with increasingly more ­conviction. While it is undoubtedly the case that Arab American sexual minorities do carry both identities at any given time, they report frequently experiencing these identities independently at different times and in varying types of situations. In any given context, one identity is likely to be more salient than another, and relatedly, it is often the case that another or multiple other identities are more relevant in a given situation. For example, imagine a scenario in which a Muslim Arab American woman is attending a religious event with her ethnic minority community. Within this community, this 22-year-old woman is one of the oldest in her generation and enjoys her position as a role model for the teenagers in her community. She wears a headscarf, considers ­herself a devout Muslim, and also identifies as a ­lesbian, but is only out to her college friends. In attending religious events as a model young person in her community, she thinks first about her age and gender, and these are the most salient identities for her in this context. She shares the same ethnic and religious identities as the rest of the group. She sees the event as an important part of her identity development; however, her knowledge of her own lesbian identity is not as relevant in this context. In another scenario, one can imagine a same-sexattracted Arab American man becoming increasingly more involved with his school’s Students for Justice in Palestine group; he is not thinking about his sexual orientation in this setting but, rather, feeling closer to his ethnic group. For some individuals, their ethnic and sexual identities are not considered together, but for others they are. Over time for many, these two identities do become better integrated, and the intersections of these minority statuses become greater than the sum of their individual parts. With this identity integration, some Arab Americans who identify themselves as sexual minorities believe that this particular combination of minority identities offers a unique perspective and a level of empathy for

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others that ideally positions them for helping or reaching out to others. Becoming advocates for minority visibility, rights, and justice has been a major driving force for many Arab American sexual minorities. This research finding flies in the face of stereotypes of minorities, especially of women and immigrants, as passive, meek, and lacking agency.

way that different Arab American families react to their family members’ coming out to them as sexual minorities. Although many react negatively, sometimes the emphasis on family connectedness among Arabs can facilitate support among family members.

Family-Related Issues

Clearly, having both an Arab American and a sexual minority identity can be challenging in the United States. Indeed, many Arab American sexual minorities have reported experiencing instances of ethnic discrimination both generally in U.S. society and in direct response to 9/11. Likewise, the participants in that study also reported heterosexist behavior from family members, schoolmates, and others. Some participants reported specific instances of heterosexist language being heard at Arab events (e.g., someone being called a “faggot”), while others expressed worries about receiving heterosexist criticism from Arab communities or groups if they were to come out to them, and therefore they avoided joining at all or coming out in those spaces. Many Arab American sexual minorities have described difficulties integrating these two identities, explaining that family members or other Arabs in their communities have remarked that being gay or lesbian does not happen among Arabs and that being gay or lesbian is a Western concept. Indeed, some scholars have noted that the Islamic world has perhaps adopted the terms lesbian, gay, bisexual, and queer from the West in a way that neglects the Arab world’s own history of same-gender sexual attractions and behaviors. However, these scholars also recognize that the problematic Arabic terms currently in use for same-sex-attracted women and men carry negative connotations. Despite the limitations of available terminology for Arab sexual minorities, according to the literature most Arab Americans and Arabs in Canada have adopted Western labels such as gay, lesbian, bisexual, queer, and pansexual.

Arab American cultures tend to emphasize family connectedness broadly and extended families as the primary family structure. However, for firstand second-generation Americans, it is often the case that the extended family has been disrupted by migration to the United States. In addition, many sexual minorities may cover up their samesex attractions from family members. For some, this decision not to disclose their sexual identity is for fear of rejection or disturbing the peace, while for others the decision is based on a desire to respect their cultural value of discretion regarding sexuality in general. These individuals explain that within their culture, discussing sexuality at all is shunned, and therefore they avoid discussing their sexual orientation and as such are often presumed to be heterosexual. Some individuals avoid coming out to family members and their ethnic communities due to fears of rejection and judgment, even if they have never been specifically told that discussing sexuality or same-sex attraction is taboo. These combined factors create a psychological distance between family members and strain for sexual minority Arab Americans. When Arab American sexual minorities choose to “come out” to their families (a notably Western concept), they can expect a range of possible reactions from family members. For example, some have reported positive and supportive reactions from family members, while others reported negative reactions and disappointment from family members. Still others described family members’ reactions that were mixed, both positive and negative. Positive reactions included beginning to feel closer with family members, affirmation, and expressions of love and acceptance. Negative reactions, on the other hand, included sadness, anger, lack of understanding, and lack of acceptance due to strong religious convictions. Taken together, these findings indicate that there is no one uniform

Sexual Orientation–Based Discrimination

Arab-Related Organizations for Sexual Minorities in the United States There are several organizations and groups dedicated to serving Arab and/or Muslim American sexual minorities. These groups include Tarab

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NYC (a community for Arab and Middle Eastern Americans that hosts events in New York and combats homophobia), Al GAMEA (a human services organization based in Detroit for the “GLBT” Middle Eastern Community), Queer Jihad (a Webbased group), and the Muslim Alliance for Sexual and Gender Diversity, which holds an annual retreat. Ayse Selin Ikizler See also Arab Americans and Gender; Arab Americans and Transgender Identity; Criminal Justice System and Sexual Orientation; Exoticization of LGBTQ People of Color; Intersectional Identities; Islam and Sexual Orientation; LGBTQ People of Color and Discrimination; Multiracial People and Sexual Orientation; Racial Discrimination, Sexual Orientation–Based; Sexual Orientation Identity

Further Readings Amer, S. (2012). Naming to empower: Lesbianism in the Arab Islamicate world today. Journal of Lesbian Studies, 16, 381–397. doi:10.1080/10894160.2012 .681258 Eichler, M. A., & Mizzi, R. C. (2013). Negotiating the confluence: Middle-Eastern, immigrant, sexualminority men and concerns for learning and identity. Brock Education Volume, 22, 84–98. Ikizler, A. S., & Szymanski, D. M. (2014). A qualitative study of Middle Eastern/Arab American sexual minority identity development. Journal of LGBT Issues in Counseling, 8, 206–241. doi:10.1080/155386 05.2014.897295 Minwalla, O., Rosser, B. R. S., Feldman, J., Varga, C., Culture, S., Mar, N., & Simon, B. R. (2005). Identity experience among progressive gay Muslims in North America: A qualitative study within Al-Fatiha. Culture, Health & Sexuality, 7, 113–128. doi:10.1080/136910 50412331321294 Whitaker, B. (2011). Unspeakable love: Gay and lesbian life in the Middle East. London, England: SAQI Books.

Arab Americans and Transgender Identity Typically in the predominant mainstream U.S. culture and media, a transgender individual is someone who identifies with a gender other than the

one that was assigned to the individual at birth (which is usually based on visible external genitalia). Among Arab Americans, a similar definition of transgender may apply; however, there has not been research on this specific issue in the psychological literature. Some sociologists and anthropologists who study either the Arab world or Islamic society have begun to address transgender issues along with cross-dressing and the issue of undergoing sex- or gender-related medical procedures. It is important to note that the majority of such research has been conducted in the Middle East and does not necessarily reflect the personal experiences of Arab Americans in the United States. This entry begins by exploring the varying degrees of importance placed on gender identity among Arabs and then specifically looks at Arab Americans identifying as transgender. Data on transgender Arab Americans are then reviewed. The entry concludes by analyzing the various effects associated with identifying as a trans Arab American.

Transgender Identity Arab Americans are an ethnic minority group in the United States that consists of individuals of diverse backgrounds in terms of generational status, nationality, religion, race, and socioeconomic status. Transgender issues and ethnic identity concerns are an important part of understanding psychology and gender. Traditionally and historically in most contexts, gender has been thought of in binary terms of man/boy or woman/girl. Men are presumed to have male sex characteristics, and women are presumed to have female sex characteristics. The problem with these assumptions is that not everyone fits neatly into these two categories. Not fitting into these socially derived constructs of gender has major implications for feelings of shame, confusion, and belongingness and is often associated with becoming the target of discrimination and feeling alienated. The intersection of both Arab identity and trans identity can have major ramifications for psychological well-being and functioning. A noteworthy concern among Arab American feminist writers and thinkers who address topics such as lesbian, gay, bisexual, and transgender (LGBT) persons’ and women’s issues in Arab culture is that they might inadvertently exacerbate

Arab Americans and Transgender Identity

negative stereotypes of Arabs as barbaric, backward, misogynistic, and homo- and transphobic. While it is true that the majority of Arabs and Arab Americans likely do find themselves immersed in homophobic and transphobic contexts, we must recognize that the dominant White non-Arab society in the United States is also largely homophobic and transphobic. Therefore, it is important to center such discussions on facts (rather than hearsay, which runs the risk of oversimplifying reality and regurgitating stereotypes), to be mindful of the pluralism within Arab and Arab American communities, and to acknowledge that some of what is true in Arab culture is also true of the dominant White American society.

Data on Transgender Arab Americans Research and mainstream media have focused very little on transgender identity in the Arab American community. Likewise, there has been neither comprehensive study on demographics nor qualitative research on trans Arab Americans. However, the 2008 National Transgender Discrimination Survey (NTDS) conducted by the National Center for Transgender Equality and the National LGBTQ Task Force did include a small percentage of respondents who self-identified as Arab or Middle Eastern. Of the 6,456 transgender and gender nonconforming people who completed the survey, 736 were classified as multiracial after selecting more than one race category to identify themselves. Only 39 selected the Arab/Middle Eastern option, and all who did so selected another race as well, so they are included in the analyses and reporting of the Multiracial umbrella racial group. People who selected Arab/Middle Eastern were by far the smallest racial group. Asian Americans were the next smallest, with 213 selecting Asian and of them 137 also selected another race. The NTDS results revealed that anti-­transgender bias and persistent institutionalized and interpersonal acts of racism combined seemed to have particularly negative consequences for multiracial transgender people and other people of color. The poverty rates were the highest among multiracial transgender and gender nonconforming people, with 23% reporting a household income of less than $10,000 per year. For comparison, the poverty rate for all transgender people and the general U.S. multiracial population is 15%, and it is 4%

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for the general U.S. population. Therefore, there appear to be compounding negative effects of the multiple minority identities of being trans/gender nonconforming and multiracial on poverty rates. Moreover, a higher percentage (54%) of multiracial respondents reported having attempted suicide as compared with 41% of trans/gender nonconforming respondents in this survey and 1.6% of the general U.S. population.

Effects of Identifying as Trans Arab American Although transgender identities, lifestyles, and activities do largely operate counter to traditional cultural expectations and indeed some harsh laws exist (which are discussed later in this entry), some aspects of transgender life may be more accepted than might be expected. Openly trans artists and performers in Arab and other Middle Eastern countries (e.g., Turkey) are often household names and quite popular, among all generations of individuals from mainstream society. However, this is largely considered an exception that is made for individuals in the arts, entertainment, or fashion industries. Professionals in these fields are often perceived as eccentric and less serious than persons in other fields. Moreover, although well-known trans people in the Middle East have openly presented themselves as one gender and later as another, their personal identities with associated labels (e.g., trans man, trans woman, or even simply just woman for a male-bodied individual) are not formally or outwardly declared. Such a lack of emphasis on identifying oneself as trans runs parallel to the lack of attention to sexual orientation identity in the Arab world, where people are less likely to define themselves by their sexual attractions and behaviors. Even though Islam is certainly not the predominant religion of all Arabs, and there is variation in how Muslims may adhere to specific aspects of their religion, some scholars have examined religious leaders and Islamic message boards to better understand how trans issues fit in with Arab culture. Some perhaps surprising liberal attitudes have been demonstrated by Iranian clergy in recent history. For example, the late Ayatollah Khomeini, a spiritual leader, ruled that transgender issues should be understood as distinct from homosexuality, and allowed gender reaffirming treatment. He and

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other spiritual leaders or experts of Islam have defined transgender concerns as a medical issue as opposed to a moral one, such that an individual’s physical body is in need of correcting to become consistent with the person’s gender identity. This quite progressive view has been proclaimed with more certainty in cases of intersexed individuals; however, it demonstrates flexibility and understanding of sex and gender in less binary terms. A much bleaker but very concrete source of insight into how trans issues are sometimes treated in the Arab world comes from a specific example of a law in Kuwait that criminalized imitating the dress or mannerisms of the opposite sex. The law called for arrest and imprisonment or payment of a large fine. Subsequently, there were 14 or more cases of individuals who were arrested for this crime. The males who were arrested were described by the police as “confused men.” In 2008, Human Rights Watch reported that some of the men had their heads shaven as punishment, some were beaten, and all were denied a legal defense. Consistent with this view that gender nonconformity should be punished, many Muslims cite passages from the Hadith stating that the prophet Muhammed apparently frowned on men imitating women and women imitating men. With this backdrop in the homelands of individuals of Arab descent, one can imagine how all aspects of trans identity development as it is thought of in the West (awareness of body dysphoria, self-identification, and coming out) might seem insurmountable for Arab Americans. For other Arab Americans less committed to the dominant U.S. trans culture’s emphasis on establishing one’s gender identity (or at least developing one), it may not fit in with their own experience of transgender-related feelings, or they may choose to lead a double life. It has been documented that many same-sex-attracted Arabs choose the latter option—one in which they are out and one in which they hide their sexual orientation—to protect themselves from shame and the family’s honor, so it is reasonable that the double-life option might be the path taken by many Arab Americans who are trans for similar reasons. On the other hand, as we have seen among Arab American sexual minorities, perhaps some trans Arab Americans do identify themselves and take the risks associated with coming out to all the important

people in their lives, families and ethnic communities included. Given the diversity of Arab American families in the United States, one cannot assume one standard or expected experience for all trans Arab ­ Americans or uniform responses from all their family members. According to the NTDS, 37% of the multiracial respondents reported family acceptance, and 61% reported gradual improvement in familial relationships after coming out as transgender. However, there is no way to know what percentage of those respondents identified as part Arab. Self-identifying one’s gender and declaring it outwardly is likely to carry very different meanings in varying contexts and may not even come up as strongly for Arab Americans as it does for Whites or other racial groups. Based on the Arab cultural values of family and collectivism (valuing the group over the needs of the individual), it would seem that gender nonconforming individuals of Arab descent might feel a less intense need to declare their gender identity to themselves or others as the drive to maintain group cohesion may be more meaningful and compelling for them. Conversely, especially if the individual has been assimilated into U.S. culture, which prioritizes individual needs over the needs of the group, the trans person may feel more of a need to self-­ identify and come out. Either case would present challenges and would benefit from the care and support of family members and friends. Ayse Selin Ikizler See also Arab Americans and Sexual Orientation; Criminalization of Gender Nonconformity; Criminalization of Transgender People; Exoticization of LGBTQ People of Color; Gender Nonconformity and Transgender Issues: Overview; LGBTQ Community, Experiences of Transgender People in; LGBTQ People of Color and Discrimination; Multiracial People and Transgender Identity

Further Readings Abdulhadi, R., Alsutany, E., & Naber, N. (2011). Arab and Arab American feminisms: Gender, violence, and belonging. Syracuse, NY: Syracuse University Press. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Washington, DC: Author.

Asexuality Retrieved from http://www.apa.org/practice/guidelines/ transgender.pdf American Psychological Association, Task Force on Gender Identity and Gender Variance. (2008). Report of the Task Force on Gender Identity and Gender Variance. Washington, DC: Author. Retrieved from https://www.apa.org/pi/lgbt/resources/policy/genderidentity-report.pdf. doi:10.1037/e516782010-001 Date, T., Graves, S. S. D., Cemetery, R., Author, U., Source, B. B., Oriental, A., & Stable, S. (2014). The effeminates of early Medina. Journal of the American Oriental Society, 74, 147–153. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L, & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Retrieved from http://www .transequality.org/sites/default/files/docs/resources/ NTDS_Report.pdf Kayyali, R. (2013). U.S. Census classifications and Arab Americans: Contestations and definitions of identity markers. Journal of Ethnic and Migration Studies, 39, 1299–1318. doi:10.1080/1369183X.2013.778150

Asexuality Asexuality is defined as an enduring lack of sexual attraction to others. Asexuality is more prevalent in women and nonbinary individuals (i.e., those who do not identify as either men or women), and it is important to the field of psychology as it is underresearched and is still sometimes conflated with sexual arousal disorders, which can lead to misdiagnosis and incorrect treatment. Asexuality has likely remained invisible to the general populace and even to many mental health professionals because of the lack of overt socio-sexual activities, fewer legal repercussions, and less public scrutiny than for sexual minorities with same-gender attractions. As society becomes more accepting and open about sex and sexual attraction, however, people who do not experience sexual attraction can start to feel more pressure to be sexual, which can cause distress. There has been much discussion about whether asexuality is a sexual orientation or signifies the lack of one, but prominent researchers in the field argue that it should be categorized as a sexual orientation because it describes who one is sexually attracted to—that is, no one. After reviewing some

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demographics about the asexual population, this entry explores the wide range of asexuality. How clinical professionals have previously classified asexuality and presently do so is reviewed. Next, studies attempting to reveal the contributing factors leading to asexuality are discussed. Finally, discrimination faced by asexuals and the opportunities for  them to join a community of asexuals are highlighted.

Asexual Population Demographics Research on British participants in a large-scale study on sexual behavior indicates that asexual people make up approximately 1% of the population, but the actual number could be higher due to self-selection (asexual individuals may skip questions about sexual attraction), ignorance (confusing sexual attraction with other forms of attraction), and fear of stigma (asexual people have reported that they feel there is something wrong with them and may not want to state in a survey what they see as their deviance). This finding was similar in size to that of other sexual minority groups such as bisexual and homosexual, who were each estimated to represent 1.11% of the population in the same 2004 study. Early research indicated that asexual people were more likely to be non-White than nonasexual people. However, more recent research with smaller samples of self-identified asexual people has predominantly White participants. That  may be a function of the sources of subject recruitment—mostly online asexual community ­ forums—or indicative of a lack of self-identification with asexuality among non-White individuals.

Range of Asexuality Asexuality, like all sexuality, is a spectrum, ranging from individuals who are completely sex repulsed and want nothing to do with it to others who find sex pleasurable but do not experience attraction toward specific people. Asexual people generally have a later onset of sexual activity (if any), less reported sexual activity, and less current sexual activity than non-asexual people, but some asexual people do still engage in sex. Sexual desire refers to the desire for sexual stimulation, whether with a partner or self, and asexuality does not always preclude sexual desire. In contrast, sexual attraction is

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Asexuality

the lustful inclination toward a specific person or category of people. People who identify as asexual do not have anything preventing physical arousal or sexual climax, although some find it repulsive or unnecessary, or have other coexisting conditions that affect their sexual function. Some asexual people do masturbate, and some describe masturbation as similar to relieving other physical needs, like scratching an itch. Others find it pleasurable, and some don’t masturbate at all, again revealing the spectrum of experiences. Some asexual individuals also experience an identity-less sexuality, known as autochrissexualism, in which they feel a disconnect between themselves and their sexual target. This often occurs when an asexual person is aroused by pornography, an erotic novel, or sexual fantasy but still does not experience any attraction for individual people and does not imagine themselves in these sexual situations. Some asexual people also report engaging in sexual activity because they felt that it was expected of them and they did not know that asexuality existed; this may inflate the number of asexual people who report having had sex in the past. Two major categories of asexuality are (1) gray asexuality and (2) demisexuality. Gray asexuality is when someone experiences very low levels of sexual attraction or rare instances of sexual attraction, or are unsure if what they are experiencing is sexual attraction or not. As the name itself suggests, gray asexuality is a gray area, and the experience varies, but the commonality is that they find that their experiences of sexual attraction do not fit with those of non-asexual people. Demisexuality is a lack of sexual attraction toward anyone until a strong emotional bond is formed. It’s not the same as waiting to have sex until you feel appropriately emotionally connected; a demisexual person goes through life without experiencing any attraction at all, until they reach a certain emotional closeness. The emotional bond can be romantic but doesn’t have to be. Romantic attraction is described as infatuation or emotional attachment to another person. Asexual people can experience romantic attraction to others, and they can have a romantic orientation toward any gender. Romantic orientation is labeled in the same way as sexual orientation, with orientations including biromantic, homoromantic, heterormantic, or aromantic, indicating the gender(s) to which a person is romantically attracted. Aromantic people

do not experience any romantic attraction to others but can still experience sexual attraction. Some individuals are both asexual and aromantic, but the terms are not synonymous. Asexual people also describe feeling aesthetic attraction, which they describe as viewing a person like they would a piece of beautiful artwork, and sensual attraction, which is described as a desire to touch or hold someone in a nonsexual way. These can be experienced by non-asexual people as well. Asexuality, unlike celibacy, is not a choice to refrain from engaging in sexual activity (in fact, a minority of asexual people do have sex) but is instead a genuine lack of sexual attraction to others. While asexual people do report having fewer sexual experiences, lower libido, and less masturbation than non-asexual populations, asexuality is not defined or characterized by a low libido, virginity, or lack of masturbation. Some asexual people have an average or high libido, and some do engage in sex or masturbate.

Classifying Asexuality Asexuality is not the same as a sexual arousal disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), someone who self-identifies as asexual should not be diagnosed with either hypoactive sexual desire disorder or female sexual arousal/interest disorder if they are not distressed by their lack of sexual attraction. However, pathologization can still occur, as asexual individuals often report feeling distressed because they sense the keen pressure of outside forces to conform to the standard sexual orientation or because they feel different; this is especially true for individuals who have not yet realized or acknowledged that they are, in fact, asexual. Asexuality is still not a widely recognized sexual orientation, and it is possible that, even with the exception from sexual arousal disorders in the DSM-5, there are still asexual people being misdiagnosed and treated as mentally ill. Further education of mental health professionals and clinicians about asexuality may be needed to alleviate this problem.

Contributing Factors of Asexuality As with most other sexual minority identities, there is no known cause for asexuality, although there are correlations with shorter stature, later onset of

Asexuality

menarche, left-handedness, and number of older brothers in men. This suggests that there may be a biological component early in development, possibly prenatally. Asexual people are also less educated and of a lower socioeconomic status than non-asexual people. They also have elevated rates of mood disorders including depression and anxiety compared with heterosexual people. This could indicate a direct link between asexuality and negative mental health outcomes, or it may reflect that asexuality, like same-gender attraction sexual orientations, is a marginalized orientation and the elevated levels of mental illness and personality disorders may be the result of discrimination. There has been much research on the relationship between mental health and the discrimination and marginalization that come with same-gender attraction, and this may be true for asexual people as well. The variety of predictors and correlates with asexuality suggest a number of independent pathways to asexuality from biological, psychosocial, and environmental factors. Asexual people were also found to be older than the non-asexual participants in one study. All of the studies conducted on asexuality have had adult participants, so asexuality is likely not due to people still being “presexual” or “late bloomers” due to their youth. It is important to recognize that regardless of the cause(s) for asexuality, it is no less a real sexual orientation because an asexual person’s subjective experience of nonattraction to others will still exist.

Discrimination The discrimination toward asexual people is often less overt than that toward other sexual minorities. Still, asexual people do face marginalization and structural discrimination in a society that values heterosexuality over asexuality. An example of structural discrimination is that marriages can be annulled for nonconsummation, implying that marriages without sex are not considered “real.” Many asexual people report having felt broken or like there was something wrong with them until they discovered the asexual community; many assumed that they would have sex someday because that was what “normal” people did. Some even reported going for sex therapy, taking medications, and engaging in unwanted sexual activities in an attempt to “fix” themselves. It wasn’t until they discovered their asexuality and found a

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community of other asexual people that they felt less alone and like there was something other than pathology to explain why they were different. Asexual people often felt that they would not be believed if they disclosed their sexual orientation and that they had to limit their disclosure to prevent negative outcomes. These concerns were not unfounded. When they did disclose their orientation, they were often met with invalidation and even arguments. Opinions included insistence that it must be a disorder, that they were just immature, or that they were secretly gay or another sexual identity and were just trying to hide it. Another study went further and found that besides delegitimizing and invalidating asexual people, heterosexual people were less likely to want to rent ­housing to, hire, or be friends with them. This is likely because they also rated asexual people as having the least human traits and characterized them as animalistic and machine-like.

Asexual Identity Asexuality has been virtually invisible for many years, so there is not a lot known about the history of asexuality. In his research on human sexuality, Alfred Kinsey did acknowledge a “Group X” of nonsexual people when developing the Kinsey Scale in 1948. Furthermore, there have been fictional characters throughout history who demonstrate no interest in sex, such as Sherlock Holmes; such anecdotal information suggests that asexual people have indeed existed in our society for some time. The current asexual community has formed within the past 10 to 15 years, primarily online, starting with the Asexual Visibility and Education Network, founded in 2001 by David Jay. Jay was an asexual man looking to establish an online resource for fellow asexual people to become educated, feel less alone, and share their experiences. Since then, thousands of asexual individuals have become members of Asexual Visibility and Education Network, and the community has expanded to include other social media sites and blogs like Tumblr and Facebook. Tamara Deutsch See also Kinsey Scale, The; Sexual Desire; Sexual Identity; Sexual Orientation: Overview; Sexual Orientation Identity

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Asian Americans and Gender

Further Readings Bogaert, A. F. (2004). Asexuality: Its prevalence and associated factors in a national probability sample. Journal of Sex Research, 41, 279–287. Bogaert, A. F. (2006). Toward a conceptual understanding of asexuality. Review of General Psychology, 10(3), 241–250. Bogaert, A. F. (2015). Asexuality: What it is and why it matters. Journal of Sex Research, 52(4), 362–379. Brotto, L. A., Knudson, G., Inskip, J., Rhodes, K., & Erskine, Y. (2010). Asexuality: A mixed methods approach. Archives of Sexual Behavior, 39, 599–618. doi:10.1007=s10508-008-9434-x Carrigan, M. (2011). There’s more to life than sex? Difference and commonality within the asexual community. Sexualities, 14(4), 462–478. doi:10.1177/1363460711406462 MacInnis, C. C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations, 15, 725–743. MacNeela, P., & Murphy, A. (2015). Freedom, invisibility, and community: A qualitative study of self-identification with asexuality. Archives of Sexual Behavior, 44(3), 799–812. Scherrer, K. (2008). Coming to an asexual identity: Negotiating identity, negotiating desire. Sexualities, 11, 621–641. Yule, M. A., Brotto, L. A., & Gorzalka, B. B. (2013). Mental health and interpersonal functioning in selfidentified asexual men and women. Psychology and Sexuality, 4, 136–151.

Websites Asexual Visibility and Education Network: http://www.asexuality.orgv

Asian Americans

and

Gender

Far from being monolithic, the Asian American group consists of individuals who differ from one another based on the nation of origin, reasons for migration, generational status, acculturation strategies, religious background, and social class and educational backgrounds. At the beginning of the 21st century, the five largest groups of Asian Americans trace their ancestry back to (1) China, (2) the

Philippines, (3) India, (4) Vietnam, or (5) Korea. Making up more than 5% of the general population in the United States, Asian Americans, many of whom are immigrants or children of immigrants, grew at a faster rate than any other ethnic group in the United States between 2000 and 2010. With current rates of growth and an estimated population of more than 9 million Asian Americans by 2050, psychologists must continue to deepen their understanding of the sociocultural and psychological processes that may influence the well-being of members of this group. To that end, this entry addresses gender in the context of culture and racism in the experience of people of Asian descent. Specifically, the importance of native Asian cultural values for both women and men is explored, as is how Asian Americans must often balance those cultural norms while adapting to differing Western cultural norms with regard to gender and race. The conflicts and stressors that gender nonconforming Asian Americans face are then investigated. Finally, directions for future study on Asian Americans and gender are suggested.

Intersectionality: A Starting Point Although gender is the focus of this entry, both gender and race/ethnicity are addressed because they are generally the first aspects of social identity people notice in one another and because these identities influence the types of experiences, including those of discrimination, an individual may have. For instance, Asian American women and men who do not conform to prescribed hegemonic norms for one’s assigned gender may experience stereotyping and shaming and be stigmatized by both Asian Americans and non–Asian Americans. Racism also may shape the types of opportunities one may receive. Asian Americans, who experience the stereotype of being naturally inclined to academic success, may be overlooked for the support that they need and may not be considered for leadership roles in their chosen professions because of stereotypes of their passivity and weak interpersonal skills. Examining Asian Americans’ experience of gender and racism without a cultural understanding could unintentionally privilege U.S.-based hegemonic notions of gender. Third-world feminists

Asian Americans and Gender

have long argued that decontextualizing gender from racism and social class disfavors women of color. For instance, ignoring the role of racism, culture, immigration, colonization, linguistic differences, and poverty in the lives of recently ­ immigrated Asian American women who have experienced domestic abuse may lead to inappropriate and ineffective services for them. Specifically, although well intended, pressures to report cases of domestic violence without attention to cultural values ignore how some women are culturally expected to endure suffering and persevere through hardship. More important, such pressures ignore the shame and/or isolation imposed on an Asian woman by her family. Men’s studies scholars have similarly argued that the study of gender must consider the role of racism and culture in the lives of men of color. Although Asian American men are privileged relative to their female counterparts, understanding their experiences of gender role stress in the context of cultural values and social norms is needed. Men are socialized with common beliefs about masculinity, with divergence occurring across cultural groups in some prescribed gender roles and traits. Because Asian American men may not fit the prescribed gender role norms that are dominant in the United States or have the physical traits associated with hegemonic masculinity, stereotypes of these men as physically weak may develop in others and be internalized in a negative way. Thus, the role of cultural values and racism in the experiences of Asian American women and men must be considered.

Cultural Norms in Asia for Women and Men Asian Americans learn about gender expectations through cultural and gender role socialization processes. Although there is variability in the cultural values of Asian cultures, some common beliefs have been identified. Six core values of Asian culture have been identified: (1) conformity to norms, (2) family recognition through achievement, (3) emotional self-control, (4) collectivism, (5) humility, and (6) filial piety. These expectations and how Asian Americans are socialized may be conveyed and emphasized differently depending on whether the individual is female or male. For

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instance, although filial piety demands that individuals respect and serve their parents and revere their ancestors, roles for women and men are differentiated and privilege men. Confucian ideology, which has influenced the cultural values of East Asians and some Southeast Asians, prescribes different roles and traits for women and men. Specifically, the “three submissions” suggest that women should be subservient (1) to their fathers when young, (2) to their husbands when married, and (3) to their oldest son when widowed. Therefore, in Confucian-based cultures, submission to men is considered a positive virtue and an ideal attainment. Taking care of the male family members and her husband’s family may be viewed as the primary role and responsibility of an Asian woman. The “four virtues” require the Asian woman to (1) be a moral and modest person, (2) speak well but in a careful and soft manner, (3) have a clean and graceful physical appearance, and (4) be a skillful housewife. Furthermore, women are expected to endure suffering and persevere in order to build strong character. These characteristics may promote the passivity of women to accept social inequalities and further their out-group membership. In essence, these women are expected to be self-sacrificing and devoted to their husbands and children, and are given support and recognition from the society for doing so to discourage them from speaking up or taking action to change their oppressive situations. Men, on the other hand, are seen to be financially responsible for the care of the elderly in their family and are therefore expected to attain high academic and career achievement. Because women are expected to engage in unpaid housework and are responsible for family closeness and the continuance of cultural practices, it is not uncommon for parents to discourage the educational pursuits of their daughters and prioritize the educational pursuits of their brothers when resources are limited. In addition, men are taught to have strong control over their emotions and to shy away from disclosing personal feelings or qualms. Because one’s own individual achievements are a reflection on the entire family, they are to accommodate to the wishes of the family. The gender role expectations for Asian men tend to be strict, focusing on values of maintaining harmony and upholding

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filial piety. Moreover, the desire to maintain harmony through deference to elders and saving face could be a protective factor in preventing interpersonal conflict. Importantly, gender roles shift over time and based on economic need and the influence of colonization. As an example, some historians highlight how gender roles in the Philippines were more egalitarian before the country experienced more than 400 years of colonization by Spain and the United States. Before colonization, women had more power in premarital and marital relations with men. Men and women shared the housework, and women engaged in work outside the home. Some women served in prominent roles, and inheritances were not based on gender but on social class and birth order. Spanish rule changed gender relations, with new, Christian values serving as a foundation for new norms and laws that favored men over women. Although U.S. rule sustained some of the practices that favored men, universal education, including education for girls, was introduced. Education resulted in more employment opportunities for women. Even though men’s roles were privileged, women’s access to higher education shaped their access to economic power and more egalitarian decision-making roles. More research is needed to understand gender and gender role relations among Filipino Americans.

Complicating Gender for Asian Americans: Acculturative and Racial Stress Asian Americans, particularly children and adolescents of immigrants, must develop their sense of self in the context of two cultural value systems and racial stressors. The values and behaviors people of Asian descent may learn regarding gender and family relations are sometimes inconsistent with the dominant messages in the United States. These conflicts in cultural values may be very salient for adolescents and young adults who are developing their gender, sexual, and racial identities. Though few studies examining the concomitant experiences of racism, sexism, and acculturative stress of Asian American women or men have been published, Asian Americans experience gender-based racism, sexism, gender role strains, as well as gender role nonconformity.

Asian American Women

Gender-based racism and sexism operate simultaneously and in intersecting ways for Asian American women. They may be stereotyped as inferior and passive because of their racial background, because of the cultural stereotypes of Asian ­Americans, and because of how sexism operates for women as a whole. Asian American women also must contend with stereotypic views of them as both subservient and sexual, the ideal woman in a Confucian society. For instance, East Asian American women have been portrayed and stereotyped as submissive China dolls, and South Asian American women have been portrayed as erotic and sexual objects. As a result, Asian American womanhood has been constructed, in part, to be based on subservience and subjugation to heterosexual men. In concert with stereotypes of Asian women as passive, sexual, and lacking leadership abilities, Asian American women may experience discrimination and harassment in the workplace. Indeed, women have reported being sexually objectified and treated as domestic servants and that they had to act in such a way as to disconfirm stereotypes of Asians by identifying more strongly with White American notions of femininity. One strategy for disconfirming stereotypes is by rejecting or distancing themselves from Asian values that may be associated with deference and humility. Importantly, Asian American women’s experiences of racism and sexism have been found to be related to depression, anxiety, interpersonal sensitivity, somatization, body dissatisfaction, low self-esteem, and fragmented identity formation. In addition to the family role women have been traditionally prescribed, Asian American women may find themselves as part of a dual-earning family. Women who do not have the experience of contributing to the financial well-being of the family in their countries of origin may, through their new economic power, experience a sense of empowerment. For working-class women who work in family businesses or in low-paying jobs, the experience of empowerment may be tempered by racism and sexism at work. In addition, Asian American women face the pressure of living up to society’s expectations for both model Asian women and American minorities, which means that they are

Asian Americans and Gender

expected to accomplish professional achievements as well as act as the traditional caretaker. As a result, many Asian American women juggle having a full-time career and being the primary caretaker of their household and their children. Asian American Men

Although privileged because of their gender, Asian American men also experience gender-based racism. Although there are some shared aspects of masculinity across cultural contexts, there are also important differences. For instance, whereas traditional masculinity in the United States prizes ­physique, physical strength, self-reliance, and assertiveness, these traits and behaviors may be deemed to be aggressive and may signify an inability to control one’s behaviors or emotions. Similarly, the prioritization of intellectual development over physical development, humility, and filial responsibility among men of Asian descent is stereotyped negatively in non-Asian contexts. As such, ­American-born Asians may negotiate Asian culture–based norms of masculinity with what they are exposed to in the Western media, where White heterosexual masculinities are privileged and Asian masculinity (as well as other marginalized masculinities) is denigrated through racial stereotypes of them as meek, weak, socially inept, and physically unattractive. Internalization of these racial stereotypes, along with conformity to hegemonic notions of masculinity, may result in gender role strain. Research indicates that gender role conflicts and racism experiences are associated with negative psychological and behavioral health outcomes for Asian American men. The focus of the gender role strain a man or woman may experience is age and context dependent. For instance, while Asian American adult men may react to these gender role strains by asserting a new masculinity that is congruent with their own values (e.g., caring for one’s parents and family), college-age men may attempt to demonstrate their masculinity in a way that is consistent with hegemonic masculinity (e.g., spending more time at the gym lifting weights). Recently immigrated Asian men in the United States may experience a different set of challenges from those faced by their U.S.-born counterparts. In immigrant homes, it is not uncommon to see a shift from a one- to two-income household.

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Immigrated men may experience a loss of power, control, and prestige within their family context because of their inability to find work that is commensurate with their level of academic training or work history. Men who do not have professional training but who were raised to believe that it is their responsibility to be the sole financial provider for their family may experience higher levels of gender-based stress and family conflict when the traditional roles within the family shift to meet the demands of a new culture. Men who are unable to shift in their thinking about gender may resort to physical dominance and control to reassert their masculinity as they must now confer with their spouses prior to making decisions. Similarly, non-English-speaking parents may see a loss of authority over their English-speaking children. This loss of authority may be experienced as a loss of control and power, particularly for men who conform to the traditional gender role norms. These changes in the power structure may cause friction between men who conform rigidly to culturally based gender role norms and members of their family. Although some men may act out aggressively to reassert their dominance, it is important to note that many other men may adapt to their new realities by shifting their gender role expectations in healthy ways.

Gender Conformity Within Asian Contexts People of Asian descent may experience homophobia/biphobia/transphobia within their ethnic communities. The rigidity with which gender has been constructed, particularly in cultures in which religion or communism plays a major role, has negative implications for individuals who do not fit into traditional gender roles. People of Asian descent who are lesbian, gay, bisexual, or transgender (LGBT) must contend with the perceived threat they pose to traditional gender roles. LGBT individuals in Asia may have to deal with oppressive environments that render them invisible or subject them to public humiliation, assault, imprisonment, or execution. The environments may be supported by policy, religious doctrine, or both. Oppressive environments also may be created within the family ­context. In a study of lesbian, bisexual, and transgender women in Japan, Malaysia, Pakistan, Sri

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Lanka, and the Philippines, the participants reported experiences of discrimination and violence, particularly by family members who claimed that the women brought shame to the family, defied parental authority, and insulted their religion. In another recent study of sexual minority and trans men in Vietnam, trans men reported more negative family interactions when family members knew or suspected gender nonconformity. In another recent study, trans individuals undergoing cross-sex hormone treatment in Southeast Asia experienced less parental acceptance than individuals who were not using that treatment. The family’s influence on gender and sexual identity also emerged as a major domain in a study of gay, lesbian, and queer Filipino Americans. The themes within one domain reflect the challenges gay, lesbian, and queer Asians in the United States may experience within their family context. They may experience lack of acceptance in the form of denial, silence, and the pressure to give back to the family, particularly as it relates to conforming to strict gender role norms. South Asians in California reported disclosing their identities to their immediate family but not to the extended family. One reason may be the shame or stigma that the immediate family may experience as a result of their disclosure. Another reason for nondisclosure is the desire to preserve harmony among family members. As a result, LGBT individuals may conform to gender roles to fulfill their parents’ desire for a heterosexual family. A focus of their gender role conforming behavior is to prevent their  family from experiencing shaming and ostracization. Though a more thorough review of the literature is beyond the scope of this entry, these studies suggest the culturally based and gender-based challenges women and men may experience in outwardly expressing their gender and sexual identity.

Future Directions Future research is necessary to understand how gender roles are enacted, reinforced, and challenged by Asian American women and men. Psychological research also is needed to deepen the knowledge on how gender in Asian Americans is produced and enacted. Importantly, future research should be considerate of the variability within the

Asian American group. Research should examine how gender for cisgender and transgender women and men is produced, but single Asian ethnic group studies may yield more nuanced results over multiethnic group examinations. Such research will inform clinical practice and prevention efforts and may shape policy and cultural practices. Christopher T. H. Liang, David Nguyen, and Ge Song See also Asian Americans and Sexual Orientation; Asian Americans and Transgender Identity; Gender Equality; Gender Roles: Overview

Further Readings Chin, J. L. E. (2000). Relationships among Asian American women. Washington, DC: American Psychological Association. Le Espiritu, Y. (2008). Asian American women and men: Labor, laws, and love. New York, NY: Rowman & Littlefield. Liu, W. M., Iwamoto, D. K., & Chae, M. H. (Eds.). (2011). Culturally responsive counseling with Asian American men. New York, NY: Routledge. Nadal, K. L., & Corpus, M. J. (2013). “Tomboys” and “baklas”: Experiences of lesbian and gay Filipino Americans. Asian American Journal of Psychology, 4(3), 166–175. Winter, S. (2012). Lost in transition: Transgender people, rights and HIV vulnerability in the Asia-Pacific Region. Bangkok: Thailand: United Nations Development Programme.

Asian Americans and Sexual Orientation Asian Americans include immigrants and individuals with ancestry from countries in Asia, such as those in the Far East, Southeast Asia, and the Indian subcontinent (e.g., Myanmar, Cambodia, China, India, Indonesia, Japan, North Korea, South Korea, Malaysia, Nepal, Pakistan, the Philippines, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam). Despite some commonalities, each ethnic group has unique histories, cultures, migrations, languages, experiences, and much more.

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Included in the uniqueness is how sexual orientation is viewed differently by various Asian cultures, meaning Asian Americans, who often retain much of their ancestors’ heritage, have different experiences with regard to sexual orientation. It is important to note that the general public often confuses sexual orientation with gender identity. The term sexual orientation refers to an individual’s affective/romantic and physical/sexual attraction toward men and/or women. Individuals may identify themselves as lesbian/gay, bisexual, heterosexual, or asexual based on self-perception of their sexual orientation. On the other hand, gender identity refers to an individual’s identification with being male, female, transgender, gender neutral, or other gender identities. A person’s gender identity may or may not be the same as the individual’s biological sex at birth. This identification with gender is independent from one’s sexual orientation. Therefore, a lesbian, gay, or bisexual (LGB) person may or may not be transgender, and vice versa. The focus of this entry is on sexual orientation issues in relation to Asian Americans. Topics covered include demographic statistics, experience with discrimination, dual minority identities, related cultural values, religion and spirituality, and the contributions of LGB Asian Americans.

of same-sex couple households among APIs are located in the following states: New York, Hawaii, Texas, and New Jersey. Furthermore, a little more than half of these same-sex couple households were located in five cities: (1) New York City, (2) Los Angeles, (3) San Francisco, (4) Honolulu, and (5) Washington, D.C. Research has examined the mental health statuses of LGB Asian Americans and found that this population has greater rates of suicidal behavior. This may result from the various kinds of prejudice this population faces, including racism, heterosexism, and discrimination against immigrants. Studies have found that Asian American gay men are more likely to attempt suicide than their heterosexual counterparts. Similarly, Asian American lesbians are more likely to experience depression than their heterosexual counterparts. LGB Asian Americans may experience rejection and isolation from their own ethnic communities due to heterosexism, and they also experience exclusion from the predominantly White LGB community due to racism. Consequently, this population may encounter more mental health and substance use concerns.

Statistics on LGB Asian Americans

Given the stereotype of Asian Americans being the model minority, there is a misperception that Asian Americans are not at risk for mental health problems or do not identify as LGB. In reality, LGB Asian Americans may be closeted and may encounter discrimination because of their ethnic identity and sexual orientation. LGB Asian Americans may experience greater harassment due to their ethnicity than their sexual orientation given the visibility of their ethnicity in comparison with their sexuality. The experiences of discrimination among LGB Asian Americans may also differ based on gender stereotypes. For instance, Asian American gay men may be perceived as asexual or submissive, whereas Asian American lesbians may be stereotyped as hypersexual and exotic. These stereotypes are often reinforced by popular culture. In April 2004, Details magazine featured an article titled “Gay or Asian?” and invalidated the lives of LGB Asian Americans by suggesting that individuals cannot be both gay and Asian. This incident resulted in

To understand the experiences of LGB Asian Americans, it is important to consider the existing research and statistics on this population. Research on Asian Americans does not always separate groups by sexual orientation and gender identity. Many studies combine the results for lesbian, gay, bisexual, and transgender (LGBT) Asian ­Americans. According to a 2012 Gallup poll, 4.3% of Asian Americans self-identify as LGBT. This percentage is likely an underestimate because many Asian Americans may not be willing to disclose their sexual orientation, even in an anonymous survey, due to fear of discrimination or confusion about their sexual orientation or gender identity. Researchers have begun to provide U.S. Census Bureau data on same-sex couple households. In 2000, the U.S. Census revealed that there were 38,203 Asian and Pacific Islanders (API) in samesex couple households. The greatest concentration

Discrimination Against LGB Asian Americans

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activism that ultimately brought together heterosexual and LGB Asian Americans in a collective effort to protest the Details article. Moreover, experiences of discrimination among LGB Asian Americans may vary by gender. One study found that most men experienced discrimination based on their sexual orientation versus their ethnicity. On the other hand, women indicated that they experienced more discrimination based on their ethnicity than their sexual orientation. However, the lesbian and gay participants believed that they experienced greater discrimination in general as a result of their double minority status. Another study found that LGB Asian Americans experienced discrimination in many domains of their lives. For example, they reported encountering discrimination from the predominately White LGB community, other LGB persons of color, other LGB Asian Americans, and the Asian American community. Many LGB Asian Americans also felt rejected because they were not deemed sexually attractive. On the other hand, LGB Asian Americans may be pursued by some people because of their ethnicity. Rice queen is a slang term used to refer to Caucasian gay men who are specifically attracted to Asians or Asian Americans. Hence, LGB Asian Americans are often viewed as a commodity, objectified, or fetishized due to their ethnicity rather than who they are as a person. Given the plethora of nationalities and ethnicities represented within the Asian American community, prejudice may occur between immigrant groups and API communities, which may stem from the colonization history of various Asian countries. For example, Japanese LGB ­persons may experience discrimination from the ­Chinese LGB community. Research has identified the top five concerns for LGB Asian Americans: (1) hate violence/harassment, (2) media representation, (3) marriage equality, (4) immigration, and (5) job discrimination/harassment. Clearly, these issues all stem from the unfair and prejudicial treatment of LGB Asian ­Americans. Another study found that LGB Asian Americans reported greater incidents of unfair treatment in comparison with their heterosexual counterparts. They also endorsed greater levels of psychological distress. These results suggest that LGB Asian Americans are at higher risk given their double minority identities.

Intersection of Ethnic Identity and Sexual Orientation LGB Asian Americans may experience greater cultural and social stress as a result of belonging to two minority statuses, their (1) ethnicity and (2) sexual orientation. Therefore, LGB Asian Americans may experience marginalization as a result of both aspects of their identities. It is important to note that LGB Asian Americans may belong to other minority statuses such as gender, religion, socioeconomic status, physical ability, and so forth. Individuals who strongly adhere to traditional Asian cultural values and beliefs may encounter obstacles in forming a positive sexual identity given the stigma against homosexuality in Asian cultures. Moreover, LGB Asian Americans who strongly adhere to mainstream LGB culture may struggle with their Asian ethnic identity due to racism experienced in the mainstream LGB community. Therefore, the development of a positive Asian American LGB identity is contingent on successfully managing, exploring, and understanding one’s double minority status. Learning how to connect one’s sexual and ethnic identities is important in forming a positive self-identity.

Asian Values and LGB Experience LGB Asian Americans may experience elevated stress when coming out to their families, given that most Asian cultures value filial piety, collectivism, and continuation of the family name. Traditional Asian philosophies such as Confucianism emphasize traditional gender roles and hierarchy within a social system. Filial piety focuses on responsibility, sacrifice, and honoring the wishes of parents and elders. Similarly, the value of collectivism focuses on reciprocity and cooperation in interpersonal relationships and the community. Therefore, taking into consideration the perspectives of others, such as one’s elders, is essential. Saving face is a related value in which individuals are expected to conform to societal expectations in order to avoid shame and preserve honor. Any behaviors that bring unwanted attention to the individual may result in shame for the family. Thus, LGB Asian Americans may hide their sexual orientation to maintain family peace and avoid generational

Asian Americans and Sexual Orientation

conflicts. Given the potential for rejection by one’s family and community, LGB Asian Americans may be pressured to choose between their ethnic and their sexual orientation identities. Another major Asian value is the importance of conforming to traditional gender roles. Asian American males are expected to continue the family name and family lineage. Asian American gay men may not fulfill their obligation of preserving the family name, and thus, Asian parents may require a longer period of time to accept their son’s gay identity. Likewise, lesbian Asian Americans may challenge their familial expectations of taking care of the family, getting married, and having children. In many Asian cultures, homosexuality is perceived to threaten the family structure and hierarchy. Another emphasis in Asian cultures is the importance of harmony with nature and the notion of complementarity. The notion of yin and yang highlights the complementary nature of dualities such as female and male. Therefore, yin and yang suggests that individuals should be unified with individuals of the opposite sex to promote harmony with nature. In addition, oftentimes in Asian cultures sexuality is a private matter that is not openly discussed. Hence, discussion of sexuality and coming out may be viewed as lack of respect for one’s family because the individual may bring shame and loss of face to the family and disrupt the traditional family structure. Given the emphasis on family and community, the family may be judged by the ethnic community and extended family as a result of the person’s coming out. Moreover, the notion of coming out and homosexuality may not directly translate into Asian languages and may have nuanced meanings depending on the Asian culture. LGB identities are Western-oriented, socially constructed concepts that may not be accepted in Asian cultures. Therefore, Asian parents may have a difficult time understanding and accepting their child’s sexual identity. In addition, Asian American families may believe that homosexuality is a “White problem” and, thus, that their child’s sexual orientation is curable. Given these cultural values and the stigma against homosexuality, the development of an LGB identity may be delayed, or it may have to take another form without a label. Research has found that sexual identity development in Asian Americans is different from that in other ethnic

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groups and that Asian American gay youth generally engage in same-sex acts an average of 3 years behind their peers. LGB Asian Americans may experience lack of support due to Asian cultural values that may conflict with their sexual identities. Furthermore, it is important to note the heterogeneity that exists among Asian values.

Religion and Spirituality Religion and spirituality are important factors when considering the experiences of LGB Asian Americans. There are a diversity of religions that are practiced in Asia, including Buddhism, Christianity, Hinduism, Islam, Sikhism, and Taoism. Filipino Americans may adhere to Catholicism and/or Latin cultural values given the history of Spanish colonialism in the Philippines. Hence, there may be an emphasis on machismo values, in accordance with which men are expected to marry, carry on the family name, and have a traditional nuclear family. Also, Catholicism perceives homosexuality as disordered and against the laws of nature. Gay and lesbian Catholics who do not stay celibate are considered to have sinned. On the other hand, gay and lesbian Catholics who do remain celibate are deemed to have the possibility to reach “Christian perfection.” Buddhism is a prevalent religion among Asians living in Asia. Therefore, Asian Americans may be influenced by Buddhism as well. Given the diversity in the different types of Buddhism (e.g., Theravada Buddhism, Mahayana Buddhism, Vajrayana Buddhism), it is difficult to determine Buddhism’s standpoint on homosexuality, bisexuality, and same-sex marriage. The focus of Buddhism is to achieve enlightenment, which is considered a personal journey. Therefore, beliefs about homosexuality and bisexuality may be highly individualized among Buddhists. Hinduism is a religion that is commonly practiced in India and Nepal. A diverse range of sexual behaviors and same-sex desires were represented in literature, art, and Hindu temples in medieval Hinduism. However, modern India and Hinduism were strongly influenced by the British colonizers, who endorsed heterosexist ­ beliefs influenced by Christian perspectives. Homosexuality became illegal in India in 1861. ­ Presently, there are both activists and opponents to ­homosexuality in India.

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Strengths-Based Perspectives on Asian American LGB Persons Despite the barriers and discrimination that Asian American LGB persons face, this population has demonstrated resilience through their contributions to society, their professions, and the LGB movement. In popular culture, George Takei is a gay Japanese American actor and activist who was known for his role as Hikaru Sulu on the television show Star Trek. Currently, Takei is a spokesperson for the Human Rights Campaign. He has been an outspoken advocate for LGBT rights and even won the GLAAD (Gay & Lesbian Alliance Against Defamation) Vito Russo Award in 2014 for his efforts in generating awareness and promoting equality for the LGBT community. Margaret Cho is a bisexual Korean American comedian known for her comedy routines that focus on social and political commentary on race and sexuality. She has been recognized throughout her career for her work on promoting equality of all individuals irrespective of race, sexual orientation, and gender identity. For instance, in 2011 she was the recipient of a Lifetime Achievement Award presented to her by LA Pride for her consistent work with the LGBT community. There are LGB Asian Americans who have made a significant impact in the profession of psychology. Tania Israel is a bisexual Asian American professor in the Department of Counseling, Clinical, and School Psychology at the University of California, Santa Barbra. Her scholarship centers on LGBT mental health services and the intersection of gender, ethnicity, and sexual orientation. Her research also has strong roots in social justice issues such as mental health of the LGBT communities, with an emphasis on women of color. She was also the beneficiary of a career development award given by the National Institute of Mental Health to support her research on mental health services for LGBT clients. Not only has she contributed through her scholarship, but she has been a leader within the field, such as her role as president of the Society of Counseling Psychology from 2010 to 2011 and as a fellow of the Society for the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues. Kevin Nadal is a gay Filipino American professor at the John Jay College of Criminal Justice, City University of New York (CUNY). In 2014, he became executive director of the Center for LGBTQ Studies at the CUNY Graduate Center. He is one

of the prominent researchers examining microaggressions directed at people of color, LGBT persons, and other marginalized populations. He has also made significant contributions to research on Filipino American psychology. Nadal advocates for the LGBT community of color beyond his roles as a professor, as a stand-up comedian, and as a poet. The contributions of LGB Asian Americans within the psychology community and the larger society highlight the resilience of these individuals in the face of adversity, and their influence and dedication with regard to creating awareness and promoting equality for LGBT persons.

Resources for LGB Asian American Issues To learn more about LGB Asian American issues, please refer to the Further Readings section of this entry. Beyond reading, it is important to engage in experiential learning. For example, it would be beneficial to have discussions with LGB Asian Americans to understand their lived experiences, perspectives, and worldview. This will allow for engaging in perspective taking and also gaining awareness of the nuanced experiences of LGB Asian Americans. Also, it would be advantageous for individuals to participate in the activities of LGBT community organizations. Becoming an ally of LGB Asian Americans may encourage individuals to understand the issues that LGB persons have to deal with. Moreover, there are Asian LGBT support groups such as the National Queer Asian Pacific Islander Alliance, Asian and Pacific Islander Family Pride, South Asian Network, and Queer Asian Spirit. There are numerous Asian LGBT support organizations and resources that can be found by searching the Internet. There are also related websites including the Lesbian, Gay, Bisexual, and Transgender Community Center, Human Rights Campaign, PFLAG (Parents, Family, & Friends of Lesbians and Gays), and GLAAD. Continual reading and exposure to LGB Asian American issues will promote greater knowledge of LGB Asian American concerns and understanding of future directions for research, service, and advocacy. Y. Barry Chung and Tiffany K. Chang See also Asian Americans and Gender; Asian Americans and Transgender Identity; Sexual Orientation: Overview

Asian Americans and Transgender Identity

Further Readings Chae, D. H., & Ayala, G. (2010). Sexual orientation and sexual behavior among Latino and Asian Americans: Implications for unfair treatment and psychological distress. Journal of Sex Research, 47, 451–459. Chan, C. S. (1997). Don’t ask, don’t tell, don’t know: The formation of a homosexual identity and sexual expression among Asian American lesbians. In B. Greene (Ed.), Ethnic and cultural diversity among lesbians and gay men (pp. 240–248). Thousand Oaks, CA: Sage. Chung, Y. B., & Katayama, M. (1998). Ethnic and sexual identity development of Asian-American lesbian and gay adolescents. Professional School Counseling, 1, 21–25. Chung, Y. B., & Singh, A. A. (2009). Lesbian, gay, bisexual, and transgender Asian Americans. In N. Tewari & A. N. Alvarez (Eds.), Asian American psychology: Current perspectives (pp. 233–246). New York, NY: Taylor & Francis. Chung, Y. B., & Szymanski, D. M. (2006). Racial and sexual identities of Asian American gay men. Journal of GLBT Issues in Counseling, 1, 67–93. Dang, A. A. T., & Vianney, C. (2007). Living in the margins: A national survey of lesbian, gay, bisexual and transgender Asian and Pacific Islander Americans. New York, NY: National Gay and Lesbian Task Force Policy Institute. Human Rights Campaign. (2015). Religion and coming out issues for Asian Pacific Americans. Washington, DC: Author. Retrieved April 19, 2015, from http://www.hrc.org/resources/entry/ religion-and-coming-out-issues-for-asian-pacificamericans Human Rights Campaign. (2015). Society and coming out issues for Asian Pacific Americans. Washington, DC: Author. Retrieved April 19, 2015, from http:// www.hrc.org/resources/entry/society-and-coming-outissues-for-asian-pacific-americans Leong, L. (1995). Asian American sexualities: Dimensions of gay and lesbian experience. New York, NY: Routledge. Singh, A., Chung, Y. B., & Dean, J. K. (2006). Acculturation level and internalized homophobia of Asian American lesbian and bisexual women: An exploratory analysis. Journal of LGBT Issues in Counseling, 1, 3–19.

Websites Asian and Pacific Islander Family Pride: http://www .apifamilypride.org/

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GLAAD (Gay & Lesbian Alliance Against Defamation): http://www.glaad.org/ Human Rights Campaign: http://www.hrc.org/ Lesbian, Gay, Bisexual, and Transgender Community Center: https://gaycenter.org/ National Queer Asian Pacific Islander Alliance: http:// www.nqapia.org/ PFLAG (Parents, Family, & Friends of Lesbians and Gays): http://community.pflag.org/page.aspx?pid=194 Queer Asian Spirit: http://www.queerasianspirit.org/ South Asian Network: http://southasiannetwork.org/ resources/lgbt-resources//

Asian Americans and Transgender Identity The Asian American transgender community has long been established, yet it is marginalized. Although this group is relatively small when compared with other racial and ethnic groups in the broader transgender community, Asian American transgender people are significant in many ways. The intersectionality between Asian American and transgender identities poses unique needs and challenges to Asian American transgender people. This entry provides a brief overview of transgender identity, Asian Americans, and Asia American transgender individuals.

Transgender Identity In a typical gender development, individuals experience congruence between their assigned gender (sex at birth or biological sex) and gender identity (identification as a woman or a man). Many societies across the globe, especially in the Western world, hold a binary view of gender—that is, only women and men exist. With this binary concept of gender, gender roles and expectations clearly dictate the differences between two genders and leave little to no room for gender diversity, fluidity, and creativity. Therefore, individuals must conform to the prescribed gender roles and expectations of their assigned gender (e.g., a man dresses in men’s clothing). While it is assumed that everyone experiences gender congruence, there are people who do not fit into a traditional view of gender and whose gender identity does not correspond with their assigned gender (e.g., a person who was born as a

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male but who identifies as a female). These individuals are gender nonconforming people who identify themselves with a transgender identity. Transgender identity is a broader term typically referring to gender nonconforming people including transgender, transsexual, cross-dressing, drag queen, intersex, androgynous, genderqueer, genderless, and bi-gender people. Although there are shared characteristics with regard to gender nonconformity, there are also unique characteristics among these individuals. For example, the terms transgender and transsexual are often used mistakenly. Transgender is a general term that refers to individuals who adopt the gender role and expectations of another, and often their desired, gender (e.g., a man wearing a woman’s dress). Closely related to transgender individuals, transsexual is a more specific term referring to individuals whose gender identity and assigned gender are incongruent, leading such individuals to experience marked gender discomfort. These individuals typically seek to live full-time as their desired gender by not only adopting its gender roles and expectations (i.e., through name change, clothing) but also wishing to pursue medical interventions (e.g., hysterectomy, genital surgery) to alter their physical characteristics to align with their desired gender. It is important to note that the term transsexual has historically been attached to an identifiable medical condition called gender dysphoria, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), or gender incongruence, according to the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10). Despite many advocates who believe that diversity in gender identity should be celebrated, gender nonconformity continues to be pathologized and stigmatized. Transgender people face discrimination, stigmatization, victimization, and violence in various social contexts, such as family, education, employment, housing, and health care. Despite the increased visibility of transgender people in multiple settings, the general public still lacks awareness, knowledge, and understanding of the unique needs of transgender individuals, resulting in social consequences including isolation and ostracism. In addition, transgender individuals continue to obtain little to no legal protection in many parts of

the world, including the United States. For example, in the United States, although many advocacy efforts have been made to protect transgender people from discrimination based on gender identity and expression, only one third of the states have antidiscrimination laws to protect transgender people. As previously noted, due to societal biases and prejudices, having a transgender identity often presents challenges to individuals. In reality, transgender people hold other social identities, such as socioeconomic status, disability status, and ethnicity. These multiple identities inevitably interact and often place transgender people in an even more vulnerable position for discrimination, stigmatization, victimization, and violence. The intersection of identities (e.g., a transgender person who is an ethnic minority) also creates uniqueness among the various identity groups in the transgender community. While the mainstream culture may view the transgender community as linear and lacking cultural variation among its members, the transgender community is racially and ethnically diverse. Similar to other social groups, the transgender community consists of people from various cultural backgrounds, including those who are Asian Americans.

Asian Americans Asian Americans refers to individuals of Asian descent who live in the United States. Asian ­Americans make up approximately 5% of the U.S. population according to the U.S. Census Bureau, and they are one of the fastest-growing populations in the United States. These individuals have their origins in various parts of Asia, including East Asia (e.g., China, Korea), Southeast Asia (e.g., Thailand, Indonesia), and the Indian subcontinent (e.g., India, Pakistan). Although it is categorized as one group, diversity exists among the Asian American community. The Asian American community comprises individuals from different countries and origins who have different cultural beliefs, values, and practices (e.g., Japanese culture is uniquely different from Vietnamese culture). However, to understand the group as a whole, the mainstream culture focuses on identifying shared characteristics, typically viewed as stereotypes, among Asian Americans. Those characteristics generally include

Asian Americans and Transgender Identity

high self-containment, strong family emphasis, and high education and career attainment. In many Asian cultures, it is important to show self-control when dealing with situations and people, even if they are undesirable and/or adversarial. Many Asian cultures place a strong emphasis on showing respect and humility toward one another, and therefore, it is critical that one remains nonexpressive and nonjudgmental in both positive and negative situations. In a society where extroverted personalities are favored, Asian Americans are viewed as being too reserved or timid to express their thoughts and feelings to others, especially in a public situation. Asian Americans are among the many ethnic groups that value a strong tie to their family of origin. First, coming from a collectivist standpoint, Asian Americans believe that it is more important to follow the family tradition and preference than their own desires (e.g., pursuing a career that is similar to their parents’). Second, regard for ancestry and older family members as well as obligations to their parents are central for Asian Americans. For these reasons, family influences one’s major life decisions, such as marriage, education, and career, which can be construed as lack of independence and self-direction from an individualistic point of view. In addition, Asian American parents are perceived to have high expectations of their children’s education and career success. Education and career attainment appear to be a shared characteristic among Asian Americans. A majority of Asian Americans are college graduates typically employed in what are perceived to be prestigious occupations. In addition to a strong emphasis on education and career achievement, Asian Americans appear to have an above-average socioeconomic status. Asian Americans have the highest median household and, in some years, personal income when compared with other ethnic groups in the United States. It is, however, important to point out that, although they are perceived to have high education, career, and income status by the general public, there are Asian Americans who attain less education, have mediocre jobs, and live in poverty. Despite their perceived success, Asian Americans face prejudice and discrimination in multiple contexts, including education and employment.

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Asian Americans are typically viewed as outsiders or foreigners who play a less visible role in the historical development of the U.S. society. Issues related to discrimination and prejudice toward Asian Americans involve language barriers (e.g., English proficiency) and cultural differences (e.g., nonverbal communication styles). While many Asian Americans have been born and raised in the United States or immigrated many years ago, others may have more recently moved to the United States and, therefore, may not be acculturated to U.S. culture.

Asian American Transgender Individuals A combination of being an Asian American and a transgender person presents a complex configuration of intersectionality—dual-identity development. The intersectionality between Asian ­American and transgender identities brings unique needs and challenges to Asian American transgender people. Similar to other transgender people of color, Asian American transgender individuals face stigmatization, alienation, marginalization, and discrimination based on the intersectionality between their race/ethnicity and transgender identity. When discussing the intersection of Asian American and transgender identities, there are aspects that should be taken into consideration. First, transgender individuals have historically been a part of many Asian cultures such as hijras or the third gender in the Indian subcontinent and kathoey in Thailand. In some Asian cultures, transgender people hold a sacred place in society, whereas in others, they are considered as secondclass citizens. It had been documented that many Asian cultures had a term for individuals who might be considered transgender much before the term transgender, a Western concept, was coined. For instance, China has a rich historical and cultural development in various societal aspects, including politics, the military, and the arts. In ancient Chinese culture, concerning same-sex ­practices, although not conflated, same-sex relationships between a masculine man and a more ­feminine man existed among the emperors and the upper-class citizens. Regarding gender identity, young boys who adopted feminine characteristics often played women’s roles in plays that were favored and preferred by the audience.

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Asian Americans and Transgender Identity

In some Asian cultures, transgender people are believed to have spiritual power; for example, in the ancient Korean culture practicing shamanism, mudang—women and men who cross-dressed— had spiritual roles in and performed traditional rites. Despite their abilities in spirituality and healing, mudang were not well acknowledged in Korean culture. This is similar to other Asian societies where transgender people have historically been marginalized and invisible. In the U.S. context, regardless of their cultural backgrounds or countries of origin, Asian American transgender individuals face systemic oppression, resulting in harassment, discrimination, ­stigmatization, and violence toward them. Added to the transgender identity, being Asian American increases the oppression and struggles of Asian American transgender people to a degree that sets them apart from the broader transgender community. For example, in major cities in the western part of the United States (e.g., San Francisco), many Asian American transgender individuals are immigrants or refugees who may have less English proficiency, less education, and lower socioeconomic status. Unlike their native counterparts, due to their immigration status, lack of formal education attainment, and language barriers, these Asian American transgender people face employment discrimination (e.g., become illegal workers), resulting in an inability to secure stable employment to support their basic needs (e.g., housing, food). They are forced to engage in undesirable activities (e.g., sex work), which puts their health and well-being at risk (e.g., increasing their risk for sexually transmitted diseases and HIV), with limited to no access to affordable health and human services (e.g., medical care, health education, counseling) as many of them are not entitled to various rights. Researchers have estimated the prevalence of HIV among Asian American/Pacific Islander transgender individuals to be 5% of the population. Although the prevalence appears to be lower than for transgender people from other ethnic minority groups (e.g., African Americans, Latinas/ Latinos), recent information has suggested that HIV infection rates among Asian American transgender people have increased. In addition, the socioeconomic status and education of Asian American transgender people are associated with their overall health and well-being. Therefore,

there is an urgency to address the health disparities and well-being of Asian American transgender people. Second, for Asian American transgender individuals, their cultural backgrounds play an ­important role in their identity development and well-being. Because of the collectivistic standpoint coupled with strong family ties, parents are typically involved in key life decisions of their children, including gender identity. The decision to express their gender identity or to “come out” as a transgender person is largely influenced by the support from family members, particularly parents. When compared with transgender people from other racial or ethnic groups, Asian American transgender people get more support and acceptance from their family members regarding their gender identity. However, it is important to note that their cultural backgrounds may prevent Asian American transgender people from discussing gender identity issues with their family members. For instance, when contemplating gender transition, transgender Asian Americans may feel reluctant to discuss their decision with their family members because they do not want to disappoint them. Another issue is related to difficulties discussing sensitive and personal topics (e.g., sexual practices). Culturally, Asian Americans are reserved and do not explicitly discuss topics related to sexual issues, particularly sexual practices that are believed to be taboo (e.g., men having sex with men). This may contribute to the lack of safe-sex practice education among Asian American transgender people, thus potentially jeopardizing their health and well-being. Last, to date, there is little information about the Asian American transgender community. The combination of transgender and Asian American identities and its impact on individuals are not well understood. Despite the growing number of Asian American transgender and gender nonconforming people, as well as multiple grassroots advocacy efforts, there is still a lack of focused, dedicated, and meaningful effort to explore the needs of the Asian American transgender community in order to identify appropriate services and resources for this population. To promote the quality of life of and decrease the health disparities among Asian American transgender people, increased national and local efforts are needed to address the unmet

Assisted Reproduction and Alternative Families

needs for health care and social services of this population across the United States. There is a need for meaningful health education and affirmative health services to help transgender Asian Americans assess and understand the risks to their health. Raising public awareness of the intersectionality between transgender and Asian American identities in the United States may result in a culturally responsive public policy that addresses the needs of Asian American transgender individuals and ultimately enhances their well-being and quality of life. Varunee Faii Sangganjanavanich See also Asian Americans and Gender; Asian Americans and Sexual Orientation; Transgender People; Transgender People and Health Disparities

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Bockting, W. O., & Coleman, E. (2007). Developmental stages of the transgender coming-out process. In R. Ettner, S. Monstrey, & A. Eyler (Eds.), Principles of transgender medicine and surgery (pp. 185–208). New York, NY: Haworth. Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the U.S. transgender population. American Journal of Public Health, 103, 943–951. doi:10.2105/ AJPH.2013.301241 Chung, B. Y., & Singh, A. A. (2009). Lesbian, gay, bisexual, and transgender Asian Americans. In N. Tewari & A. N. Alvarez (Eds.), Asian American psychology: Current perspectives (pp. 233–246). New York, NY: Routledge/Taylor & Francis. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., . . . Zucker, K. (2011). Standards of care for the health of transsexual, transgender, and gender nonconforming people (Version 7). International Journal of Transgenderism, 13, 165–232. doi:10.1080/15532739.2011.700873 Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality/National Gay and Lesbian Taskforce.

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Human Rights Campaign. (2015). Coming out issues for Asian Pacific Americans. Retrieved from http://www .hrc.org/resources/entry/coming-out-issues-for-asianpacific-americans Human Rights Campaign. (2015). Employment NonDiscrimination Act. Retrieved from http://www .hrc.org/resources/entry/employment-nondiscrimination-act Human Rights Campaign Foundation. (2008). Transgender inclusion in the workplace (2nd ed.). Washington, DC: Author. Retrieved from http:// www.fs.fed.us/cr/HRC_Foundation_-_Transgender_ Inclusion_in_the_Workplace_2nd_Edition_-_2008.pdf Kim, B. S. K., Atkinson, D. R., & Umemoto, D. (2001). Asian cultural values and the counseling process: Current knowledge and directions for future. The Counseling Psychologist, 29, 570–603. doi:10.1177/0011000001294006 Nemoto, T., Operario, D., Keatley, J., Han, L., & Soma, T. (2004). HIV risk behaviors among male-to-female transgender persons of color in San Francisco. American Journal of Public Health, 94(7), 1193–1199. World Health Organization. (2010). International statistical classification of diseases and related health problems (10th ed., text revision). Geneva, Switzerland: Author.

Assisted Reproduction Alternative Families

and

The human desire to have children is strong, regardless of sexual orientation and marital status. Assisted reproductive technologies (ARTs) offer many people facing challenges conceiving on their own technological options to create families. While such services are available to heterosexual (married) couples who can afford it, ARTs are not uniformly available to same-sex couples or single people seeking to bring children into their lives. People seeking to create families outside heteronormative conditions have faced numerous legal and social challenges. Providers of infertility treatment in the United States have traditionally made a distinction between medical infertility (defined by trying for a year or more to conceive through heterosexual sex without success) and social infertility (not having natural access to a partner of the opposite sex). For

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many insurers in the United States, some aspects of medical infertility may be covered; but social infertility has been more problematic. There are signs, however, that these trends have changed in the United States: the American Society for Reproductive Medicine issued an opinion in 2013 stating that single people and same-sex couples seeking parenthood through ARTs should be offered access to care. In 2015, the U.S. Supreme Court legally recognized same-sex marriage. Yet many people still face structural and economic challenges in forming their families through technology.

Single Women and Lesbian Couples Women without male partners commonly use donor sperm to create their families. Pregnancy can be achieved either through self-insemination with sperm from a known donor (i.e., someone who is personally known to the woman seeking pregnancy or her female partner) or with an anonymous sperm bank donor. Sperm bank donors can be either anonymous or identity release, meaning their identities can be revealed to the children born from their sperm when the child reaches 18 years of age. In the mid-1980s, the Sperm Bank of California emerged specifically to provide reproductive services to all women, since many women had been denied such services in traditional infertility practices at the time. In the United States, other sperm repositories began to follow suit and open up services to all women, regardless of marital status or sexual orientation. Internationally, women from countries where sperm donation is prohibited or restricted typically purchase donor sperm from abroad and have it shipped. Switzerland, Sweden, and Germany, for example, only permit donor insemination for heterosexual married or, in some cases, cohabiting couples. When infertility is an issue, although more practices offer services to all people, many women still face challenges trying to access treatment. Samesex partners may have to jump through legal hoops to have the parental rights of the nonbiological parent recognized. Some couples attempt to get around these legal obstacles by having one woman provide the egg and the other carry the fetus, so that both have a “biological connection” to the child. However, this approach involves injecting fertility drugs to stimulate oocyte production in the donor (the genetic mother), medically

syncing donor and recipient cycles, and in vitro fertilization and embryo transfer, which is costly and higher risk due to the necessity for injectable hormones and surgeries. Women may also face paternity challenges from donors, especially when sperm from a known donor is used.

Single Men and Gay Couples For single men and gay couples, creating families can be even more challenging and costly as men require access to both an egg donor and a gestational surrogate. Egg donors in the United States can cost anywhere from a couple of thousand dollars to well over $10,000, depending on what kind of donor one is seeking. Gestational carriers cost typically upward of $23,000. An entire cycle including an egg donor, a gestational carrier, legal and other agency services, and medical treatment can cost well over $100,000. Many clinics and agencies in the United States are emerging specifically to address the reproductive needs of gay couples. The United States is the primary destination for egg donation and surrogacy for gay couples internationally, due to restrictions in most other countries barring access.

Cross-Border Fertility Travel Intercountry adoption laws have become increasingly restrictive, driving more same-sex and heterosexual couples and single people to seek family creation through ARTs. However, the prohibitive costs of access to ARTs in the United States drive many people abroad for reproductive services. Cross-border fertility treatment is often more affordable than fertility treatment in the United States. However, it is not without challenges. Different countries have different laws surrounding gestational surrogacy. While in some countries, like Spain, gestational surrogacy is banned outright, in other countries, the woman who gives birth to the child—even if she is a paid gestational carrier and not biologically related to the child—is perceived as the mother and can keep the child. There are cases, for example, in Thailand and India, where gestational surrogates have been recognized as the mother of the child and have hence refused to relinquish the child they carried. Recent changes in laws in Thailand and India prohibit access to surrogacy for single people and gay couples, leaving

Assisted Suicide, Euthanasia, and Gender

those who have already entered into these arrangements in limbo. In other cases, children born of surrogacy arrangements that may be illegal in the intended parents’ home country may end up stateless— without citizenship. This can have devastating effects on not only the intended parents but also the children born of these arrangements. Safety and health issues for oocyte donors and gestational surrogates are yet another concern—especially since, internationally, low-income women are usually the ones who provide these services. Conflicting and ever-changing international laws, restrictions on access to treatment, and the quest for low-cost fertility treatment lead many same-sex intended parent couples, like their heterosexual counterparts, to new destinations and into tenuous legal arrangements. This can have deleterious consequences not only for the people who enter into these arrangements—whether as commissioning parents or providers of fertility services—but also for the children born from them. Diane Tober See also In Vitro Fertilization; Infertility

Further Readings Ethics Committee, American Society for Reproductive Medicine. (2013). Access to fertility treatment by gays, lesbians, and unmarried persons: A committee opinion. Fertility and Sterility, 100(6), 1524–1527. Mamo, L. (2007). Queering reproduction: Achieving pregnancy in the age of technoscience. Durham, NC: Duke University Press. Tober, D. (2002). Semen as gift, semen as good: Reproductive workers and the market in altruism. In N. Scheper-Hughes & L. Wacquant (Eds.), Commodifying bodies (pp. 137–161). Thousand Oaks, CA: Sage.

Assisted Suicide, Euthanasia, and Gender Assisted suicide refers to the intentional providing of means and/or information to enable a person’s suicide. Physician’s aid-in-dying is an alternate term used to dissociate this method of death from suicide. Euthanasia occurs when someone deliberately

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implements the means that end a person’s life, with the presumed intention of ending that person’s suffering. Assisted suicide and euthanasia are types of hastened death. Euthanasia can be voluntary (when it is requested), involuntary (when it is against the person’s will), or nonvoluntary (when consent was not sought and/or not obtainable). Some distinguish active from passive euthanasia, with the latter defined as the withholding of life-supporting treatments. Yet others consider the withholding of lifesupporting treatments as simply allowing a person to die, not a type of euthanasia. This entry reviews the legal status of assisted suicide and euthanasia in the United States and elsewhere. It then reports on the eligibility criteria for assisted suicide in Oregon, where assisted suicide has been legal since 1997, with comparisons with hastened-death eligibility criteria internationally. Finally, this entry reviews Oregon’s assistedsuicide patterns by sex, compares them with hastened-death patterns internationally, and dis­ cusses them in light of women’s and men’s suicide patterns, socialization, and life experiences.

The Legal Status of Assisted Suicide and Euthanasia In the United States, suicide via physician’s assistance first became legal in Oregon with the passing of the Death With Dignity Act (DWDA). As of August 2015, physician-assisted suicide was also legal in Washington and Vermont. Active involuntary euthanasia is illegal in the United States, though voluntary and nonvoluntary euthanasia are reported as practiced. Assisted suicide and euthanasia are illegal around the world, with some exceptions. Assisted suicide has been legal since 1918 in Switzerland, where it involves volunteers rather than physicians. Both physician-assisted suicide and euthanasia have been allowed in the Netherlands since the 1980s and were legalized in 2002. As of August 2015, euthanasia was also legal in Belgium, Colombia, and Luxembourg.

Eligibility Criteria for Assisted Suicide and Euthanasia Under Oregon’s DWDA, adult residents of Oregon can obtain a prescription for self-administered lethal medication from an Oregon physician if they

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have a terminal disease presumed to result in death within 6 months according to two physicians. The physicians must determine that the individual petitioning to hasten their death is capable of making and communicating health care decisions and is acting voluntarily. If either physician believes that the petitioner’s judgment is impaired by a mental disorder, the petitioner must be referred for psychological evaluation and treatment and can become eligible for assisted suicide only when the judgment-impairing condition has cleared. Petitioners with mental disorders who are deemed not to have impaired judgment retain their eligibility for the DWDA process. The prescribing physician must inform the petitioner of alternatives to assisted suicide, such as palliative care. With regard to the timeline, the petitioner must make two oral requests (separated by no fewer than 15 days) to the prescribing physician and also provide the prescribing physician a written request, signed by two witnesses who attest that the petitioner is mentally capable and not coerced into a hastened death. The DWDA does not require that the physicians stay in contact with the petitioner—for example, to monitor the petitioner’s mental status to see that it does not deteriorate, to provide psychological and/or medical support, or to ensure that the lethal medication is not administered by others. In the Netherlands, Luxembourg, Belgium, and Switzerland, assisted suicide and/or euthanasia are available on the basis of unremitting, unbearable pain (including psychological suffering) rather than a terminal illness.

Assisted Suicide and Euthanasia by Sex Oregon maintains a record of DWDA decedents’ profiles and the DWDA process. According to this record, between 1998 and 2014, 53% of the DWDA decedents were men and 47% women, with a median age of 71 years. The similar proportion of women and men among the DWDA decedents contrasts with the divergent proportion of women and men among Oregon’s suicides (men constitute more than 70% of Oregon’s suicides). Most DWDA decedents reported being “White” (97%) and well educated (72% had some college or more education). With regard to illnesses, cancer was listed in 78% of the cases. The top three reported reasons

for assisted suicide were loss of autonomy (in 92% of the cases), decreasing ability to participate in enjoyable activities (89%), and loss of dignity (79%). Being a burden to others was reported as a reason in 40% of the cases. Referral for psychiatric evaluation was the cause in 6% of the cases. Women’s representation among the assisted suicides in Oregon is consistent with hastened-death patterns elsewhere. Across studies and locations, women constitute about half of hastened-death cases. The exception is Switzerland, where about two thirds of assisted suicides involve women.

Analysis of Assisted Suicides and Suicides by Women Women’s and men’s similar representation among persons whose death is hastened has generated contrasting interpretations. Proponents of assisted suicide view it as indicating that women and men equally take advantage of an opportunity for selfdetermination. Proponents draw a parallel between the legalization of assisted suicide and the legalization of contraceptives and abortion. Opponents question the idea that access to hastened death empowers the individual as access to birth control methods does. After all, hastening one’s death is the choice that eliminates all other choices. Incidentally, in the United States ethnic minority women and men are a rarity among those who die of assisted suicide, suggesting that they do not view it as a powerful new right. The fact that in the United States women represent a minority of suicides but about half of assisted suicides has been interpreted as suggesting that killing oneself with the help of physicians may be more socially acceptable for and by women— perhaps because assisted suicide requires approval by medical authorities and a prescription, and is presented as a graceful exit. For sure, the reasons why people hasten their death are complex. Likely these reasons differ in some ways by sex, given women’s and men’s different socialization and location in the social and economic map. There are indications that for women, being a burden, when older and/or ill, may be a particularly significant concern, likely because women do not have the economic resources that men have and perhaps also because women have less practice with being recipients of care from family members (especially

Attraction

from their husbands). There is also evidence that issues of control may be a particularly important concern for older and/or ill men, likely related to dominant norms of masculinity. Silvia Sara Canetto See also Aging and Gender: Overview; Disability and Aging; Internalized Sexism; Suicide and Gender

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following repeated exposure (mere exposure effect) and are attracted to individuals the more they see and interact with others (propinquity effect). People encounter others in close proximity more often and, as a result, become more attracted because of familiarity. If a person is disliked to begin with, however, increased exposure will not lead to greater liking.

Similarity

Further Readings Basta, L. L. (1996). A graceful exit: Life and death on your own terms. New York, NY: Plenum Press. Canetto, S. S. (2011). Legal physician-assisted suicide in the United States: Issues, roles and implications for clinicians. In S. H. Qualls & J. Kasl-Godley (Eds.), End of life care and bereavement (pp. 263–284). Hoboken, NJ: Wiley-Blackwell. Canetto, S. S., & Hollenshead, J. D. (1999–2000). Gender and physician-assisted suicide: An analysis of the Kevorkian cases, 1990–1997. Omega, 40, 165–208. Golden, M., & Zoanni, T. (2010). Killing us softly: The dangers of legalizing assisted suicide. Disability and Health Journal, 3, 16–30. Quill, T. E. (1993). Death and dignity: Making choices and taking charge. New York, NY: W. W. Norton. Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and U.S. states: Systematic literature review. Medical Care, 51, 938–944.

Attraction Attraction is a force that draws people together. It can take a variety of forms (e.g., admiration, liking, love) and is integral to the formation of friendships and romantic relationships. This entry briefly reviews several psychological perspectives on interpersonal attraction. The manner in which ­proximity, similarity, and physical appearance affect attraction is first discussed. How evolution and attachment theory relate to attraction is also considered.

Proximity Individuals are attracted to others who are in geographic and temporal proximity. Specifically, people develop a preference for persons and objects

Another factor that influences attraction is similarity. Similarity is the match between two individuals in terms of their physical appearance (matching hypothesis), backgrounds, attitudes, beliefs, and so on. Much research suggests that similarity (as in the saying “Birds of a feather flock together”) rather than complementarity needs (“Opposites attract”) increases attraction. For example, in a study of same-sex relationships, gay men who scored high on masculinity desired a partner who also scored high on masculinity, while those who scored high on femininity desired a partner who scored high on femininity. However, there are some exceptions in the literature with regard to similarity and attraction. Research has found that the positive association between perceived similarity and liking was stronger in North American than in Asian cultures. Whereas the motivation to feel good about oneself is lower in collectivistic societies, individualistic cultures may prefer similarity because it confirms likeable qualities and positive feelings about the self. Furthermore, with respect to gender, heterosexual men have been found to give higher priority to good looks, whereas heterosexual women have been found to give higher priority to good financial prospects. The preference for physical attractiveness in heterosexual men tends to be greater in Western societies (e.g., the United States, Canada), possibly due to the influence of the media in these cultures. Counter to this argument, however, gay men have been found to be indistinguishable from heterosexual men in their preference for good looks. Similarly, research has demonstrated that women, in general, value physical attractiveness just as much as men. These effects are likely to occur in cultures where women and men inhabit similar roles (e.g., professions) and have equal access to resources.

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Attraction

Physical Attractiveness Much research has shown that people, regardless of gender and sexual orientation, express a greater preference for attractive others compared with unattractive ones. Individuals are also quick to associate attractive persons with positive characteristics (e.g., kindness, intelligence), which is referred to as the “what is beautiful is good” stereotype. In support of this belief, attractive people make more money, are popular and well liked, and are less likely to be found guilty of a crime. Although the “what is beautiful is good” stereotype is found cross-culturally, what is considered “beautiful” might vary in different societies. For example, North Americans value personal strength and self-reliance, whereas Koreans value integrity and concern for others.

Evolution From an evolutionary perspective, attraction is important for reproductive success. That is, given the goal of passing one’s genes on to future generations, individuals are attracted to those who appear healthy and fertile. Heterosexual men are drawn to youthful women who have large eyes, a small nose, full lips, and an hourglass figure. These characteristics are a sign of a woman’s fertility. Heterosexual women, on the other hand, prefer men who have broad shoulders, are tall, and have dominant facial features (e.g., thick eyebrows, a square jaw) because they signal high testosterone (i.e., dominance, masculinity). Factors (e.g., weight, waist-to-hip ratio) predict attractiveness judgments differently based on one’s culture. For instance, in societies where access to food is unreliable, heavier women are considered more attractive because body fat is important for pregnancy and lactation. Additionally, although most societies demonstrate substantial agreement in the extent to which faces are judged to be attractive or unattractive, cultural differences for some facial features do exist. Symmetry—where the size, shape, and location of features on one side of the face match those on the other—is more valued in parts of Africa than in western Europe. Furthermore, although heterosexual Asian men find women’s sexually mature features (e.g., a large chin) to

be less attractive than non-Asian men (e.g., White, Hispanic), there are no differences in either group of men’s attraction to “baby face” features in women (e.g., small nose, large eyes). Finally, with respect to sexuality, nonheterosexual (e.g., gay, bisexual) males express a greater preference for feminine facial features when they are more dominant in a relationship, whereas nonheterosexual men who are more submissive in their relationship exhibit a preference for masculine facial features.

Attachment Theory Finally, from the perspective of attachment theory, individuals turn to close relationships for comfort and support during times of need (e.g., stress, anxiety). Although everyone is equipped with an attachment behavioral system at birth, there are individual differences in people’s attraction to close others (attachment figures). Secure persons typically have a positive view of themselves and relationship partners, resulting in greater feelings of closeness, intimacy, and trust. In contrast, anxious individuals feel insecure in their relationships, which may make them clingy, obsessive, and overly worried about being loved. Avoidant persons, in turn, are characterized by a tendency to be independent and emotionally distant from others. In a study of 62 different countries, the results revealed that a secure attachment style was endorsed by a majority of participants from most cultures. Individuals from South and East Asia and more collectivistic societies, however, were more likely to endorse an anxious attachment style compared with participants from other regions of the world and individualistic cultures. Research also suggests that people are at greater risk of developing insecure attachments (anxious, avoidant) when raised in stressful environments (e.g., low socioeconomic status, absence of the father). In these cases, attachment insecurity has the potential to lead to early menarche, sexual activity at an earlier age, and increased risk for teen pregnancy. These effects are more pronounced in females than in males. Erin A. Van Enkevort, Cathy R. Cox, and Mike Kersten

Avoidant Personality Disorder and Gender See also Evolutionary Sex Differences; Intimacy; Marriage; Romantic Relationships in Adulthood; Sexual Desire

Further Readings Finkel, E. J., & Eastwick, P. W. (2015). Interpersonal attraction: In search of a theoretical Rosetta Stone. In J. Simpson & J. Dovidio (Eds.), APA handbook of personality and social psychology: Vol. 3. Interpersonal relations (pp. 179–210). Washington, DC: American Psychological Association. Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York, NY: Guilford Press. Sprecher, S., Felmlee, D., Metts, S., & Cupach, W. (2015). Relationship initiation and development. In J. Simpson & J. Dovidio (Eds.), APA handbook of personality and social psychology: Vol. 3. Interpersonal relations (pp. 211–245). Washington, DC: American Psychological Association.

Avoidant Personality Disorder and Gender Avoidant personality disorder (PD) refers to a long-standing and maladaptive pattern of social isolation, insecurity, and sensitivity to the judgments of others, which usually appears in an individual by adolescence and causes the person ­considerable suffering or difficulty at school, at work, or in relationships. Theodore Millon introduced the concept in 1969, but psychological writings since the early 1900s have referred to precursors of the idea of an avoidant personality, although they conflated the current concepts of schizoid and avoidant PDs. Absent from earlier versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), avoidant PD joined other disorders in the then newly formed Axis II of the DSM-III in 1980. Since its inception, avoidant PD has been one of the few PDs researchers generally consider to be equally prevalent in men and women, though findings have not been entirely consistent in this regard. How people express avoidance behaviorally and how avoidance affects important areas of functioning (e.g., work

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performance vs. interpersonal communication and relationships) may differ according to gender and depending on cultural expectations.

Current Definitions and Brief History In its DSM-5 definition, avoidant PD is a relatively stable tendency toward feeling inadequate, social inhibition and shyness, and being overly fearful of negative evaluations by others. It corresponds to the International Classification of Diseases, 10th Revision (ICD-10) label “anxious (avoidant) PD,” described as patterns of high tension, fear, insecurity, and inferiority. The DSM-5 groups avoidant PD in Cluster C (“anxious/avoidant”) along with dependent and obsessive-compulsive PDs. For a diagnosis of avoidant PD, the DSM-5 requires four out of seven symptoms or signs to be present: (1) avoidance of occupations or careerrelated activities that involve much social interaction (because of interpersonal sensitivity), (2) an unwillingness to approach interpersonal interactions (unless reassured that interpersonal rejection is unlikely), (3) inhibition in intimate relationships (because of fear of humiliation), (4) inhibition in broader interpersonal situations (because of feeling inadequate), (5) a cognitive preoccupation with social criticism or rejection, (6) a self-image as incompetent (or inferior or unappealing to others), and (7) hesitancy to try new activities or take personal risks (out of fear of embarrassment). In addition, the pattern must be present since early adulthood and must not be attributable to other mental or general health problems. The ICD-10 includes similar criteria as well as criteria related to feelings of tension or apprehension and restricting one’s activities out of excessive concern for physical safety. Since including the disorder in the DSM in 1980, the American Psychiatric Association’s official stance has been that avoidant PD is equally prevalent among men and women, and most research has supported this claim. However, some researchers have suggested that complex links may exist among sex, gender roles (including masculinity/femininity), and avoidant PD; in particular, people tend to view avoidant and fearful behavior as more feminine than masculine in essence. In addition, when examining the

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diagnostic criteria, Leslie Morey and his collaborators found that men and women differed in the way they endorsed two criteria in particular. The tendency to endorse the symptom of avoidance of occupations or job-like activities that involve much social interaction was more strongly linked to the other avoidant PD criteria in men than in women, whereas women were more likely to endorse the symptom of reluctance to try out new things or take personal risks because of fear of embarrassment.

Epidemiology and Course Between 1.0% and 6.4% of the U.S. general adult population have avoidant PD, according to a review by Mark Lenzenweger and his collaborators. The DSM-5 estimates avoidant PD’s prevalence at 2.4% and as roughly equivalent between women and men. However, researchers have reported varying results across studies, including reports of a higher prevalence in women, a higher prevalence in men, or roughly equivalent rates. Research concerning transgender persons is scant and is usually based on nonrepresentative samples, so few conclusions can be drawn. In a recent study, transgender individuals (both male to female and female to male) were found to have increased risk for avoidant PD (and paranoid PD) relative to a nonclinical, heterosexual, cisgender sample. These results may be due to avoidance being one reaction to the severe societal stigma transgender people often face. Among mental health patients, the prevalence of avoidant PD is much greater than in the general population, with typical estimates ranging from 14.7% to 37.0%. Thus, avoidant PD is one of the most common PDs in both the general population and clinical samples. The onset of avoidant PD is typically in late childhood or early adolescence. As individuals mature, some may no longer meet the criteria for the diagnosis, but interpersonal symptoms may persist and continue to have a negative impact on functioning.

Genetic and Early Environmental Factors Both genetic and environmental factors play a significant role in the risk for avoidant PD. In one twin study by Line Gjerde’s team at the Norwegian

Institute of Public Health, the heritability of avoidant PD was found to be high at 0.64 overall. That is, more than 60% of the variation in avoidant PD symptoms among Norwegians was explainable by genetic differences. The genetic influences were stronger than the influences of unshared environmental factors (those specific to the individual and not shared with siblings), whereas environmental factors shared with siblings seemed to play no significant role in explaining the disorder; no sexspecific heritability patterns emerged. The genetic underpinnings of avoidant PD may involve specific heritable traits (e.g., fear of negative evaluation) or heritable broader aspects of temperament (e.g., anxiety proneness or an even more general tendency to experience negative emotions across situations). Indeed, research on personality traits links avoidant PD to high scores on trait neuroticism and low scores on trait extraversion. Parenting style is an early environmental factor that may be linked to the development of avoidant PD. Research links critical, shaming, and intolerant parenting to avoidant PD in the offspring. However, such research has relied on participants’ retrospective reports about the parenting they received, and negative memory biases and other alternative, noncausal explanations have not been ruled out. In addition, whereas socially anxious individuals may have experienced overly protective and controlling parenting, the parents of individuals with avoidant PD may not have these qualities. Insecure attachment, particularly fearful attachment, may also play a role.

Differential Diagnosis and Comorbidities Avoidant PD is highly comorbid with other PDs. However, careful differential diagnosis may reduce some apparent comorbidity. The most common diagnostic challenge is to differentiate avoidant from schizoid PD, though National Comorbidity Study Replication data show that avoidant PD symptoms correlate more strongly with symptoms of paranoid and dependent PD. The key distinction between avoidant and schizoid presentations is that individuals with schizoid PD appear indifferent to relationships with others, whereas individuals with avoidant PD often desire to have at least some close relationships. The DSM criteria for both disorders make this distinction clear, despite

Avoidant Personality Disorder and Gender

some superficial overlap in the behavioral manifestations of symptoms. Research suggests that social anhedonia (the lack of positive emotions in social interactions) appears uniquely tied to schizoid personality, whereas the need to belong while fearing shame appears to characterize avoidant personality. In practice, this distinction is not always clear, and it may vary with sex or gender. For example, Daniel J. Winarick and collaborators reported a significant moderate correlation between avoidant and schizoid PDs in women but not in men. Avoidant PD also frequently co-occurs with mood and anxiety disorders. Social phobia, especially its generalized form, co-occurs with avoidant PD so often that a large controversy exists about the distinctiveness of these conditions. In a study by Bridget Grant and colleagues, for example, up to 61.4% of patients with social phobia also met the criteria for avoidant PD. Efforts to distinguish the two conditions rely on describing avoidant PD as (a) a more severe, impairing, and chronic disorder and/or (b) a broader form of anxiety that is less about social performance and more about failure in general. These distinctions are likely ones of degree of severity rather than a truly qualitative difference. In addition, unlike other anxiety disorders (which have a greater prevalence among women than among men), social anxiety disorder resembles avoidant PD with its equal sex ratio. Other mood and anxiety disorders also ­co-occur with avoidant PD, though at lower rates. Patients with generalized anxiety disorder, specific phobias, and/or panic disorder with agoraphobia have rates of avoidant PD as high as 35%. Avoidant PD is also relatively common in patients with depressive and bipolar disorders. In addition to its strong overlap with the internalizing disorders noted herein, some evidence links avoidant PD to externalizing disorders. High levels of avoidant PD traits have been reported among male domestic violence perpetrators, perpetrators of spousal homicide, and persons diagnosed with alcohol abuse.

Assessment The assessment of avoidant PD (and other PDs) is a complex process that may involve self-report measures, clinician ratings, informant reports, and important decisions about the pros and cons of

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particular psychological instruments. One of the strongest arguments against relying on self-report to evaluate avoidant PD is that lack of insight may prevent accurate reporting by the individual. Nevertheless, several instruments have shown adequate reliability and validity in this realm (e.g., the Personality Assessment Inventory and the Schedule for Nonadaptive and Adaptive Personality). The Personality Assessment Inventory, in particular, was designed with a goal of addressing gender bias in diagnosis. In contrast, according to Morey, the Millon Multiaxial Clinical Inventory, as an example, may overdiagnose avoidant PD in women. When feasible, structured interviews (e.g., the Structured Clinical Interview for DSM-IV Axis II Personality Disorders and the Structured Interview for DSM-IV Personality) are the best standard for assessing personality pathology; by systematically assessing multiple domains of personality dysfunction, they can help mitigate the risk of gender bias during interviewing. Less structured, narrativebased interviews (e.g., Drew Westen’s Clinical Diagnostic Interview) may be very useful for a full case conceptualization and treatment planning, but they do not assess each criterion systematically. In general, the accurate diagnosis of PDs requires detailed multisource/multimethod assessment, and systematic and structured approaches may help reduce gender bias. During interviews, clinicians should frame questions carefully to avoid artificial exaggeration of sex or gender differences (e.g., grilling men about work performance fears and women about desires and insecurities about their love life).

Treatment The literature on evidence-based treatments specifically aimed at symptoms of avoidant PD is very limited. Regarding PDs in general, both psychodynamic and cognitive behavioral psychotherapy emerged as effective in a 2003 meta-analysis by Falk Leichsenring and Eric Leibing, with psychodynamic psychotherapy seeming to yield more lasting results. Conversely, looking specifically at avoidant PD, Paul M. G. Emmelkamp and collaborators found stronger evidence for the efficacy of cognitive behavioral versus short-term psychodynamic therapy. Evidence-based treatments for avoidant PD’s major comorbidities are available

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and effective, albeit harder to implement in the presence of a PD. Anecdotally, patients with avoidant PD may skip therapy sessions (out of fear of humiliation) after something anxiety provoking happens to them outside of therapy; thus, they dilute their own treatment. Generally, the first choice of treatment for social phobia is cognitive behavioral psychotherapy combining exposurebased and cognitive restructuring techniques. The evidence is weaker for routinely including social skills training, but it may be indicated when social skills deficits are present (which seems likely in avoidant PD). Although outpatient treatment is the norm, short-term inpatient work can be effective for helping ameliorate symptoms of severe Cluster C PDs. Psychopharmacological treatments of avoidant PD generally depend on the comorbid conditions present. Research has generally supported the effectiveness of selective serotonin reuptake inhibitors and monoamine oxidase inhibitors in treating avoidant PD, but relapse is likely if the medication is discontinued. The evidence for the usefulness of combining medication with psychotherapy remains inconclusive.

Future Directions Although avoidant PD has received increasing attention in research since its introduction in the DSM-III in 1980, much about it is still unknown. The disorder shares many of the same controversies that plague its fellow PDs. For example, are dimensional models more accurate than the current categorical approach to diagnosis? Is the high comorbidity among PDs an indication that these conditions are not discrete or that they are just inadequately operationalized? What roles do dispositional genetics and temperament play in the

development of PDs, and how do they interact with environmental risk factors? Research will need to continue to address these broader concerns. Future directions specific to avoidant PD include (a) clarifying its distinction from generalized social anxiety disorder and (b) developing effective empirically supported treatments, likely both short-term and more intensive varieties, ­specific to avoidant PD. Kile M. Ortigo and Pavel Blagov See also Dependent Personality Disorder and Gender; Personality Disorders and Gender Bias; Schizoid Personality Disorder and Gender; Social Anxiety Disorder and Gender

Further Readings Alden, L. E., Laposa, J. M., Taylor, C. T., & Ryder, A. G. (2002). Avoidant personality disorder: Current status and future directions. Journal of Personality Disorders, 16(1), 1–29. doi:10.1521/pedi.16.1.1.22558 Emmelkamp, P. M. G., Benner, A., Kuipers, A., Feiertag, G. A., Koster, H. C., & Van Apeldoorn, F. J. (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. British Journal of Psychiatry, 189, 60–64. doi:10.1192/bjp .bp.105.012153 Morey, L. C., Alexander, G. M., & Boggs, C. (2005). Gender. In J. M. Oldham, A. E. Skodol, & D. S. Bender (Eds.), The American Psychiatric Publishing textbook of personality disorders (pp. 541–559). Washington, DC: American Psychiatric. Winarick, D. J., & Bornstein, R. F. (2015). Toward resolution of a longstanding controversy in personality disorder diagnosis: Contrasting correlates of schizoid and avoidant traits. Personality and Individual Differences, 73, 25–29. doi:10.1016/j.paid.2015 .01.026

B thoughts or feelings into account when explaining a behavior. It is solely based on what is observable and quantifiable. There are several domains of behaviorism. Those that are behavioral dominant include experimental analysis of behavior, radical behaviorism, and applied behavior analysis (ABA). These focus solely on observable behavior, with significant contributions from well-known behaviorists including John Watson, Ivan Pavlov, B. F. Skinner, and Don Baer. However, there are also contributions made within cognitive behaviorism that have combined cognitive principles, which focus on the thoughts that lead to or maintain behavior, and behavioral principles alike. Popular cognitive behaviorism pioneers include Aaron Beck, Albert Ellis, and Marsha Linehan.

Behavioral Approaches and Gender Behaviorism is an approach based on explaining behaviors through direct observations. In the early 1900s, psychology was primarily dominated by the study of psychoanalysis and other mental processes, focusing on one’s own conscious thoughts and feelings as a primary method of exploration. However, later in the first decade of the 20th ­century, several authors delineated psychology as the science of behavior, which is influenced by the environment. Since then, numerous theories have developed, including those incorporating cognitive processes to determine behavior. A combination of behavioral and cognitive principles serves as a basis for learning to identify a sense of gender identity. This entry examines gender identity development and how it relates to behavioral approaches.

Experimental Analysis of Behavior

In the 1930s, Skinner published the first book summarizing his laboratory research focusing on two types of behavior: respondent and operant. Respondent behavior, a term coined by Pavlov, is a behavior based on phylogeny, or one’s genetic endowment. Respondent behavior is a reflex and is brought out or elicited by the stimuli that precede it. Commonly referred to as stimulus-stimulus pairing or classical conditioning, this concept was based on the famous experiment that Pavlov conducted by repeatedly pairing a conditioned ­ stimulus with a neutral stimulus that elicited an unconditioned response. After multiple trials, the neutral stimulus eventually turned into a

Behaviorism The objective of behaviorism is to understand why people behave the way they do. It is based on observing a person’s behaviors and focusing on the exact topography or form of the behavior. Behaviorism also takes into account the antecedents that led to the specific behavior and later observes its consequences. In traditional psychology, the focus would be to try to understand a behavior by seeing it as the outcome of what one thinks, feels, and wants. However, behaviorism does not take any 121

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conditioned stimulus eliciting the same unconditioned response. Essentially, these behaviors or responses are involuntary and always occur when the eliciting stimulus is presented. Operant behavior is any behavior that is ­determined by its history of consequences. It is a ­voluntary action that is based on a person’s ontogenic history—the learner’s interaction with the environment. Operant behavior is part of an antecedent behavior consequence contingency, in which an antecedent evokes a behavior and a ­particular consequence is dependent on the occurrence of that specific behavior. Operant behavior includes consequences that either increase or decrease the future of the behavior through the use of reinforcement or punishment procedures, respectively. This type of conditioning explains how we learn our voluntary behaviors. Radical Behaviorism

Shortly after his research into the experimental analysis of behavior, Skinner wrote extensively on the philosophy of the science of behaviorism. He questioned whether or not a science based only on behavior exists and whether it accounts for every aspect of human behavior. Taking a radical approach, Skinner proposed that in addition to observable behavior, the inclusion of private events such as thoughts and feelings in terms of controlling variables in the history of the person leads to a better understanding of behavior. He was the first of the behaviorists to consider private events as behavior that should be analyzed with the same conceptual and experimental tools that are used to analyze publicly observable behaviors. Skinner assumed that (a) private events including thoughts and feelings are behavior, (b) private events are behaviors that occur beneath the skin and are dissimilar from publicly observable ­behavior only based on their inaccessibility, and (c) private events are influenced by the same functions as publicly observable behaviors. All behaviorists acknowledge that all behaviors (whether private or publicly observable) are the result of certain functions. These functions serve as a purpose for people to engage in certain ­behaviors. The four functions of behaviors are (1) sensory, (2) escape/avoidance, (3) attention, and (4) tangible. The sensory function serves as a type of automatic reinforcement where the person exhibiting

the behavior is being reinforced independently of the social mediation of others (e.g., scratching an insect bite to stop the itching). The behavior that serves the function of escape is meant to ­discontinue an ongoing aversive stimulus, such as walking away from a boring lecture. Avoidance could be achieved, for example, by not attending class, knowing that it will entail a boring lecture. Attention is a common function of many behaviors. Some behaviors that may serve the function of attention are talking out loud, throwing a tantrum, and so on. Last, the tangible function serves the purpose of a person receiving a tangible object (i.e., food, a toy, etc.). Applied Behavior Analysis

ABA is a scientific approach for exploring the environmental variables that reliably influence socially significant behavior. It focuses on developing a technology for behavior change that is ­practical and applicable. ABA is widely used with various populations for a wide range of disorders and problem behaviors. In the late 1970s, the seven dimensions of ABA were defined by Baer, ­Montrose Wolf, and Todd Risley: (1) behavioral, (2) applied, (3) technological, (4) conceptually systematic, (5) analytical, (6) generality, and (7) effective. All interventions used in ABA are derived from three principles: (1) punishment, (2) extinction, and (3) reinforcement. Punishment interventions include adding or removing a stimulus to decrease the frequency of a behavior. Extinction entails withholding a maintaining reinforcer to extinguish the behavior. Reinforcement involves adding or removing a stimulus to increase the frequency of a behavior. Through the use of such interventions, ABA is able to build a technology that is practical and applies to socially significant behaviors by focusing on behavior and experimentally analyzing functional relationships that are generalizable and effective in various settings in the community. Cognitive Behaviorism

Over the course of time, it has become clear that people do not understand their behaviors through experimentally analyzing just the behavior. Relatively, one’s behaviors must also be understood by internal processes. This includes our thoughts and feelings that relate to our behaviors. Cognitive

Behavioral Approaches and Gender

behaviorism incorporates pure behavioral theories with cognitive theories and is problem based to decipher specific interventions to decrease maladaptive behaviors. Rational emotive behavior therapy (REBT) was the first cognitive behavioral treatment approach developed by Ellis. REBT proposes that a person engages in maladaptive behavior and experiences emotional disturbances due to the maintenance of irrational beliefs. While Skinner and other ­behaviorists would state that there is a direct contingency between the antecedent and the behavior, REBT would oppose this and state that the contingency is between the belief about the antecedent and the behavior it leads to, or between belief and consequence. For example, rather than concluding that the mother refusing to give candy to her child leads to the child crying, Ellis would state that it is the belief that the mother does not love the child that results in the child crying and feeling emotionally disturbed. To dispute such a belief, the child must replace the irrational belief with one more rational. Cognitive behavioral therapy, developed by Beck, somewhat overlaps with REBT but focuses more on empirical hypothesis testing as a means of changing existing beliefs. Behavioral assignments as well as cognitive-based homework are given to clients to allow them to test the validity of their beliefs. Parallel to Ellis’s irrational beliefs theory, Beck posited that psychological symptoms result from automatic thoughts that are maladaptive and may result in depression. He coined the maladaptive cognitive triad, which includes a (1) negative view of the self, (2) negative view of the world, and (3) negative view of the future. A person would be considered to be depressed if he or she were to acquire all three domains of the triad, therefore contributing to the maintenance of maladaptive behaviors. Linehan proposed another type of cognitive behavioral therapy, termed dialectical behavior therapy (DBT). DBT is a structured outpatient therapy program known to be very successful with those with borderline personality disorder. DBT underlines the concepts of acceptance and change. It focuses on the present behavior and the current contributors controlling that behavior. It includes individual therapy, telephone contact, group skills training, as well as therapist consultation, all of which aim at reducing behaviors that interfere with the course of therapy.

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Social Learning Theory Social learning theory was influenced by Albert Bandura and is called the theory of observational learning. It proposes that learning and development are acquired beyond the result of classical conditioning and reinforcement and punishment (operant conditioning); learning and development are also a result of observation of others’ actions. Learning and development occur from watching others engage in certain behaviors, which later leads to imitating the behaviors of those who model them. Bandura’s Bobo doll study in the 1960s is a perfect example of observational learning with children. In this study, children were exposed to an adult being physically aggressive toward a Bobo doll. It was later observed that those ­children who were exposed to such violent models tended to imitate the exact violent behavior they had observed. These children learned through direct observation that it is okay to hit the Bobo doll because someone else had done so without any consequence. Social learning theory requires four steps: (1) attention (attending to the model), (2) retention (remembering what is seen or heard), (3) production (reproducing the memory during imitation), and (4) motivation (reinforcement for accurate performance). Children grow up learning different concepts, both simple and complex—which include how to react to certain situations, how to feel, how to think, and so on—through observations. These situations may relate to various factors that lead to a child’s development and identity. This process begins during the early stages of childhood and continues into adulthood. As children establish their own identity, they encounter various situations that may alter their development and identity based on attending to models, remembering what was observed, and then engaging in imitation. Attention and Retention

Infant attention is based on higher-order cognitive processes called executive functions. This includes working memory, reasoning, task flexibility, problem solving, planning, and execution. All of these processes develop over time based on numerous environmental factors involved in the infant’s life. These executive functions are linked to

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school readiness. Retention also develops over time alongside attention. If an infant is able to attend to certain stimuli, how well he or she is able to pay attention determines the strength of the retention. Imitation

Imitation occurs up to the first 2 years of a child’s life, termed the sensorimotor period by Jean Piaget. In this stage, a child learns symbolic ­thinking, which leads to the ability to associate behaviors with actions and also sets up the child for the development of cognitive and social communication behaviors. Such behaviors include language and play specific to the child’s cultural environment. Symbolic thinking allows a child to understand concepts through the use of language and behaviors to communicate with others. When a child observes Mother or Father engaging in a behavior, through symbolic thinking, the child is able to understand the concept of why Mother or Father engaged in that behavior and the consequences of that behavior. The child is then able to imitate that behavior with the understanding that it will have the same consequence. For instance, if a child sees Father tapping Mother on the shoulder to get her attention, the child will imitate that behavior and hope to get the same consequence of Mother’s attention. If the child imitates a certain behavior that always results in a positive consequence, the child will continue to engage in that behavior. The behavior has been reinforced or strengthened and will increase in the future. However, if the child imitates a behavior and the consequences are not rewarding, the child learns not to engage in that behavior again and the behavior will weaken. The behavior has been punished and most likely will decrease in the future. Modeling

Children are exposed to various types of people and influences that serve as models for them. Such models include parents, siblings, other family members, peers, teachers, people on television and in books, and salient voices of one’s culture. These models significantly influence a child’s actions and behaviors that continue into adulthood. These

actions and behaviors could be specific to gender; however, children will imitate behavior regardless of the gender of the person exhibiting that behavior. In some cases, it is based on the history of reinforcement and/or punishment. However, research has shown that during observational learning, in general, models who are of high status, nurturing, and of the same sex as the observer are more likely to be imitated than ­models who are of low status, nonnurturing, and of the opposite sex. This is true in all cultures and environments. Some factors that lead to this are due to the media, politics, and stigmatization that affect a child’s environment. When a daughter sees her mother put on makeup every morning for work, she may later pick up an object similar to a makeup brush and imitate her mother’s behavior. However, if a son were to exhibit the same behavior as his mother’s, punishing consequences may be evoked. His parents may give him a disapproving look and scold him for doing so, or his peers may laugh at and taunt him. In addition to classical and operant conditioning, Bandura believed that we perform a behavior not only due to its having been reinforced or ­punished in the past but also due to anticipating reinforcement in the future. Cognitively, a child anticipates reinforcement, thinking that if he exhibits a certain behavior that was observed, the same reinforcement that was given to the model will be given to the child as well. Since anticipating reinforcement is a cognitive activity, social learning theory includes both behavioral and cognitive principles.

Gender Identity Development Gender refers to coming to identify oneself as a boy or a girl in one’s family, peer group, and community. It requires learning and internalizing the community’s expectations for how boys and girls should behave and becoming aware of how well one meets the social expectations for a boy or girl. Males and females are often assigned different roles in every type of community, including one’s family. The specific expectations of gender roles depend on the culture of each person and over time allow individuals to integrate their experiences, knowledge, and observations to form the concept of gender identity.

Behavioral Approaches and Gender

Behavioral approaches and cognitive theories alike contribute to gender identity development. Through the use of operant conditioning, reinforcement increases gender-appropriate behaviors and punishment decreases gender-inappropriate behaviors. In childhood, the development of gender identity occurs through the dynamics between the child and the parents. The child engages in behavior that is rewarding and comforting to the child, knowing that it will gain positive consequences from her parents. The child also tries to eliminate any unpleasant or threatening environments, thereby avoiding engaging in any negative behaviors that would elicit parental anger or conflict. For instance, if a child engages in a negative behavior but apologizes to the parent and swears to do better next time, this decreases the anger of the parent. In the future, when the parent is angry with the child again, the child will most likely apologize and swear not to repeat the negative behavior again. With regard to social learning theory or observation learning, the child uses more cognitive processes to choose appropriate gender-related ­ behaviors. The child engages in observing a variety of models, both real models and images, to develop a sense of what are appropriate gender behaviors. While observing such behaviors, the child tends to navigate toward behaviors that are rewarded. Children are more likely to imitate a behavior that they have observed to be rewarded in the models they learn from. Moreover, children are likely to imitate behavior that has not been punished regardless of whether it is a positive behavior. For instance, if a child were watching a movie where a criminal engages in a violent act but does not get punished, the child would most likely engage in violent acts thinking that he will not get punished as well. The child is more likely to imitate a model if there is a sense of power and prestige attached to the model, especially if the model is of the same sex as the child. Parents are especially likely to encourage g­ enderappropriate behavior and discourage gender-­ inappropriate behavior. Although ultimately the child develops her own knowledge and standards for her own behavior, the influence of her environment, especially the people she encounters more frequently, is very powerful. The learning through observation is cognitive, but the performing of

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behaviors is behavioral. Whether or not the ­performing occurs is based on the observed consequences and beliefs about gender appropriateness.

Evolution of Behaviorism Throughout the 20th century, behaviorists have altered their understanding of behaviors. Specifically, they have shifted away from understanding behavior only in relation to what is publicly observable in the laboratory to understanding the cognitive processes that lead to behaviors, e­ specially in children. Although classical and operant conditioning poses a foundation for learning behaviors appropriate and inappropriate to gender, the incorporation of cognitive processes through social observation also serves for a better understanding of gender identity development. Various factors should be taken into account that affect the development of gender identity, including family, peer groups, culture, and ­community. Parents are a strong influence on how children acquire a sense of gender identity; h ­ owever, in general, children tend to be more highly influenced by models who are of the same sex, more prestigious, and nurturing. Mary-Jo Bautista See also Behavioral Theories of Gender Development; Childhood and Gender: Overview; Children’s Cognitive Development; Cognitive Approaches and Gender; Cognitive Theories of Gender Development

Further Readings Beck, J. D. (1995). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education. Dyden, W. (2009). How to think and intervene like an REBT therapist. New York, NY: Routledge. Eysenck, M. W., & Keane, M. T. (2010). Cognitive psychology: A student’s handbook (6th ed.). New York, NY: Psychology Press. Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York, NY: Guilford Press. Newman, B. M., & Newman, P. R. (2009). Development through life: A psychosocial approach (10th ed.). Belmont, CA: Wadsorth Cengage Learning.

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Rathus, S. A., Nevid, J. S., & Fichner-Rathus, L. (2011). Human sexuality in a world of diversity (8th ed.). Boston, MA: Allyn & Bacon. Skinner, B. F. (1938). Behavior of organisms: An experimental analysis. Cambridge, MA: B. F. Skinner Foundation. Skinner, B. F. (1974). About behaviorism. New York, NY: Knopf.

that violate the rights of others. These may include aggression, destruction of property, criminal acts, and conflict with societal norms and authority figures, based on a person’s inability to control either emotions or behaviors.

Symptoms of Behavioral Disorders Aggression

Behavioral Disorders and Gender Behavioral disorders are a combination of behavioral and emotional disturbances that affect an individual. Many mental health disorders are more prevalent in a specific gender, but it is the severity of the symptoms and onset of the diagnosis that set a larger contrast. In addition to gender, behavioral disorders may be more common in certain cultures and are also related to an individual’s environmental factors. The entry examines various types of behavioral disorders that may be more frequently diagnosed in a specific gender.

Behavioral Disorders Behavioral disorders are a broad category that encompasses several types of mental health diagnoses including both behavioral symptoms and emotional symptoms. Some of the more general types of mental health disorders that include behavioral disorders are neurodevelopmental, bipolar, depressive, anxiety, obsessive-compulsive, stress and trauma, paraphilic, personality, and addiction disorders. Although these diagnoses may be from different categories, behavioral disorders, in general, have many symptoms in common. One particular category of mental health disorders that includes both emotional and behavioral symptoms is the disruptive, impulse control, and conduct disorders grouping. These disorders include oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, pyromania, kleptomania, and other and/or unspecified disorder. They include symptoms specifically related to the self-control of emotions and behaviors, particularly behaviors

Aggression is a common symptom of a behavioral disorder. This could be exhibited verbally or physically. Aggression could be directed at a ­certain person or could be displayed indirectly. Broad ­categories of diagnoses that include specific behavioral disorders with aggression symptoms are attention-deficit/hyperactivity disorder (ADHD); autism spectrum disorder (ASD); personality disorders; trauma- and stressor-related disorders; disruptive, impulse control, and conduct disorders; as well as substance-related and addictive disorders. In general, physical aggression is more common among males. However, despite the stereotypical view that only males are physically aggressive, there are quite a number of female perpetrators of physical aggression as well. As for verbal aggression, males and females exhibit this behavior equally. There is a difference, though, in how aggression is perceived. Many women view their aggression as coming from a source of stress and a sense of loss of control. Men, on the other hand, perceive their aggressive acts as a way of taking control and challenging their self-esteem and integrity. In addition to direct acts of aggression, those with behavioral disorders may also exhibit aggression indirectly. This is usually done verbally and not performed directly on the person under attack. Indirect aggression includes spreading false rumors or gossiping, or even sharing secrets with others without permission. Indirect aggression and verbal aggression are more likely to be performed by females. There are various reasons why this is the case, but cultural background is one major factor. In some cases, verbal aggression, especially from women, is accepted. Also, compared with men, women receive more negative reactions when engaging in physical aggression than verbal aggression. Therefore, it is more socially acceptable to be

Behavioral Disorders and Gender

aggressive indirectly. There is also a biological reason for women engaging more in verbal or indirect aggression. Most males have the physical strength to be physically aggressive. Moreover, females tend to mature faster than males, making them less likely to engage in aggression. The differences in displaying aggression between genders are also exhibited early on in childhood. Typically, girls tend to play with a smaller, more intimate group of friends, while boys play with a larger group that is less defined. Engaging in verbal or indirect aggression would be less socially unacceptable for a girl in her small group of friends. However, if boys were to engage in physical aggression, it portrays them in a higher light than other male peers. Impulsivity

Impulsivity is the tendency to engage in activities that are typically poorly conceived, with little to no consideration or reflection of the consequences. Usually, impulsive actions are inappropriate, and the consequences of engaging in such behaviors are undesirable. Specific diagnoses that involve impulsivity are oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, and substance-related and addictive disorders. Typically, such disruptive, impulse control, and conduct disorders tend to be more common in males than in females. Although male predominance is usually the case for all disruptive, impulse control, and conduct disorders, there are still a sizable number of females who are diagnosed. ­ These disorders are more prevalent in males at different ages prior to adolescence. Prevalence rate does change over the course of adolescence and adulthood, and differences in specific behaviors occur between genders. However, a more viable factor is the environment in which the child has grown up, which may include hostile parenting or lack of parenting. Personality disorder is another domain that includes symptoms of impulsivity. Specifically, males are diagnosed three times more than females with antisocial personality disorder. Antisocial personality disorder includes a pattern of engaging in behaviors that disregard and violate the rights of others. Other symptoms of antisocial disorder

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include aggression, a reckless disregard for the safety of self and others, as well as a significant lack of remorse for mistreating others or engaging in criminal acts. There is also a high comorbidity rate for males with alcohol use disorder and antisocial personality disorder. More than likely, a child diagnosed with conduct disorder is later diagnosed with antisocial personality disorder. However, there is some debate as to females being underdiagnosed with antisocial personality disorder due to their not meeting some of the criteria for conduct disorder. Females are more likely to be diagnosed with borderline personality disorder, which also includes marked impulsivity symptoms. Borderline personality disorder includes lack of control and significant impulsivity, which lead to self-destructive behaviors such as excessive sex, substance use, binge eating, indiscriminate spending, and reckless driving. Those diagnosed with this disorder also may have recurrent suicidal behaviors and difficulty controlling their anger. About 75% of those diagnosed with borderline personality disorder are females. Other behavioral disorders that involve impulsivity are substance-related and addictive ­ disorders. Engaging in impulsivity also poses risk to one’s health. Such disorders involve health risk behaviors related to addiction to substances (i.e., alcohol, nicotine, medication, etc.). Some research has shown that males have higher rates of alcohol use and females tend to develop higher alcohol levels per drink than men due to generally ­weighing less and having more fat and less water in their bodies. This leads to females being more susceptible to health-related concerns, such as liver disease. In fact, alcohol dependence disorder is more than twice as high in males as in females. However, males and females alike have the same high rates of impulsivity that leads to alcohol use. Females have higher rates of impulsivity when using nicotine. One factor that may influence females’ higher rates of impulsivity when using nicotine could be the gender difference of women preferring to smoke in groups, as opposed to men, who usually smoke alone. Research has also shown that females engage in smoking more for nonnicotine effects, such as being around others while smoking, rather than smoking for nicotine effects. With regard to prevalence rates of nicotine

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dependence, males have slightly higher rates of dependence (14%) than females (12%). Females tend to smoke brands that yield lower nicotine levels, are less likely to inhale deeply, and smoke fewer cigarettes per day. Noncompliance

Noncompliance is another common symptom associated with behavioral disorders. Noncompliance is defined as a deliberate refusal to obey a wish, command, law, or regulation. Noncompliance could be exhibited through various behaviors, such as tantrums in children, engaging in selfinjurious behaviors, or even property destruction. Specific behavioral disorders associated with symptoms of noncompliance include ADHD and ASD, as well as the previously mentioned personality, conduct, and impulse control disorders. ADHD most commonly affects males (twice as much as females) in childhood. However, in adulthood, the rate for males decreases slightly. ­ ADHD criteria include both inattention and hyperactivity/impulsivity or either. Those who meet the inattention criterion usually avoid engaging in ­ tasks that require significant attention and effort and will deliberately refuse to engage in such tasks. Typically, females are more likely to present primarily with inattention features than males. ­ Children diagnosed with ADHD often do not ­follow instructions in various environments (i.e., school, home, community) and tend to interrupt or intrude on others. ASD is another behavioral disorder that involves the symptom of noncompliance. ASD is characterized by persistent deficits in social skills, such as communication and interaction across various environments and contexts. ASD criteria also require symptoms such as a restricted, repetitive pattern of behaviors, interests, or activities that may be exhibited through stereotypical motor movements (e.g., flapping hands, echolalia, or lining up objects), inflexibility of routines or ritualistic patterns, and/or fixations on specific interests. ASD also includes symptoms of hyperactivity. The severity of ASD also is taken into account when diagnosing this disorder. Those diagnosed with ASD may also have an intellectual disability or another medical or genetic condition. There are three levels of severity for ASD: those requiring

(1) very substantial support, (2) substantial support, or (3) just support. The severity level is determined by a combination of the deficits in social communication as well as the restricted, repetitive behaviors. Due to the rigidity of its features, those diagnosed with ASD engage in noncompliant behaviors. These are exhibited through tantrums and other behaviors of acting out. Research has shown that those diagnosed with ASD are mainly males: Males are diagnosed four times more than females. However, females are more likely to have intellectual impairments or language delays, which are not recognized as readily in males with ASD.

Other Contributing Factors Many behavioral disorders have factors other than behaviors and emotions that are associated with them. Those diagnosed with a behavioral disorder are more likely to have a dual diagnosis that may emphasize other symptoms such as depression, psychotic features, and motor disruptions, to cite just a few. Cultural factors including ethnicity, sexual preference, socioeconomic status, and other environmental aspects are also associated with the disruptive or significant behaviors found in behavioral disorders. Mary-Jo Bautista See also Adolescence and Gender: Overview; Alcoholism and Gender; Childhood and Gender: Overview; Personality Disorders and Gender Bias; Substance Use and Gender

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Barlow, D. H. (2008). Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed.). New York, NY: Guildford Press. Bartol, C. R., & Bartol, A. M. (2008). Current perspectives in forensic psychology and criminal behavior (2nd ed.). Thousand Oaks, CA: Sage. Bette, L. B., Najdowski, C. J., & Goodman, G. S. (2009). Children as victims, witnesses, and offenders: Psychological science and the law. New York, NY: Guilford Press.

Behavioral Theories of Gender Development Marlatt, G. A. (1998). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York, NY: Guilford Press. Tincani, M., & Bondy, A. (2014). Autism spectrum disorders in adolescents and adults: Evidence-based and promising interventions. New York, NY: Guilford Press.

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(2) behavioral accounts, such as social learning theory. This entry provides an inclusive definition of gender development in terms of multiplicity, reviews behavioral theories of gender development, and examines the implications of a b ­ ehavioral understanding of gender development for the field of psychology.

Defining Gender Development

Behavioral Theories of Gender Development Gender development refers to the process by which individuals construct their internal sense of self within the context of societal gender norms. ­Gender norms include traits stereotypically associated with genetic males (“masculine traits,” e.g., aggression, dominance, and competitiveness) and those associated with genetic females (“feminine traits,” e.g., nurturance, innocence, and passivity). In addition, gender norms define role acceptability in terms of biological birth sex. For example, men are often expected to work outside the home while women assume primary responsibility over child rearing. Throughout the lifespan, individuals are exposed to countless influences on their development as gendered (or a-gender) individuals. Adults may selectively provide infants and children with gender stereotypic toys and clothing (e.g., dolls ­ and pink for girls but trucks and blue for boys). Adolescents face novel milestones in their gender development as they transition into the world of romantic and sexual attraction. Adults encounter gendered norms in the workplace in terms of wage rates and promotion opportunities. Exposure to gender norms across the life span cumulatively contributes to how individuals experience and define themselves in terms of gender. The discipline of psychology has proposed a number of theories that attempt to account for the dynamic process of gender development across the life span. In addition to biological theories of ­gender development, which define gender in terms of biological sex (X- and Y-chromosome configurations), psychological science has proposed two primary theories of gender development: (1) cognitive accounts, such as gender schema theory, and

Gender development begins at birth and extends across the life span. Throughout this process, complex domains of experience arise and intersect. For example, individuals receive gendered cues from their immediate environment (e.g., the types and colors of available toys), familial interactions (e.g., how parents respond to their son playing with makeup compared with their daughter), and other interpersonal interactions (e.g., gender-based ­bullying of effeminate boys or tomboy girls), as well as societal influences (e.g., media portrayals of boys/girls and men/women). These intersecting domains contribute to the construction of individualized notions of gender constancy, gender ­labeling, gender identity, and gender expression. Gender constancy encompasses beliefs regarding the extent to which gender is fixed or fluid. Gender labeling refers to the ability to define self and others in terms of gender. As they further develop, children eventually become aware of the concept of gender roles—characteristics and behaviors that society associates exclusively with either males or females. Finally, some individuals reach an understanding of gender identity—one’s sense of self as male, female, both, or neither— which incorporates conceptualizations of gender constancy, gender labeling, and gender roles. Gender expression refers to the ways in which individuals communicate and express their gender identity to the external world. Gender expression includes personal appearance (e.g., hairstyles or clothing choices), preferred names or nicknames, social behaviors (e.g., expressions of aggression vs. intimacy or dominance vs. dependency), as well as social relationships (e.g., gender distribution of peers and of those one chooses to imitate). In young children, parents define and restrict gender expression; however, as individuals develop across the life span, two changes occur. First, they accrue increasing levels of personal choice with regard to

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gender expression, and second, their rigidity in perceiving gender and gender norms becomes increasingly flexible.

Gender as Behavior Behavioral psychologists emphasize the utility of observable behaviors rather than cognitions in understanding phenomena such as gender ­ development. While it is not possible to accurately discern thought processes, psychologists can ­isolate stereotypically gendered behaviors. For example, aggressive behaviors such as fussiness and tantrum throwing are associated with male infants, whereas nonverbal communication (e.g., eye contact and synchronous facial expression) are associated most frequently with female infants. In toddlers, one might observe a boy endorsing stereotypic gender norms by approaching play with trucks, avoiding interactions with dolls, and/or refusing to wear the color pink. In school-age children, concepts of gender constancy, gender labeling, and gender roles are demonstrated through the phenomenon by which girls proclaim that “boys have ‘cooties.’” Such proclamations demonstrate assumptions of gender constancy (i.e., boys remain boys), gender labeling (i.e., being a “boy” is distinct from being a “girl”), and gender roles (i.e., coyness among girls and roughness/dominance among boys), which overall constitute a particular form of gender expression. Before the age of 3 years, children have the ­ability to distinguish between toys typically used by boys versus girls as well as activities frequently attributed to boys versus girls. By the age of 4 years, many children have developed a stable sense of self as either a “boy” or a “girl.” Despite the fact that society attributes a certain constellation of characteristics and behaviors to males and a s­eparate constellation to females, no one person embodies perfect femininity or masculinity. Rather, a blend of both stereotypically masculine and stereotypically feminine traits constitute individual gender expressions. While most children generally display gendertypical behaviors, which align with the societal expectations for their biological sex, some children transgress gender norms and ­ challenge genderbased assumptions. These ­children, often referred to as “gender atypical” or “gender nonconforming,” may face bullying and discrimination not only from peers and the larger society but from parents and other family m ­ embers as well.

As a result of the complex interactions of internal, interpersonal, familial, and societal influences on gender development (including gender constancy, gender labeling, gender roles, gender identity, and gender expression), a diverse spectrum of gender expressions and identities has emerged. For example, as of 2015, society has begun moving away from binary conceptualizations of gender (i.e., exclusively defining gender in terms of male/ female) and toward representations of gender multiplicity (including gender identities such as ­ genderqueer, transgender, agender, and bi-gender). As this spectrum continues to expand and garner awareness and in light of the increased discriminatory and negative mental health experiences of gender nonconforming individuals, psychological theories must also grow to encompass gender developmental experiences.

Behavioral Theories of Gender Development A number of disciplines have developed theories of gender development based on the central tenets of their theoretical orientation. For example, sociologists emphasize the influence of the social milieu on how individuals identify and express themselves in terms of masculinity and femininity. Anthropologists highlight the role of cultural norms, whereas biologists emphasize genetic determinants such as chromosomes and hormones. Psychologists remain divided in their locus of emphasis. Some underscore the role of cognitions (e.g., the beliefs individuals hold regarding their gender and the ways individuals think about themselves in terms of masculine/feminine mannerisms, presentations, roles, and behaviors). Others posit that to effectively explore and explain gender development, behaviors rather than thoughts must be considered. The following discussion focuses on behavioral theories of gender development—­ specifically theories exploring gender development in terms of three conceptual clusters: (1) classical conditioning, (2) operant conditioning, and (3) observational learning.

Behaviorism According to the behavioral approach, all behaviors and personality result from a form of learning called conditioning. Conditioning occurs when

Behavioral Theories of Gender Development

experiences modify behavioral responses. For example, if a rat receives food after pressing a lever, it will modify its behavior (continue to press the lever) in response to this experience (receiving food). Behaviorism describes two forms of conditioning that influence gender development: ­ (1) classical conditioning and (2) operant ­conditioning. In addition, social learning theory conceptualizes gender development in a way that bridges the cognitive and behavioral theories. The behaviorist approach emphasizes that ­gender-appropriate behaviors, like all cultural patterns, are learned behaviors shaped by consequences. Gender roles, beliefs, and behaviors result from conditioning and observational learning; they are not innate. Throughout the life span, parents and society condition individuals’ gender experiences, expression, and identity within the context of socially constructed gender norms. The sections below describe in detail how different learning experiences influence gender development. Classical Conditioning

In classical conditioning, individuals learn new stimulus associations through pairings of events. In a well-known example, Ivan Pavlov trained dogs to salivate in response to a ringing bell after pairing the bell with food. The natural relationship between food and salivation allowed salivation to occur in response to a previously neutral stimulus (the bell). Although it is more complex than P ­avlov’s example would indicate, classical ­conditioning similarly contributes to gender development. Children observe their parents and society endorsing norms of masculinity and femininity by wearing certain clothing, exhibiting mannerisms and gestures, and using communication styles repeatedly paired with their biological sex (and repeatedly absent in the opposite sex). For e­ xample, when children repeatedly observe girls wearing pink while boys wear blue, they begin to associate the color pink with femininity and the color blue with masculinity. These repeated pairings of g­ ender conforming behaviors influence how individuals conceptualize gender as a construct as well as how individual gender development unfolds. Pairing gendered experiences with expressions of positive affect (e.g., a smile or a laugh) further increases the strength of classically conditioned gender norms. For example, advertisements

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portray happy young girls playing with dolls and strollers, whereas boys are rarely portrayed in this role. Associations between expressions of positive affect and traditional femininity are further strengthened when children observe their mothers (sources of positive affect) exhibiting feminine gender norms such as passivity, coyness, and ­ dependence while their fathers exhibit traditionally masculine traits such as adventurousness, strength, and dominance. As a result, children who understand themselves as biological males adopt traditionally masculine behaviors, whereas biological females adopt traditionally feminine ­ behaviors. While classical conditioning ­theoretically accounts for some aspects of gender development, it fails to account for complex intersections of ­individual, interpersonal, and societal experiences. For example, transgender children, whose gender ­identity does not align with their biological sex, may not exhibit gender conforming behaviors in response to pairings of masculinity with males and femininity with females. In accounting for such complexities, operant conditioning provides a stronger explanation. Operant Conditioning

Operant conditioning is any process in which behavior increases or decreases depending on its consequence. Behaviors followed by positive experiences (something the individual experiences as rewarding, e.g., praise, affection, or attention) are likely to be repeated, whereas behaviors followed by negative experiences (e.g., punishment or criticism) are less likely to be repeated. Edward L. Thorndike described this pattern as the “law of effect.” B. F. Skinner later expanded on Thorndike’s law of effect, proposing that individuals learn response patterns within the context of consequences by actively operating on the environment. The resultant term, operant conditioning, describes the learning process by which observable behavior is changed by its consequences. There are two categories of operant learning: (1) reinforcement, which strengthens behavior, and (2) punishment, which weakens it. Reinforcement

Reinforcement is an increase in the strength of a behavior due to its consequence. In positive

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reinforcement, a pleasant stimulus (e.g., affection or approval) is presented contingent on a behavior. For example, when a little girl cries, her parents provide attention by soothing her. The positive consequence of soothing strengthens the girl’s behavior of displaying emotional distress. This reinforcement increases the likelihood that the girl will display sensitive emotions in the future. Similarly, parents of boys exhibit less anxiety than parents of girls when their child wanders off to explore the environment. For example, parents may nod with approval when their son climbs a tree and, thus, reinforce the traditionally masculine trait of adventurousness. In contrast, they might urge their daughter to “be careful” and, thus, reinforce the traditionally feminine trait of ­ ­cautiousness/passivity. In negative reinforcement, an aversive stimulus (e.g., criticism) is removed contingent on a behavior. For example, a transgender woman with some physiological characteristics of biological males (e.g., a protruding Adam’s apple) may experience violence or discrimination when wearing clothing typically associated with biological females (e.g., a dress). Behaviors that remove the negative ­experience of discrimination would be negatively reinforced. This individual may suppress her gender expression by wearing traditionally masculine clothing rather than dresses. Alternatively, she may undergo surgical procedures to decrease the physiological characteristics associated with biological males. In either case, the aversive stimulus (i.e., discrimination) is removed contingent on her behavior. Although they are frequently conflated, positive reinforcement entails the addition of a pleasant stimulus, whereas negative reinforcement involves the removal of a negative stimulus. Both forms of reinforcement strengthen and increase the frequency of behaviors and thus contribute to ­gender development. In automatic reinforcement, behaviors are repeated when they result in intrinsic satisfaction. If a father reprimands his son for wearing makeup but this behavior evokes a rewarding internal experience stronger than that of his father’s punishment, then the son is likely to continue wearing makeup. The concept of automatic reinforcement therefore explains the persistence of cross-sex behaviors in transgender individuals despite repeated exposure to and reinforcement of societal

gender norms and pressures to conform. Transgender individuals continue to behave according to their experienced gender identity rather than their birth sex because doing so results in pleasant experiences (e.g., contentment with their gender ­ identity/expression). When schedules of reinforcement and punishment compete, the stronger of those schedules is what either maintains or decreases behavior. Different schedules and their strengths contribute to individual differences in gender development.

Punishment Whereas reinforcement refers to behaviors increasing based on their consequences, punishment is a decrease in the strength of a behavior due to its consequence. In punishment, an aversive stimulus or a negative experience follows a behavior, thus decreasing the likelihood that the individual will engage in that behavior in the future. Positive ­punishment involves the addition of an aversive stimulus (e.g., a father may scold his son for losing a wrestling match). The act of scolding is a punisher that decreases the probability that the son will lose another match, thus encouraging conformity with the traditionally masculine trait of competitiveness. Negative punishment involves the removal of a pleasant stimulus, which results in a decrease in the associated behavior. For example, a daughter who violates her curfew may be “grounded”—in which access to pleasant stimuli (e.g., friends, cell phones, television, or video games) is removed for a period of time. This form of negative punishment decreases the likelihood that the daughter will be coming home late in the future. Negative punishment influences gender development through its differential imposition on girls/women compared with boys/men. For example, parents tend to impose harsher curfews on their adolescent daughters than on their sons and to punish their daughters more severely than their sons for breaking curfew. Such differential patterns of punishment determine the frequency with which individuals engage in gender conforming behaviors. Observational Learning

As described by behavioral psychologists such as Thorndike and Skinner, behaviors are a function

Behavioral Theories of Gender Development

of their environment. Individual experiences and expressions of gender are shaped across the life span in response to environmental stimuli and operant learning. Behaviors that lead to something pleasant tend to be repeated, whereas behaviors leading to something aversive are less likely to be repeated. While this understanding forms the basis of traditional behavioral theories of gender ­development, stimulus pairing, reinforcement, and punishment do not comprehensively explain ­ the dynamic and complex process of gender development. Observational learning is a change in behavior due to the experience of observing the contingencies related to a model’s behavior. As such, observational learning allows for influences of ­ vicarious reinforcement and vicarious punishment. A behavior is vicariously reinforced when an observer witnesses a model’s behavior producing reinforcement. For example, when a male student acts competitively or aggressively in class and receives extra credit or social acceptance as a result, other male students who observed this reinforcement will likely imitate his behavior in an attempt to receive the same form of reinforcement in the future. Vicarious punishment, on the other hand, occurs when an observer looks on as a model’s behavior is punished. For example, a female student who acts competitively or aggressively in class may be punished and labeled as “attention-seeking” for exhibiting these traditionally masculine behaviors. Other girls observing this punishing experience are less likely to imitate her behavior.

Social Learning Theory Social learning theory, proposed by Albert Bandura, further expands upon observational learning by highlighting the importance of who is being observed in addition to what is being observed. Social learning theory posits that individuals learn to repeat certain behaviors based upon their observation of others being reinforced/punished for the same behaviors, but that this learning process is moderated by the relationship between the individual and their observed model. The influence of vicarious punishment or ­reinforcement is strongest when the model is influential. For example, a son is more likely to imitate

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the behaviors of his father or his favorite television star than those of a stranger he passes briefly on the street. Imitating the behaviors of an influential model is called identification. The concept of identification may provide further explanatory ­ context for the persistence of cross-sex behaviors among transgender and gender nonconforming ­individuals despite the overwhelming presence of gender conforming models compared to gender ­ nonconforming models. The sense of strong identification with a transgender model may outweigh the influences of observational learning with less influential models. Behavioral theories of gender development maintain that individuals develop gender-related behaviors by observing and learning from their environments. Individuals learn to repeat gender conforming or non-conforming behaviors through experience with experiential pairing, reinforcement, and punishment. While few researchers have studied gender development from an exclusively behavioral perspective, the previously described applications of these theories to gender development demonstrate the promise of this perspective in accounting for gender development across the lifespan. Chassitty N. Whitman and Theresa Fiani See also Behavioral Approaches and Gender; Biological Theories of Gender Development; Childhood and Gender: Overview; Cognitive Theories of Gender Development; Gender and Society: Overview; Gender Development, Theories of

Further Readings Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall. Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37(4), 451–463. doi:10.1037//0012-1649.37.4.451 Gray, S. A., Carter, A. S., & Levitt, H. (2012). A critical review of assumptions about gender variant children in psychological research. Journal of Gay & Lesbian Mental Health, 16(1), 4–30. doi:10.1080/19359705 .2012.634719 Katz, P. A., & Ksansnak, K. R. (1994). Developmental aspects of gender role flexibility and traditionality in middle childhood and adolescence. Developmental

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Bem Sex Role Inventory

Psychology, 30(2), 272–282. doi:10.1037//00121649.30.2.272 McConaghy, M. J. (1979). Gender permanence and the genital basis of gender: Stages in the development of constancy of gender identity. Child Development, 50(4), 1223–1226. doi:10.2307/1129354 McNamara, K., & Rickard, K. M. (1989). Feminist identity development: Implications for feminist therapy with women. Journal of Counseling & Development, 68(2), 184–189. doi:10.1002/j.1556-6676.1989.tb01354.x Nestle, J., Howell, C., & Wilchins, R. A. (2002). Genderqueer: Voices from beyond the sexual binary. Los Angeles, CA: Alyson Books. Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, S. B. (2013). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: An 11-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(2), 143–152. doi:10.1016/j.jaac.2012.11.006 Skinner, B. F. (1953). Science and human behavior. New York, NY: Simon & Schuster. Skinner, B. F. (1974). Walden Two. Cambridge, MA: Hackett. Skinner, B. F. (1978). Reflections on behaviorism and society. Englewood Cliffs, NJ: Prentice Hall. Stoller, R. (1968). Sex and gender: The development of masculinity and femininity. London, England: Karnac.

Bem Sex Role Inventory Sex roles refer to the standards for behaviors, attitudes, values, vocational preferences, physical attributes, and personality traits that are viewed as appropriate for women and for men in a given culture. The terms sex role and gender role are sometimes used interchangeably, although sex role is inherently linked to biological gender and g­ ender role is psychologically based. Despite gender differences that might be due to biological sex (e.g., childbearing), the general consensus is that sex roles are socially constructed and that children internalize sex roles mostly through social ­interactions with salient individuals in their lives. Standards for sex roles differ across cultures and in U.S. society, but the Bem Sex Role Inventory (BSRI) is one of the most popular measures of sex role personality traits. This entry briefly presents

the development and utility of the BSRI as a measure of masculine and feminine personality traits. The entry concludes with a definition of the concept of androgyny generated by the BSRI.

Long-Form and Short-Form BSRI The BSRI was developed by Sandra Bem in 1974 as a measure of masculine and feminine personality traits, loosely defined as personality traits ­traditionally associated with men (e.g., aggressive, self-sufficient) and those traditionally associated with women (e.g., compassionate, kind). The ­selection of the final BSRI items was based on the desirability ratings of 100 Stanford undergraduate students of 421 personality traits. The final, 40-item BSRI comprises only personality traits that were supposedly desirable, excluding traits rated as undesirable by the Stanford sample. To complete the BSRI, respondents are instructed to indicate on a 7-point scale how descriptive the personality traits are of themselves, with 1 indicating never or almost never true and 7 indicating always or almost always true. Unlike previous measures of masculinity and femininity, which generated a single score per person, the BSRI generates two scores per person: (1) BSRIM (BSRI Masculine) and (2) BSRIF (BSRI Feminine) scores. Although Bem implicitly hypothesized sex role personality traits as having two clean dimensions, masculine and feminine, numerous validation ­studies did not fully support her supposed two dimensions. For example, many studies reported that the masculine dimension is more complex than the feminine dimension and could be broken down into more than one cluster of personality traits. Based on the collective critiques, Bem ­introduced the short version of the BSRI, which comprises 10 BSRIM and 10 BSRIF items from the original 40 items. The short-form BSRI is reported to be conceptually purer and tends to produce one clean cluster for femininity and two for masculinity: independence and aggressiveness. The items on the masculinity subscale of the short form are (1) defend my own beliefs, (2) independent, (3) assertive, (4) have leadership abilities, (5) willing to take risks, (6) willing to take a stand, (7) strong personality, (8) forceful, (9) dominant, and (10) aggressive. The items on the

Bem Sex Role Inventory

femininity subscale items are (1) affectionate, (2) sympathetic, (3) sensitive to the needs of others, (4) understanding, (5) compassionate, (6) eager to soothe hurt feelings, (7) warm, (8) tender, (9) love children, and (10) gentle. The totals of the scores on each ­ subscale item generate two subscale scores: BSRIM and BSRIF. In 1981, Bem contended that the BSRI items reflect more or less stable operational definitions of feminine and masculine personality traits. While the BSRIM and BSRIF scores have been shown to be reliable across different samples, whether the BSRI items actually measure masculinity and femininity has long been debated among sex role researchers.

Classification of Individuals In addition to using the BSRIM and BSRIF scores as two continuous variables in psychological research, the two scores can also be used to classify individuals by psychological sex role categories. Typically, a median split method is applied to each subscale, putting 50% of the individuals in the “high” group and 50% in the “low” group. These splits yield a four-way classification: (1) high ­ masculine/high feminine (androgynous), (2) high masculine/ low feminine (masculine), (3) low ­masculine/high feminine (feminine), and (4) low masculine/low feminine (undifferentiated). Another way to classify individuals is as either sex typed or non–sex typed. Sex-typed individuals are masculine men and feminine women, and nonsex-typed individuals include androgynous and undifferentiated men and women. This categorization is aligned with biological sex, while the ­four-way categorization mentioned above is a psychological gender categorization irrespective of one’s biological sex. According to the BSRI traits, a ­sex-typed man in the United States is one who is assertive, aggressive, and independent, and has leadership abilities; a sex-typed woman is one who is dependent, affectionate, and compassionate, and loves children.

Concept of Psychological Androgyny Prior to the publication of the BSRI, masculinity and femininity were viewed as dichotomous concepts aligned with biological sex: Males were expected to possess masculine personality traits

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and females, feminine personality traits. The development of the BSRI reflected a new and r­adically different way of conceptualizing gender as psychological, in that a person could possess both masculine and feminine personality traits. One important consequence of this new conceptualization was the creation of a new type of sex role: androgynous. Androgynous individuals, regardless of their biological sex, were viewed as having both positive masculine and positive feminine traits. Empirical studies in the 1970s showed that androgynous individuals, more than the other three groups of individuals, achieved at higher levels in various domains of human performance, were able to adapt adroitly to various tasks and situations, and thus were mentally healthier than masculine or feminine individuals. Later studies, however, suggested that it is high masculinity, not necessarily a balance between high masculinity and high femininity (androgyny), that contributes to higher human functioning and better mental health, thus challenging the concept of androgyny. Noticeably, increased masculinity scores in modern women following social and cultural changes (e.g., the women’s liberation movement in the late 1960s to 1970s) have been reported in several studies, providing evidence for the socially constructed nature of sex roles. The BSRI has kindled much research on sex roles and related concepts and continues to be an important measure of masculinity and femininity. Namok Choi See also Femininity; Gender Identity; Gender Roles: Overview; Gender Stereotypes; Gender Versus Sex; Masculinities

Further Readings Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42, 196–205. Choi, N., & Fuqua, D. R. (2003). The structure of the Bem Sex Role Inventory: A summary report of 23 validation studies. Educational and Psychological Measurement, 63, 872–887. Pedhazur, E. J., & Tetenbaum, T. J. (1979). Bem Sex Role Inventory: A theoretical and methodological critique. Journal of Personality and Social Psychology, 37, 996–1016.

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Benevolent Sexism

Twenge, J. M. (2001). Changes in women’s assertiveness in response to status and roles: A cross-temporal metaanalysis, 1931–1993. Journal of Personality and Social Psychology, 81, 133–145.

Benevolent Sexism Benevolent sexism is a type of sexism that includes seemingly positive views of women and is a component (along with hostile sexism) of ambivalent sexism. There are three subcomponents of benevolent sexism: (1) protective paternalism, which is the belief that because women are warm, caring, and maternal, they should be protected and ­provided for by men; (2) complementary gender differentiation, which is the belief that women (who are warm, other oriented, morally pure, and weak) and men (who are competent, independent, morally corruptible, and strong) have contrasting but complementary attributes; and (3) heterosexual intimacy, which is the belief that women and men are dependent on each other for both emotional closeness and reproduction. Although benevolent sexism rewards women with prosocial treatment, it reinforces their subordinate position relative to men and has detrimental effects on women, both as individuals and as a collective. This entry briefly introduces benevolent sexism in relation to ambivalent sexism and then discusses the large-scale societal impacts as well as the smaller-scale individual impacts of benevolent sexism. The entry concludes with current research directions regarding benevolent sexism.

Connection to Ambivalent Sexism Ambivalent sexism was conceptualized by Peter Glick and Susan Fiske to include both negative (hostile) and positive (benevolent) sexism and is measured with the self-report scale they created, the Ambivalent Sexism Inventory. The two types have been found to be moderately positively correlated in all the nations studied, with those men and women who score high on both scales being termed ambivalent sexist. Benevolent sexism has been identified in 19 different countries, with women typically endorsing benevolent sexism to a greater extent than hostile sexism. Benevolent

sexism predicts positive evaluations of women who conform to traditional gender roles, whereas hostile sexism predicts negative evaluations of women who violate traditional gender roles. Thus, together they create ambivalent views of women as a whole.

Societal-Level Effects Glick and Fiske, as well as other researchers, argue that the combination of hostile and benevolent sexism contributes to societal gender inequality. Benevolent sexism is prosocial treatment directed toward gender conforming or traditional women (e.g., mothers, wives), and thus rewards women for staying in lower-status roles relative to men. Indeed, national levels of benevolent sexism have been shown to be objective indicators of societal gender inequality. In cultures characterized by a high level of hostile sexism, women are more likely to endorse benevolent sexism, suggesting that they may enact gender conforming, lower-status behaviors to earn protection rather than risk overt hostility from men. Benevolent sexism therefore ­ may weaken women’s resistance to sexism and gender inequality. Indeed, John Jost and Aaron Kay found that priming women with complementary gender stereotypes as well as complementary (benevolent plus hostile) sexist items increased support for the societal status quo (i.e., reduced women’s motivation to enact change in a sexist society). Thus, benevolent sexism is implicated in the maintenance of gender inequality at the s­ ocietal level.

Individual-Level Effects A great deal of research has also shown the negative effects of benevolent sexism on individual women. Benoit Dardenne and colleagues found that women exposed to benevolent sexist instructions prior to taking a test of job skills as part of an employment interview performed more poorly than women exposed to hostile sexist or nonsexist instructions. They argue that because benevolent sexism is not as easily recognized as sexist (i.e., it seems positive), exposure results in women doubting their competence and cognitive abilities in a workplace context. Laurie Rudman and Peter Glick presented evidence that paternalistic/

Biculturalism and Gender

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sexism. Journal of Personality and Social Psychology, benevolent sexist beliefs in employment settings 70, 491–512. doi:10.1037/0022-3514.70.3.491 can prevent women from being offered high-risk/ Glick, P., Fiske, S. T., Mladinic, A., Saiz, J. L., Abrams, D., high-status opportunities, slowing their career Masser, B., . . . López López, W. (2000). Beyond advancement. Instead they are offered lower-­ prejudice as simple antipathy: Hostile and benevolent status, communal job roles that are more congrusexism across cultures. Journal of Personality and ent with traditional gender norms. Benevolent Social Psychology, 79, 763–775. doi:10.1037//0022sexism has also been shown to limit women’s 3514.79.5.76 opportunities in romantic relationship contexts Jost, J. T., & Kay, A. C. (2005). Exposure to benevolent and is associated with acquaintance rape victim sexism and complementary gender stereotypes: blaming. Benevolent sexism is often unrecognized Consequences for specific and diffuse forms of system as sexist, yet research shows that it can have damjustification. Journal of Personality and Social aging ­consequences on individual women’s lives.

Current and Future Directions Benevolent sexism was first defined in the mid-1990s and is an active topic of research. ­ Researchers who study benevolent sexism have begun investigating the social implications of confronting it, as well as interventions to reduce the endorsement of benevolent sexist attitudes and beliefs. Researchers have also begun studying the cardiovascular reactivity associated with experiences of benevolent sexism. Much of the research conducted on benevolent sexism to date has used primarily White, middle-class participant samples; future research should consider whether the findings generalize to different racial and ethnic groups as well as people with differing levels of socioeconomic status. Intersectional research on benevolent sexism has been strongly encouraged. Because benevolent sexism is often subtly experienced and not actively resisted in the same way as hostile sexism, research investigating its antecedents, effects, and reduction is of paramount importance. Jessica J. Good See also Ambivalent Sexism; Gender Discrimination; Gender Roles: Overview; Gender Stereotypes; Hostile Sexism; Sexism

Further Readings Dardenne, B., Dumont, M., & Bollier, T. (2007). Insidious dangers of benevolent sexism: Consequences for women’s performance. Journal of Personality and Social Psychology, 93, 764–779. doi:10.1037/00223514.93.5.764 Glick, P., & Fiske, S. T. (1996). The ambivalent sexism inventory: Differentiating hostile and benevolent

Psychology, 88, 498–509. doi:10.1037/0022-3514. 88.3.498 Rudman, L., & Glick, P. (2008). The social psychology of gender. New York, NY: Guilford Press.

Biculturalism

and

Gender

Biculturalism consists of two components: (1) a person’s sense of belonging to two distinct cultures and (2) the person’s ability to competently interact and engage with people in both cultural groups. Bicultural people must understand and accept the gender rules of both groups, which is often a ­psychologically stressful process to navigate. This entry discusses how gender informs biculturalism for people of color, immigrants, and other minority groups in the United States.

Biculturalism as Competence Many theorists have referred to biculturalism in terms of being biculturally competent. Biculturally competent people have the knowledge and psychological skills to thrive in their native group (often a minority group) as well as in the additional culture (often a majority group). Bicultural competence requires that a person have knowledge of the beliefs and values of both groups, including the perspectives that both cultures have on gender roles, religious practices, political issues, and social rules. Bicultural competence also requires that bicultural individuals have positive attitudes toward both the majority and the minority cultural group, whereby they can hold each group in a positive regard and believe that they can live a satisfying life in both groups, without sacrificing their sense of belonging to either individual group.

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Another dimension of bicultural competence is a person’s ability to communicate effectively and behave appropriately, both verbally and nonverbally, with people in both cultural contexts. ­Competence also requires that a person develop a strong support network within both groups, which will enhance the person’s ability to cope with the psychological stress of living in and engaging with two cultural worlds. Gender is a core component of culture. Cultural systems designate expectations and norms for gender groups. These may include differing ­ ­expectations for men and women with regard to family life, roles for genderqueer and transgender people, career and work expectations for gender groups, as well as expectations about intimacy and dating. Biculturally competent individuals will need to have a firm sense of the gender roles and expectations for both the native and the majority group.

Gender Nonbinaries and Culture As bicultural individuals integrate their cultural identities, they will often encounter differences in gender beliefs. An important first example refers to how gender is structured and conceptualized. White American culture, the dominant culture in the United States, has historically structured g­ ender as a binary identity. In a binary system, gender is a two-category construct where people are expected to identify as one of two identities: a man or a woman. They are also expected to express this gender identity according to societal norms of gender expression. For example, in the United States, a person wearing a skirt is often assumed to be dressing “like a woman,” according to gender binary systems. In contrast, many non-White American cultures (e.g., Pakistani, Indian, Thai, Native American) have historically regarded gender as nonbinary. In these communities, it is not uncommon for people to identify with a gender other than the gender assigned to them at birth (i.e., transgender) or to identify with no gender at all (i.e., genderqueer). In the latter half of the 20th century, White American gender constructs have evolved to become somewhat more fluid, such that gender is viewed as being on a continuum rather than as categorical. As a result, men and women in the United States

are not as restricted in how they dress and behave as they have been in the past, and transgender and genderqueer people have become increasingly more visible. However, it is important to note that bicultural people in the United States may experience U.S. gender systems as either more or less restrictive depending on how their native culture has normed gender classifications.

Biculturalism, Race, and Gender For people of color in the United States, gender norms of the native culture often differ from White American gender norms. The following section offers an introduction to the gender norms of several American cultural groups. Each group consists of multiple ethnic and tribal cultural distinctions, and it is imperative to note that none of these groups represent a single, monolithic culture. White Americans

As the majority racial group in the United States, White Americans set the criteria for what are often referred to as “mainstream” values. These values are historically informed by Judeo-Christian and European value systems, which classify gender into categories of men and women. Here, men are expected to exhibit masculinity through physical strength, independence, sexual power, and ability to lead and direct others. In contrast, White American culture expects women to exhibit femininity through their ability to relate with others, provide a clean and accommodating home, entertain, raise children, and remain sexually pure. Throughout the 20th century, White American gender norms have become less strictly defined and, thus, more fluid. Gender identities have become more secularly based, and egalitarian roles for men and women have gradually taken shape. Bicultural people will need to learn these norms to competently engage and interact with people in White American contexts, so that they may then foster a sense of belonging in both White American spaces and their native cultural context. Asian Americans/Pacific Islanders

Asian American/Pacific Islander (AAPI) native cultures are often based on highly patriarchal

Biculturalism and Gender

systems, where women are afforded subordinate positions compared with men in the family. Daughters are taught to focus on education and to avoid excessive social interaction with boys, and sexuality is considered a taboo subject. AAPI boys are expected to pursue education, morality, and ­self-growth rather than physical dominance. These gender expectations can conflict with gender norms in American schools, as peers encourage socializing with students of other ­ genders and deprioritizing schoolwork. AAPI ­ youths may also feel pressures to thwart stereotypes of AAPIs as antisocial and school oriented when interacting in White American environments. ­Fostering bicultural identities that thrive in both school (i.e., majority) and home (i.e., native) ­contexts can thus create significant psychological distress. Of note, some Pacific Islander cultures (e.g., Filipino) are characterized by more egalitarian gender roles than East Asian (e.g., Chinese, ­Japanese) native cultures. Moreover, transgender people are more visible in some Asian Indian and Pacific Islander cultures than in East Asian native cultures. Thus, AAPI bicultural identity development will vary depending on the values of the broad AAPI culture as well as one’s specific ethnic culture. Latina/os

Within Latina/o families, women are expected to be the caretakers of the household in accordance with marianismo, a Latina/o concept steeped in Catholicism that encourages women to be “like the Virgin Mary.” Marianismo emphasizes ­self-sacrifice, submission, and nurturance of ­others. In contrast, men are responsible for providing financial security and safety for the family, in accordance with machismo. Machismo also emphasizes physical and psychological strength and dominance, among others. Thus, bicultural Latina/os must navigate the conflicting norms of their native culture and the majority White American culture. For example, Latina women may feel conflicted when encouraged to pursue financial independence and a career over family responsibilities. In contrast, Latino men may feel conflicted in how to convey their masculinity—in accordance with the tenets of their

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native machismo expectations or in accordance with White American definitions of masculinity. In particular, machismo notions of masculinity are often challenged when Latino immigrants t­ ransition to the United States. Immigration often necessitates loss of financial, social, and career-related power, subsequently deflating one’s sense of ­dominance, pride, and ability to provide. Black/African Americans

Black/African Americans uniquely carry a history of institutionalized slavery in the United States. This racial context complicates bicultural identity development, while also informing Black men and women’s gender identities. Within the Black community, Black women are expected to build supportive and caring relationships, while also serving as advocates and spokespersons for their communities. Black men are expected to value self-determination and accountability, while prioritizing family, pride, and spirituality. Black gender norms are additionally challenged by stereotypes that characterize the Black community as inherently violent, immoral, irresponsible, and aggressive. For example, when a Black woman pursues a professional career, she may feel pressured by her family to spend more time with them rather than on her work. Simultaneously, she must also conform to act in a way aligned with White American values within her workplace, to avoid being perceived as lazy, irresponsible, or aggressive by her colleagues. Navigating both spaces competently thus requires an ability to switch roles and protect one’s sense of belonging in each space. Indigenous/Native Americans

There is tremendous diversity within Indigenous/ Native American cultures. Historically, in some tribal cultures (e.g., Algonquin), men are expected to provide food and safety for the family, whereas women are tasked with household chores and child care. This vastly differs from the norms in other tribal cultures (e.g., Hopi), wherein women are seen as superior to other genders and are expected to participate in community decision making. In addition, Navajo tribal culture conceptualizes a third gender role, attesting to a n ­onbinary system of gender. Thus, bicultural Indigenous Americans

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must navigate the specific tribal ­customs that they are socialized in, including the gender expectations specific to that community, while simultaneously navigating the White American gender system as well. Arab Americans

Arab American native cultures often have been informed by religiously conservative and ­patriarchal gender systems. For some, these systems are experienced as more restrictive than White ­American gender systems. For example, some native Arab cultures restrict women in their dress, peer relationships, and familial roles. By contrast, men are often afforded more freedom and power in the household and society at large. As a result, for many bicultural Arab Americans, becoming bicultural and accepting and understanding White American gender systems may present a challenging psychological process. For Arab American immigrants in particular, emigrating from comparatively conservative cultural systems to the United States will likely incur psychological distress. Multiracial People

Multiracial people (i.e., people identifying as more than one race) face the challenging task of navigating a bicultural identity from birth. Multiracial people often must learn how to adeptly interact in two or more cultures of origin; they must be able to engage in satisfying ways within each context, sometimes in addition to White American contexts. Depending on the differences between the person’s cultures of origin, this process can also contribute to psychological distress and identity confusion.

Immigration and Biculturalism For immigrants, leaving their native country and moving to the United States is a necessarily stressful process. Immigrants come to the United States for varying reasons, including political and/or religious freedom, escape from abject poverty, ­ exposure to war, as well as educational opportunity. As part of their transition into the United States, immigrants must learn to navigate White

American culture. This process of acquiring the knowledge, skills, and competence to thrive in a White American context, while also maintaining a sense of one’s native culture of origin, is often encountered as an alienating experience, creating a sense of loss of native culture. Specifically, many immigrants struggle with re-creating gender identities that no longer reflect the norms of their native culture. Loss of identity, community, familiarity, and self-esteem then contributes to the development of depression, anxiety, and intergenerational conflict between immigrant parents and their U.S.-born children.

Further Directions Navigating two contexts, especially when one belongs to a minority group, is an inherently ­complex task. Biculturalism is thus an important ­concept for future clinical inquiry and research, for psychologists working with bicultural individuals, as well as for researchers assessing the positive and negative impacts of maintaining bicultural identities. Marcia M. Liu See also Cross-Cultural Differences in Gender; Immigration and Gender; Race and Gender

Further Readings Bacallao, M. L., & Smokowski, P. R. (2005). “Entre Dos Mundos” (between two worlds): Bicultural skills training with Latino immigrant families. Journal of Primary Prevention, 26, 485–509. doi:10.1007/ s10935-005-0008-6 Barkdull, C. (2009). Exploring intersections of identity with Native American women leaders. Affilia: Journal of Women and Social Work, 24, 120–136. doi:10.1177/ 0886109909331700 Bell, E. L. (1990). The bicultural life experience of careeroriented Black women. Journal of Organizational Behavior, 11, 459–477. doi:10.1002/job.4030110607 LaFromboise, T., Coleman, H. L. K., & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395–412. doi:10.1037/0033-2909.114.3.395 Qin, D. B. (2009). Being “good” or being “popular”: Gender and ethnic identity negotiations of Chinese immigrant adolescents. Journal of Adolescent Research, 24, 37–66. doi:10.1177/0743558408326912

Biculturalism and Sexual Orientation Shirpak, K. R., Maticka-Tyndale, E., & Chinichian, M. (2011). Post-migration changes in Iranian immigrants’ couple relationships in Canada. Journal of Comparative Family Studies, 42, 751–770. Wingfield, A. H., & Wingfield, J. H. (2014). When visibility hurts and helps: How intersections of race and gender shape Black professional men’s experiences with tokenization. Cultural Diversity and Ethnic Minority Psychology, 20, 483–490. doi:10.1037/ a0035761

Biculturalism Orientation

and

Sexual

The concepts of biculturalism and sexual orientation share an overlapping emphasis on identity integration within specific cultural demands. Biculturalism is the integration of two cultures and can occur on an individual or societal level, whereas sexual orientation typically refers to sexual attraction and/or romantic attraction toward a member of a particular group. The intersection of these concepts reveals the reciprocity that is inherent in the relationship between culture and identity; in other words, culture and identity shape and inform each other in meaningful ways. The purpose of this entry is to introduce and describe the nature of the intersection between biculturalism and sexual orientation. Thus, the entry offers a brief overview of the literature on both concepts, followed by descriptions and examples of three ways in which these concepts overlap, with a discussion of their implications for psychological well-being.

Biculturalism Within the field of psychology, biculturalism is typically associated with the process and experience of integrating two cultures within one ­individual and is often linked to acculturation literature. Within many proposed frameworks for the acculturation process, biculturalism is considered one way to successfully blend two (or more) cultures. Related concepts include monoculturalism, which refers to a single cultural identity or orientation, and multiculturalism, which refers to an ­orientation in which diversity among cultures is celebrated and considered mutually enriching.

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Biculturalism requires awareness of two cultures and can develop as a result of a multitude of intercultural interactions, including immigration and emigration, colonization, and familial growth (e.g., one person marrying someone from a different cultural background). The two cultures involved in biculturalism are most often the mainstream or dominant culture and a heritage or familial homeland culture. There are no specific temporal stipulations that dictate the emergence of a bicultural identity; that is, biculturalism can develop along myriad timelines, regardless of when the introduction to the second culture occurs. Notably, acculturation research identifies some of the ways in which timing and age can have an impact on how a person learns to cope with and live amid cultural changes. Extended exposure to another culture or immersion in a bicultural ­environment demarcates the development of dual cultural knowledge. With this dual cultural knowledge, a bicultural identity orientation can also develop. However, simple exposure to a bicultural environment does not directly relate to a bicultural identity, nor does it automatically imbue one with the increased ability to navigate the environment. Nonetheless, explicit bicultural identification is related to an increased ability to be attuned and responsive to cultural diversity. Someone who is biculturally competent is someone who has successfully integrated two distinct cultures into their self-concept. At times, these cultures can have conflicting values or beliefs, but at other times, they can be complementary. Research suggests that this conflict can result in various signs of psychological distress, including anxiety, depression, and low self-esteem. One’s ability to successfully navigate this integrative process may be an indicator of psychological wellness. Specifically, the ability to effectively adhere to expectations for how to behave and the ability to be knowledgeable about both cultures signify bicultural competency. At times, the heritage ­culture may become marginalized within the dominant culture, which can further complicate how these cultures are ultimately understood. These cultures need not exclusively relate to nationality, ethnicity or race, or immigration status. For the purposes of this entry, culture emerges in any group in which shared experience, behaviors, and/ or beliefs become characteristic of that group. For

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example, lesbian, gay, and bisexual (LGB) culture includes a shared history of the oppression, symbols, art, education, and experiences of those who identify as LGB. Annual Pride marches, rainbow flags and upside-down triangles, expressive slang, and elaborate styles of dress all exemplify aspects of LGB culture.

Sexual Orientation Sexual orientation is considered fluid and dimensional and pertains to the emotional, romantic, and sexual desire, fantasies, and attraction one may have for others. In general, a person can be oriented toward others of the opposite gender, ­ the same gender, and/or all genders. Thus, the terms lesbian, gay, bisexual, pansexual, and, more recently, queer are used to describe sexual orientation. Additionally, there are some people who may not be sexually orientated toward others at all or use other terminology to denote their unique ­experience of attraction. Sexual orientation is one part of an overall sexual identity, which can include one’s gender, romantic preferences, and sexual practices. As a whole, individuals who do not identify as heterosexual or straight (i.e., ­lesbian, gay, bisexual, or queer [LGBQ] persons) are considered to be sexual minorities, compared with heterosexuals, who constitute a sexual majority. Significant literature describes the numerous physiological and psychological correlates of sexual orientation. The work of Alfred Kinsey, ­William Masters, and Virginia Johnson is credited with pioneering the exploration of sexuality and illustrated the complex nature of desire, attraction, and arousal. Subsequent research has attempted to identify an individual basis for sexual orientation, including genetics, personality, and social circumstances. Notably, prior to the removal of ­ homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973, ­initial research on sexual orientation focused on heterosexuality as the social norm, while same-sex attraction was considered a deviation from this norm that has social implications. Experiences of discrimination and prejudice among LGB people are well documented in the literature given the heteronormative (e.g., heterosexuality is considered the norm) aspects of society.

Intersections and Implications The implications of biculturalism and sexual orientation differ depending on the individual’s ­ sexual orientation. Coming to a bicultural identity may be complicated by the added strain of coming to terms with same-sex attraction, particularly because the perspective on and treatment of that attraction may differ between cultures. For example, one culture may have greater acceptance of diverse sexual orientations, while another espouses homophobic expectations. This difference is often described as a conflict between cultures. In contrast, the cultures may align on certain values. For instance, both cultures may recognize heterosexuality as the only viable sexual orientation. Given the myriad combinations of cultural agreement and disagreement, it follows that the intersection of biculturalism and sexual orientation manifests in myriad ways depending on which perspective on biculturalism is taken. These concepts overlap in three interrelated ways: (1) in separate yet related bicultural and sexual orientation identities, (2) when considering biculturalism as a framework to understand sexual orientation, and (3) as a ­combination of the first two. First, a person can have a bicultural identity as well as a sexual orientation. If biculturalism is understood to refer to cultures based on ethnicity, race, or nationality, then a person may be considered bicultural with a separate sexual orientation. For example, a South Asian American heterosexual woman may be bicultural on the basis of her ­ethnicity and nationality while holding a separate (yet related) heterosexual sexual orientation. The aforementioned processes of development and the consequences of the milestones associated with a bicultural identity are illustrated in this example as well. A second way to envision this overlap is to consider biculturalism as a framework to understand how sexual minorities navigate marginalized identities in the context of the dominant culture. Here, an expanded definition of culture is necessary to understand how this connection can be made. When expanding the definition of biculturalism to include cultures based on other social identities, such as sexual orientation, it becomes possible to recognize how a person’s sexual orientation experiences may be bicultural in nature. This relates

Biculturalism and Sexual Orientation

well to the experiences of those who identify as bisexual; these individuals must be able to respond to the demands of both the heteronormative dominant culture and the gay culture. The literature suggests that part of a bisexual and bicultural experience means having to contend with ostracizing forces that pressure one to “choose” a side despite a subjective preference to “straddle” both communities. Last, these two perspectives may be combined to explicate the experiences of LGBQ people of color, whose experiences of being double minorities demarcate the intersectional properties not only of oppression but also of privilege. Research suggests that LGBQ people of color’s experiences are unique given a White-dominated larger LGBQ culture. Taken together, this means that in addition to living in their heritage or home culture they are also living within the dominant White culture and simultaneously navigating the culture demands associated with their sexual orientation. Racism from within the LGBQ community and homophobia from within their ethnic or racial communities are commonly cited structural issues affecting the lives of LGBQ people of color. Successful navigation also requires an ability to cope with discriminatory practices within both groups of belonging. At times, attempting to merge cultures may prove discouraging for some and affect their sense of efficacy and life satisfaction. Thus, marginalization from both groups based on belonging to both groups is also tied to psychological distress. Fortunately, the literature suggests that this process need not be perpetually straining, that the distress can be ameliorated by one’s ability to feel secure and ­confident in one’s position. A person is considered biculturally efficacious when they are able to feel grounded and knowledgeable, and able to pull from a vast repertoire of cultural information populated by both cultures. Research regarding bicultural self-efficacy identifies a positive relationship with overall self-efficacy, though it is considered unique. This form of self-efficacy and competence then allows an individual to be more successful in navigating the challenges of a bicultural existence. Thus, it is probable that the process of bicultural identity integration can prepare one to cope more effectively with developing an LGBQ identity. Biculturalism and sexual orientation are concepts that, when considered together, illustrate the

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nuanced, complex, and intricately interwoven aspects of identity. This intersection illustrates the possibility of singular bicultural identities as well as dual bicultural identities. A breadth of research exists that explicates the various implications of multiple identities. These intersections have implications for minority stress, a concept that describes the unique and additive stress of identity-based marginalization. Minority stress has implications for health and mental health disparities among racial, ethnic, and sexual minorities. Due to the underrepresentation of LGBQ people in society, their experiences are often overlooked or obscured. Scholars have termed this phenomenon “intersectional invisibility,” which occurs when a person does not conform to the prototypical image for a given identity. For example, if the prototype for a gay person is a White male, then seeing a Latino male may be disconcerting and may lead to misrecognition of diverse experiences. This has an impact on one’s developing a positive self-concept in the absence of self-efficacy and support. Recognizing the benefits of both cultures enhances one’s appreciation and understanding of each at times and can have an ameliorating effect on stress. Being able to live along the margins is also tied to increased flexibility and tolerance for living ­outside of the box. Thus, developing a sense of efficacy can improve one’s competence in navigating one’s worlds and having the best possible psychological outcome. Aasha B. Foster and Melanie E. Brewster See also Asexuality; Biphobia; Bisexuality; Heterosexuality; Homosexuality; Minority Stress; Queerness; Sexual Orientation Identity

Further Readings Brown, L. S. (1989). New voices, new visions. Psychology of Women Quarterly, 13, 445–458. doi:10.1111/ j.1471-6402.1989.tb01013.x Fassinger, R. E., & Arseneau, J. R. (2007). I’d rather get wet than be under that umbrella: Differentiating the experiences and identities of lesbian, gay, bisexual, and transgender people. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (pp. 19–49). Washington, DC: American Psychological Association.

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LaFromboise, T., Coleman, H. L., & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395–412. doi:10.1037/0033-2909.114.3.395 Nguyen, A.-M. D., & Benet-Martínez, V. (2007). Biculturalism unpacked: Components, measurement, individual differences, and outcomes. Social and Personality Psychology Compass, 1, 101–114. doi:10.1111/j.1751-9004.2007.00029.x Parent, M. C., DeBlaere, C., & Moradi, B. (Eds.). (2013). Approaches to research on intersectionality: Perspectives on gender, LGBT, and racial/ethnic identities [Special issue]. Sex Roles, 68, 639–645. doi:10.1007/s11199-013-0283-2

Biculturalism Identity

and

Transgender

Biculturalism and transgender are terms that represent the intersection of multiple identities, such as race, gender, culture, and citizenship. Biculturalism is the integration of two cultures, and transgender identity refers to constructions of gender beyond that of a binary (i.e., man or woman). Both constructs represent belonging to multiple identities and are important to understanding the complexities and dimensionality of identity. The purpose of this entry is to introduce and describe bicultural socialization among transgender populations and the implications of the transgender experiences for biculturalism. This entry begins with a brief description of biculturalism and transgender identity within psychological literature, followed by a discussion of how these constructs intersect and combine to create unique experiences of navigating multiple identities and oppressions.

Biculturalism Biculturalism is typically associated with the process and experience of integrating two cultures within one individual. It is closely linked in the field of psychological research with the construct of acculturation, or how one learns and adapts to a new culture. Within many proposed frameworks for the acculturation process, biculturalism is considered one way to successfully blend two cultures. Biculturalism is distinct from monoculturalism, or

inhabiting a single culture, and multiculturalism, or celebrating diversity and exchanging cultural artifacts. The process of becoming a bicultural individual begins with exposure to one culture (the heritage culture), followed by or in conjunction with exposure to a second, dominant culture. This ­ exposure is said to lay the foundation for a bicultural identity by developing dual cultural ­ knowledge. Biculturalism can develop in myriad ways, including forced or voluntary immigration, intercultural marriage, domestic and international travel, national conflict, education and the media, or birth or adoption. As a result, there is variation in biculturalism and the ways in which individuals negotiate and combine cultural identities to create unique personalities. Biculturalism requires awareness of both cultures and depends on several ­factors that affect how the individual chooses to internalize the value and meaning of each culture. Despite the varying routes to biculturalism, the process itself requires personal integration and an individual and reflective process. Researchers have attempted to study biculturalism in its many facets: (a) the psychological impact of being bicultural and how best to measure adjustment, (b) the process of acquiring a second culture, (c) the construct of bicultural competence, and (d) the individual characteristics that contribute to the development of biculturalism. Initial research suggests an inevitable conflict when two cultures merge. This assumption of incompatibility is based on the assumed ­differences between the cultural norms and expectations for participation and identification. For example, there are different expectations for the way one should look, feel, and act in society. The way a person presents their gender, behaves as a gendered person, and feels about their gender are embedded in and communicated through socialization processes. Conflict between cultures can also occur when parents raise and socialize their children using practices and beliefs incongruent with the dominant culture. This is often seen between the first and second generations in immigrant families. Notably, being raised in a ­ bicultural environment does not always necessitate that an individual develop a bicultural worldview—the possibility of a monocultural ­ identity still remains.

Biculturalism and Transgender Identity

The development of an adaptive and integrated identity drawing on both cultures is often ­complicated by competing or contradictory ­cultural expectations. For example, if the cultural expectations for a woman are to be passive, collectivistic, and submissive, how then would a 16-year-old Latina girl living in the United States integrate the expectations of her heritage culture with the dominant cultural values of independence and assertiveness? Encountering conflicting cultural norms has psychological consequences resulting from the various degrees of acculturation (e.g., taking on the cultural characteristics of the environment through processes of assimilation, separation, and marginalization). Feeling torn and unable to meet both sets of conflicting standards may produce emotional and psychological distress for some bicultural individuals. In some cases, biculturalism is found to offer an advantage over monoculturalism due to the flexibility, perspective, empathy, and awareness developed during the process of integration. Conflict arises when the individual perceives the two cultures as incompatible. Individual factors such as personality traits, affective states, sense of selfefficacy, and salient life experiences can also influence how one utilizes cultural knowledge to maneuver socially. More specifically, how a person evaluates and emotionally responds to the differences or perceived distance between cultures will determine the process of acculturation or development of a bicultural identity. Therefore, dual membership can be a problem if the individual ­ internalizes the conflict between the two cultures, but harm is not necessarily an outcome for all individuals who are bicultural. Teresa LaFromboise and colleagues conducted a multidisciplinary literature review and produced a model of bicultural competence. Bicultural competence can be achieved through the development of competence in both cultures, as well as with self-sufficiency and ego strength (e.g., the sense that one can successfully integrate identities or cultures), communication skills, an understanding of the myriad roles and responsibilities, and a sense of being grounded in both cultures. These factors enable a person to withstand the destabilizing experience of being caught between two worlds, such that they can understand themselves from both outside and within.

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Transgender Identities The understanding of transgender identities, much like that of biculturalism, has expanded to include multiple identities and environmental stressors within an interactive web. Transgender people share a similar experience as existing between two worlds, those of both man and woman, as well as many other variables that coalesce to form the individual experience of being transgender. Transgender, sometimes abbreviated to trans or trans* is also used as an umbrella term for persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex they were assigned at birth. Notably, not everyone who appears to be gender nonconforming will identify as transgender, though it can be helpful to summarize diverse experiences under this overarching term. Transgender identities may represent a transgression from the traditional depiction of gender as binary and conflated with biological sex. Referred to as a gender transgression, it can ­reference not solely the trans person’s experience but also any action or attitude that defies traditional gender norms and expectations. Thus, though a person may not identify as transgender despite having a gender nonconforming presentation, she/he/they could still be considered a gender transgressor.

Bicultural Transgender Experience Bicultural and transgender individuals both endeavor to integrate competing narratives of how to be a person in the world. Thus, being both transgender and bicultural requires navigating and negotiating countless combinations of conflicting cultural and gender-related social expectations. Little research explicitly articulates how transgender individuals are biculturally socialized or achieve bicultural competence, nor is it clear how their gender identity development and other salient psychosocial factors may affect the process of acculturation. For example, gender roles, expectations, and demands associated with the assigned sex and expressed gender vary depending on the culture of origin and the secondary culture being integrated. The transgender bicultural person may move in and out of minority statuses based on the

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perception of others and social conformity. Their choices of behavior may be heavily influenced by the context. The individual may select and behave according to cues from their environment about which culture or gendered behaviors and norms to enact. It is not clear if being exposed to a second culture is adaptive or maladaptive for transgender individuals. The issue of biculturalism and ­bicultural competence is complicated by societal expectations pertaining to how one should express gender, which vary from culture to culture with some overlap and some differences. Certain physical markers of femininity and masculinity are both overtly and subtly conveyed based on gender, including appropriate style of dress, pitch of voice, gait, and attitude. For the transgender person, whether they “pass for” or are objectively received as their expressed gender can affect their ability to actively define and successfully cultivate their bicultural identity. Therefore, a transgender person may be forced to conform to standards based on their assigned sex rather than the way they want to be seen. The ability to both “pass for and confirm” different aspects of gender and cultural identities can mitigate the negative consequences of marginalization. However, eliminating the choice to pass for or confirm can have negative effects on the individual’s psychological wellbeing. If they are not understood and supported through this process, symptoms of distress, such as depression, social anxiety, and possible suicidality, may occur. Bicultural and transgender identities require thoughtful consideration of complicated, yet flexible, terms. One particularly difficult aspect of the combined transgender-bicultural experience are the competing views, reference points, expectations, and norms from each culture. If one culture is more accepting of trans identities or gender transgressions while another is less affirming, the trans person may find themselves grappling not only with how to make sense of their gender ­identity but also how to fit this within their experience of two different cultures. When two unique identities intersect, the individual must integrate additional information into a coherent sense of self. This process is further complicated when the messages conflict, as is often the case. For example, a conflict may arise if a bicultural transgender

person feels pressured to “come out,” a norm of Western, White, LGBT culture. The value of individualism is inherent in the concept of “coming out,” which may feel contradictory to aspects of their cultural identity that emphasize collectivist values. As the individual comes to terms with their identity as transgender, they are also operating within a bicultural framework. Therefore, someone who is both bicultural and transgender is often influenced by both their own level of acculturation as well as the differing levels of acculturation among their family. The individual must differentiate while retaining connection to both cultures, without internalizing heteronormative or other prejudicial biases. Successful bicultural integration among transgender people would require merging the dominant, binary gender culture and their own ­nonbinary identity. Inherently, this may produce a conflict. However, similar to the findings on bicultural identity integration, some individuals cope better with multiple intersecting identities due to various personality traits (e.g., self-­efficacy, cognitive flexibility, etc.). Labeling oneself as a woman or man of trans experience, as opposed to a trans-woman or -man, can be seen as a way of integrating competing expectations from the dominant and minority cultures. “Trans-woman” positions the minority status first, while “woman of trans experience” positions the dominant identity first. This shift in language allows diversity among transgender experiences and identities to be inferred. Furthermore, the process of making sense of one’s socialization of gender for the transgendered person (to conform and adhere to the gender expectations of another g­ ender) could be seen as parallel to that of developing a bicultural identity. The psychological struggle ­ that accompanies the personal formation of gender identity is immense. For those who wish to pursue surgical or hormonal intervention to affirm their gender, numerous mental h ­ealth– related prerequisites are required. Though typically explained as a way to confirm one’s desire to live and be perceived differently, this process is also a time in which they will be personally exposed to the culture of that gender and begin the initial process of merging their previous gender socialization with their present gender expression.

Bi-Gender

Biculturalism and transgender identities are interdependent social identities that interact ­intersectionally to create complex and multidimensional phenomena. Every group exists within a matrix of other social organizations, thus creating value in examining the combined effects of identities, as the sum may be greater or less than the parts. Therefore, the psychosocial experiences of bicultural and transgender individuals are highly varied, suggesting great differences in the way they navigate the processes. These individuals face constant challenges, such as meeting the highly ­ coveted, and sometimes contrasting, norms of the ethnic and mainstream cultures. They must learn to deal with these conflicts and the cognitive dissonance induced by the circumstances, or else they are at risk for psychological distress. Self-efficacy regarding the ability to manage two cultures and a complex gender identity is particularly important. Successful integration of these identities is deserving of attention due to the potential psychological consequences of poor adjustment for divided and compartmentalized identities. Further research is needed on the specific factors that have an impact on the development of bicultural and transgender identities. Aasha B. Foster, Joanna C. Min Jee Rooney, and Melanie E. Brewster See also Biculturalism and Sexual Orientation; Cultural Gender Role Norms; Multiracial People and Transgender Identity; Transgender Studies; Transphobia

Further Readings Burnes, T. R., & Chen, M. M. (2012). The multiple identities of transgender individuals: Incorporating a framework of intersectionality to gender crossing. In R. Josselson & M. Harway (Eds.), Navigating multiple identities: Race, gender, culture, nationality, and roles (pp. 113–127). New York, NY: Oxford University Press. Nguyen, A.-M. D., & Benet-Martínez, V. (2007). Biculturalism unpacked: Components, measurement, individual differences, and outcomes. Social and Personality Psychology Compass, 1, 101–114. doi:10.1111/j.1751-9004.2007.00029.x Stryker, S., & Whittle, S. (2006). The transgender studies reader. New York, NY: Taylor & Francis.

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Bi-Gender Broadly defined, bi-gender, sometimes represented as bi+gender or bigender, describes an individual who shifts between masculine and feminine gender identity and behaviors across time, activities, and context or setting. Some bi-gender individuals have distinct male and female personas, whereas others may express masculinity and femininity alternatively, and some others have a mixed or fluid ­gender expression most of the time. The American Psychological Association (APA) recognizes ­bi-gender as a subcategory of transgender identity. While some bi-gender individuals report a sense of agency and self-determination that contributes to the experiences of their gender identity, others report an involuntary and unpredictable switching across and between their gender identities, which can cause significant intra- and interpersonal ­distress. This entry begins with a discussion of the evolution of recognition of bi-genderism and then describes some of the disparities in where and how bi-gender identity and experience are represented. Next, several case studies, media representations, and narratives are examined, leading to a discussion of current research into the complexities of bi-gender identity. Last, this entry reviews some emerging scientific literature providing early biological support for bi-gender identity.

Defining Bi-Genderism Historically and across a variety of cultures, sex and gender have been synonymous, meaning that the chromosomal, hormonal, and anatomical markers of sex have not been distinguished from the psychological sense of one’s gender. As part of the lesbian, gay, bisexual, and transgender (LGBT) movement, it has been increasingly recognized that one’s sex and gender may differ and that these can both be independent from one’s affectual identity. As such, more individuals are openly identifying as intersex and transgender. Although individuals and communities self-identify with a plethora of gender nonconforming identities, a 1999 survey of the transgender community conducted by the San Francisco Department of Public Health noted that almost 3% of individuals who were assigned male at birth identified as bi-gender and almost 8% of

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individuals who were assigned female at birth identified as bi-gender. As the transgender and gender nonconforming communities (e.g., agender, androgyn, genderqueer, nonbinary, third gender, two spirit) continue to be marginalized and are notoriously underrepresented in research, it remains unclear how many individuals identify as bi-gender at any point in time. However, bi-gender identities are widely ­represented in social media, such as on Facebook, Tumblr, and Instagram, as well as on bi-gender-specific Internet sites such as Bigender.net Journals. Bi-genderism and bi-gender individuals are largely underresearched and unrecognized in scholarly literature, with a few notable exceptions. ­Bi-gender is referenced in two qualitative studies: (1) Sarah F. Pearlman’s 2006 study of mothers’ experiences of transgender sons and (2) Daniel Welzer-Lang’s 2011 piece on biphobia. Since 2011, several case studies and narratives have emerged in popular media and in the blogosphere. A 2015 episode of the podcast Invisibilia focused on the experience of a bi-gender identified individual who described their gender identity as being in flux, flipping between male and female depending on environmental contexts or physiological stimuli. Since the airing of the episode, the participant has spoken out, reporting that she no longer flips and now identifies as a queer trans* woman. While some may see bi-gender as a temporal identifier or developmental stage, there is diversity in the characterization of bi-genderism. A 30-year-old ­ individual featured in “Transgender Stories,” which appeared on the New York Times website, described bi-gender as a gradation of the transgender spectrum and identified as a ­“bi-gendered male and female”; it should be noted that although identifiers in the past tense (e.g., “bi-gendered”) are typically frowned on in the LGBTQ movement, this was the specific identifier utilized by the person in the New York Times article. Likewise, several other bi-gender individuals have described their identities as bi-gender queer or bi-gender trans*.

Representations of Bi-Genderism Among the popular accounts of bi-gender individuals across various media, most, with a few exceptions, characterize bi-gender as the flipping, or switching, between male and female gender

identities. These flips have been reported as lasting for moments, days, weeks, and/or months and are often involuntary and unpredictable. In most narratives, the change in gender includes a parallel shift in gender presentation, with clothing, grooming, and expectations for physicality commensurate with the social and/or personally ­identified norm for the inhabited gender, such as wearing dresses when female identified or growing facial hair when male identified. Narratives and case studies of bi-genderism are distinct from those of other intersecting gender orientations, including genderqueer and genderfluid. In bi-gender discourse, gender is typically described primarily in dichotomous terms: The individual is either male or female, although these genders are embodied in a singular vessel. Bi-gender individuals report diverse sexual orientations and affectual preferences, with several describing a romantic partner who is equally attracted to both genders.

Emerging Research While gender has been theorized as a social ­construct, in a 2012 study with bi-gender individuals, Laura Case and Vilayanur Ramachandran identified higher levels of specific neuropsychiatric occurrences associated with bi-genderism. ­Specifically, the authors found that persons who identified as bi-gender were likely to switch genders without an amnesia state; most reported ­experiencing phantom breasts or genitalia while in their nonbiological gender state, and a decreased lateralization of handedness. These findings, taken together, led the authors to suggest that there is a biological basis for bi-genderism, defined by the authors as alternating gender incongruity (AGI). The authors went on to hypothesize that AGI may be related to an unusual degree or depth of hemispheric switching, as well as corresponding callosal suppression of sex-appropriate body maps in the parietal cortex (specifically the superior parietal lobule) and its reciprocal connections with the insula and hypothalamus. The rationale for their line of reasoning was twofold: (1) there was an elevated rate of reported bipolar disorder among the bi-gender individuals in the study, and bipolar conditions have been scientifically linked to slowed hemispheric switching, and (2) there is a historic

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association between the brain hemispheres and gender. Although it is intriguing, this study is a first step toward better understanding of bi-gender identity from a biological perspective. Following from this quantitative and qualitative work, it appears that the bi-gender identity is a distinct subset of trans* identity and is worthy of further exploration. The experiences expressed by bi-gender persons continue to challenge conventional notions of gender, how gender is experienced, as well as how sex and gender influence and are influenced by biological, social, cultural, and other mechanisms. Psychologists and counselors alike may benefit from learning more about this identity. Melissa Luke, Cara A. Levine, and Kristopher M. Goodrich See also Gender Fluidity; Genderqueer; Trans*; TwoSpirited People

Further Readings Behan, C. (2006). Talking about gender in motion: Working with the family of the transgender person. Journal of GLBT Family Studies, 2(3/4), 167–182. Case, L., & Ramachandran, V. (2012). Alternating gender incongruity: A new neuropsychiatric syndrome providing insight into the dynamic plasticity of brainsex. Medical Hypotheses, 78(5), 626–631. doi:10.1016/ j.mehy.2012.01.041 Clements, K., & Clynes, C. (1999). The transgender community health project: Descriptive results. Retrieved from http://hivinsite.ucsf.edu/InSite?page= cftg-02-02 Pearlman, S. F. (2006). Terms of connection: Mother-talk about female-to-male transgender children. Journal of GLBT Family Studies, 2(3/4), 93–122. Welzer-Lang, D. (2008). Speaking out loud about bisexuality: Biphobia in the gay and lesbian community. Journal of Bisexuality, 8(1/2), 81–95.

Biological Sex Development

and

Cognitive

Group differences in intelligence is a controversial topic of research, and psychological researchers

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have been criticized on the basis of their views. One internationally known example of this trend occurred when the president of Harvard University, Lawrence Summers, suggested in 2005 that women’s (relative) lack of mathematical ability explained the sex differences in science faculty at the postsecondary level. This research is quite complex in that researchers may come up with vastly differently conclusions. For instance, a European male psychologist who might write a book chapter entitled “Sex Differences in Intelligence” may come to radically different conclusions from an ­American female psychologist who writes a similar review titled “Gender Similarities in Cognitive Abilities.” Either scholar may not cite each other’s work, may draw on very different studies, and come to radically different conclusions. Many people want to believe that men and women are equal not only in potential but also in ability. They argue that even if there are small but actual, verifiable ability differences they should not be explored or explained because of the divisive effect that it will have on both sexes. Given the limited quality and quantity of research in the area of gender and sex differences, there is a great deal of popular debate about things such as the sexlinked glass ceiling, cliff, escalator, and “sticky” floor—all of which imply that career opportunities are quite different for men and women. This entry examines popular versus scientific perceptions of cognitive development and sex differences, discusses both research and theorizing on the topic, and proposes future directions for study.

Popular Versus Scientific Conclusions One reason why there may be differing opinions on the subject of sex differences and cognitive abilities is the contradiction between popular and scientific writers. There are many popular books that portray a simple evolutionary perspective that describes, and often rejoices in, sex differences in almost all human behavior—particularly communication, relationships, and work. These works are contrasted with measured and cautious academic books and articles that note how complex some of these seemingly simply questions are and how all the answers require numerous qualifiers. Further studies on lay people’s beliefs about their own and others’ intelligence consistently

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show that everybody believes they are “above average.” Also known as the Lake Wobegon effect (a term coined by David G. Myers), people have a natural tendency to overestimate their own ­abilities. Despite this, females of all ages think that they are less intelligent than men, specifically in terms of spatial and mathematical intelligence. Yet women do rate themselves higher on emotional ­intelligence. Lay people are likely to believe these differences to be greater than the scientific literature has shown. In comparing differences between the sexes, there are two strongly competing, opposite forces: (1) those who stress the biology of difference and (2) those who stress the sociology of similarity. The former often suggest that these differences are immutable, though we know that all innate traits can be changed with experience. While nearly everyone acknowledges that humans are biopsychosocial beings, there are those who see humans more as biologically oriented than biopsychosocial. Such worldviews affect how one explains or interprets the observed differences. Furthermore, some scholars argue that well-established sex differences in abilities, personality, and values ­ inevitably lead to both different occupational choices and adaptation to those jobs. Others want to stress the social forces that for a variety of ideological reasons have pre- or proscribed gender differences at work that do not exist.

Definitions of Differences At the heart of this issue is the quality and quantity of the differences, as well as their cause and consequence. Though the focus has always been on differences, the trend has been to talk of similarities, which is what a great deal of the literature s­ uggests. Indeed it has been argued that the word difference is too easily confused with deficiency. Reviewers of this topic can be described as maximizers versus minimizers. Maximizers want to find and explain the (many large) differences between the sexes, while minimizers want to emphasize how few differences there are. Part of this debate can be seen in the interpretation of a statistic called Cohen’s d, which is an indicator of difference. While there are conventions about how to label the difference—as no, trivial, small, medium, large, and very large— even this is contested. Thus, minimizers are happy to see that many differences are trivial and

dismissible as unimportant in every sense, while maximizers are eager to describe and explain all the differences that they find.

Research Implications Psychologists and other researchers in this area are mindful of the radical claims that are made on the basis of poor studies. They know how important and difficult it is to do good research that leads to clear answers. Perhaps the best “checklist” has been offered by Diane Halpern, whose standard book on this topic has been through four editions. She suggests a number of questions to be asked that help correctly evaluate the research claims. For example, when examining studies, it is important to note who the participants were and how they were selected. One must examine their ages and background as well as their representativeness in the general population. One can analyze which measures were used and what was their justification, as well as any known psychometric properties they may have. One can consider if the results are consistent with those of other studies and other theories of sex differences; if they are not, then one can question why they were not. Finally, critical thinkers can contemplate on how the results have been influenced, by whom, and where the testing took place. Because scientific research is difficult, time-consuming, and complex, it is important for research methods to be carefully examined and to be deemed both reliable and valid.

Theoretical Positions on Sex Differences Over the past century, there have been periods when both the “difference” and the “nondifference” views were in favor. The growth of environmentalism and feminism from the 1960s onward perpetuated the idea that any observable differences between the sexes were the result of socialization. However, the pendulum from the 1990s onward swung the other way, toward a more ­biological and evolutionary perspective that recognized and “explained” sex difference. There are five major theoretical positions when it comes to sex differences in intelligence: 1. There are no differences at all for one of two reasons: First, there are no good evolutionary

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or environmental theories or reasons to suppose there are, and second, the early tests were so developed to show no difference. That is, tests were included and excluded so that neither sex was advantaged or disadvantaged. 2. There are no mean or average differences between the sexes, but there are differences at the extremes. Thus, men tend to be overrepresented at both extremes of the bell curve. The most brilliant are men and so also the most challenged, meaning the average is the same but the distribution is wider for men. This explains the Nobel Prize phenomenon. 3. There are numerous demonstrable and replicable sex differences in a whole range of abilities that make up overall intelligence. They may be small, but they are definitely there and possibly explicable in terms of evolutionary psychology. 4. Sex differences that do emerge are not real. They occur for three reasons. Females are taught humility and males hubris: This social message leads women and men to approach tests differently. Next, it is less of a social requirement (particularly in mate selection) for girls to be intelligent, so they invest less in education and skill development. Females are less emotionally stable than males, and thus anxiety is reflected in their test performance. Any differences that emerge do not reflect the underlying reality: It is all about attitude toward and experience in test taking. 5. There are real differences between the sexes, with males having a 4- to 8-point advantage, which becomes noticeable after the age of 15 years. Before adolescence, females in fact have an advantage. The difference between the sexes is greatest for spatial intelligence. The difference is reflected in the brain size difference (corrected for body size) between men and women. Furthermore, this “real” difference also “explains” male superiority in the arts, business, education, and science.

There are those now who say that the sex difference in intelligence is important and real. They tend to opt for five arguments:

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1. Similar differences are observed across time, culture, and species (hence, these differences are unlikely to be learned). 2. Specific differences are predictable on the basis of evolutionary specialization (hunter/warrior vs. gatherer/nurse/educator). 3. Brain differences are established by prenatal sex hormones; later on, hormones affect ability profiles (e.g., spatial processing is suppressed by estrogen, but hormone replacement therapy helps maintain verbal memory). 4. Sex-typed activity appears before gender role awareness. At age 2 years, girls talk better, but boys are better at construction tasks. This is not learned. 5. Environmental effects (e.g., expectations, experience training) are minimal. They may exaggerate (or perhaps reduce) the differences.

These arguments have been disputed by researchers who stress sociological processes when it comes to the socially constructed concept of gender. They bitterly dispute the “biology is destiny” fatalism of the evolutionary theorists.

Meta-Analyses In recent years, meta-analyses have acknowledged the sex differences in certain specific abilities. However, researchers point out that these differences are small, though they might have important consequences. In her research, Diane Halpern noted the tasks at which females excel: generating synonyms (associational fluency); language production and word fluency; computation; forming anagrams; memory for words, objects, personal experiences, and locations; and reading comprehension and writing. She argued that the underlying cognitive processes that explain this are rapid access to and retrieval of information in memory. She also reported on the tasks at which males excel: verbal analogies; mathematical problem solving; mental rotation and spatial perception; spatiotemporal tasks (e.g., dynamic visual ­displays); generating and using information in visual images; and mechanical reasoning and some science-related tasks. She suggested that the underlying cognitive

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processes were the maintaining and manipulating of mental representation in visual-spatial working memory. Janet Hyde has worked in this area for a very long time and has an important summary of almost a century of discussion and debate. She noted that there is evidence for the gender similarity hypothesis. She noted two theoretical approaches. First, cognitive social learning theory explains psychological gender differences as being a result of females and males receiving different rewards and punishments for their behaviors, people’s tendency to imitate same-gender models, and cognitive processes such as attention and self-efficacy. Second sociocultural theory argues that contemporary psychological gender differences have their origins in the prehistoric division of labor by gender; once males and females take on different roles, they develop the psychological qualities that equip them for those roles. Hyde concluded that there are far more gender similarities than differences but that there are some large differences. For instance, in threedimensional mental rotation tasks, men do much better; in the personality dimension of agreeableness/tender-mindedness, women score higher than men; in sensation seeking, men score higher; with regard to a greater interest in things versus people, men score higher; in physical aggression, men score much higher than women; and in relation to some sexual behaviors (e.g., masturbation and pornography use), men score higher.

Implications and Future Directions As research on biological sex differences further establishes and explains various trends between the sexes, psychologists can advocate for changes in social policy. Educational institutions, b ­ usinesses, and other institutions may consider how gender differences may be influenced by gender socialization, and create policies that increase ­ opportunities for historically marginalized groups. Furthermore, psychology research can help understand how other social identities may account for these differences—examining demographics such as race, sexual orientation, gender identity, immigration status, age, social class, religion, physical ability status, and other factors. Specifically, future

studies can explore how biological and sociological factors affect outcomes for transgender and gender noncomforming people, who do not identify with the sex they were assigned at birth. Finally, it is necessary for popular media and culture to base their findings on empirical research rather than opinions and beliefs without scientific support. Adrian Furnham See also Biological Sex and Health Outcomes; Biological Sex and Language and Communication; Biological Sex and Mental Health Outcomes; Biological Sex and Social Development; Biological Sex and the Brain; Biological Sex Differences: Overview; Biological Theories of Gender Development

Further Readings Furnham, A. (2007). 50 ideas you really need to know in psychology. London, England: Querkus. Halpern, D. (2012). Sex differences on cognitive abilities. New York, NY: Psychology Press. Hyde, J. (2005). The gender similarities hypothesis. American Psychologist, 60, 581–592. Hyde, J. (2014). Gender similarities and differences. Annual Review of Psychology, 65, 373–398. Lynn, R., & Kanazawa, S. (2011). A longitudinal study of sex differences in intelligence at ages 7, 11, and 16 years. Personality and Individual Differences, 51, 321–324.

Biological Sex and Health Outcomes When discussing sex rather than gender, the terms male and female are appropriate. However, in humans, separating sex from gender is nearly impossible, as gender roles and expectations socialize people to behave in ways that align with what is considered masculine or feminine. Furthermore, transgender and gender nonconforming (TGNC) people may have a gender identity that does not match the sex they were assigned at birth. This entry concentrates primarily on cisgender people (or people who identify with their assigned birth sex) and will refer to those of different sexes as women and men.

Biological Sex and Health Outcomes

Similarities and Differences The sexes are more physically and biologically alike than they are different. Many of the differences that people perceive are the results of culture, social rearing, and learned expectations. Nevertheless, the reproductive systems in women and men differentiate into very different external genitalia, secondary sex characteristics, and hormonal ­secretions in response to differing steroid concentrations in utero. The basic production and time patterns to make ova and sperm (menstrual cycles vs. ongoing spermatogenesis) are also different. In addition, the ranges of normal within each sex make men and women as a whole largely overlap in body size. Although men have a larger muscle mass and women larger fat mass, aerobic potential may be similar. There is a general size difference in internal organs such as the brain, heart, liver, lungs and kidneys; however, men’s organs are larger than women’s in proportion to the whole body’s size. Metabolic differences between women and men relate to women’s greater body fat; sex differences in insulin glucose metabolism remain controversial, although a greater proportion of men than women develop type 2 diabetes mellitus (T2DM). Finally, there are disease differences between men and women. Cancers of the reproductive organs are sex specific, but breast cancer, although more common in women, can also develop in men. Lung cancer has differed in prevalence by sex largely due to gendered differences in cigarette use; with changes in culture, that gap is now narrowing, and women with lung cancer may have a higher mortality. Women are more than twice as likely to develop all types of immune-related diseases, such as rheumatoid arthritis, multiple sclerosis, and inflammatory bowel and thyroid diseases, probably due to the immune activation caused by higher estradiol levels. Cardiovascular diseases (CVDs) occur in men 10 years earlier than in women. Although traditionally this was attributed to women’s higher estradiol (estrogen) levels, that theory has been disproven by multiple, large randomized controlled therapy trials in both men and women. An innovative hypothesis is that ovulatory ­menstrual cycles providing normal estradiol and progesterone levels result in women’s relative cardioprotection. Lung diseases such as chronic obstructive lung disease (COPD) are dominant in

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men—perhaps related to cigarette use; however, asthma is more common in women, in whom morbidity and disability are greater than in men. Osteoporosis, with its manifestation through fragility fractures, is considered an older women’s disease; the higher risk may relate to lower peak cortical bone mass as well as to women’s inevitable bone losses in perimenopause and menopause. Overall, hospitalization for hip fracture is many times higher in elderly women than in similar-aged men. However, when 10-year incident fractures in community-dwelling men and women were documented in a population-based, national sample, hip fracture risks were found to be equal, perhaps due to men’s higher competing mortality. Thus, there are real but few solely sex-related biological differences between men and women.

Reproductive System Differences Gonadal Steroid and Hormonal Differences

Throughout their life cycles, both women and men have measureable levels of all three major gonadal steroids: estradiol, progesterone, and testosterone. These levels are basically equal by sex in childhood but for the first weeks of life may differ by sex. Estradiol and progesterone are markedly higher in premenopausal women than in younger men; testosterone levels remain higher in men than in women through the life cycles of both. Surprisingly, older men’s estradiol levels exceed those in menopausal women. Internal Reproductive Organs and Gametogenesis

Although in both men and women the levels of hypothalamic gonadotropin–stimulating hormone and the pituitary hormones (luteinizing hormone and follicle-stimulating hormone) are the same, they have actions to promote the formation of ova and sperm in very differently organized reproductive systems. Women’s reproductive system is organized in a cyclic fashion, with the majority of hormones of one menstrual cycle produced by the dominant follicle that will subsequently involute rather than by the ovaries in general. Women’s lifetime supply of ova are created when they are in utero, but men’s sperm are produced anew every 3 months or so. The hormones released by specific

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follicles create most of the estradiol and progesterone during pre- and perimenopause; testosterone is made by the ovarian theca in menopausal women. In contrast, men’s testicles both produce the dominant sex steroid, testosterone, and create sperm. External Genitalia

Although there are some rough analogies between women’s vulva and men’s scrotum and between men’s penis and women’s clitoris, the ­parallels end quickly. Men’s testicles hang in the scrotum outside their bodies, in contrast to women’s deeply internal ovaries. Secondary Sex Characteristics

Visible characteristics that indicate the sex of a mature individual include general body shape (women tend to have wider pelvises and narrower shoulders) and the presence of dark and coarse facial hair in men and obvious breasts in women. With male-to-female transgender women, observers may also look to the size of the thyroid ­cartilage (Adam’s apple) to appreciate their biological sex. Breast structure and potential in men and women are surprisingly similar; men can be hormonally treated and successfully lactate. The distinguishing characteristic of the ovulatory woman (or one who has been exposed to progestins, as in hormonal contraception) is the larger size of the areola, the darker-colored skin around the nipple; in nonovulatory women and men, the areola is less than 2 to 3 centimeters in diameter, compared with more than 5 centimeters in mature women.

Body Size Differences Musculoskeletal Systems and Potential for Physical Activity

Human body and musculoskeletal system sizes are highly variable by when in the millennia of human history they are assessed, race, the source population’s general nutrition, as well as sex. Nevertheless, in general, men are larger and have bigger skeletons and more muscle tissue than women. Men’s bone advantage is predominantly in the greater proportion and amount of cortical bone (the hard outer shell of long bones); sisters and brothers in one study, however, showed similar

cancellous bone by spine bone mineral density (BMD) adjusted for body size. Cancellous bone is the honeycomb-like and more metabolically active other type of bone that is in the center of vertebrae, the heel bone, and the ends of long bones. There is considerable debate about sex and potential optimal performance in short-duration versus very long-duration aerobic-type sports. Clearly, men usually excel in power sports and currently in both 100-meter and marathon time ­ records. However, women’s winning times are decreasing more than men’s, and women have beaten men in some ultramarathons and in extended and endurance sports like dog-sled races. Women athletes tend to have more subcutaneous fat than men when both are at their ideal fitness; this may provide the energetic needs for sports with continued exertion extending over many hours or days. Although almost all of the literature on sportrelated disturbances in reproductive hormone production has been about women (prejudicially termed the female athlete triad), it is now clear that insufficient energy intakes for expenditure needs are a fundamental issue in hypothalamic, reversible suppression of ovulation and perhaps the menstrual cycle in women and testosterone and sperm production in men. Internal Organs

In general, the sizes of the brain, heart, lungs, liver, kidney, and thyroid and adrenal glands are finely tuned to body size. Since, as mentioned, body size is usually greater in men than in women, these organs are proportionately larger in men. This is usually not a problem, but it is reportedly a disadvantage during women’s cardiovascular surgery that both the coronary arteries that are obstructed and the blood vessels that are needed for coronary artery replacement are smaller than in men. Metabolism Differences

Prepubertal girls and boys do not differ in the percentage of total body fat or subcutaneous fat; however, after puberty and throughout life thereafter, women store more fat. Furthermore, during exercise, women seem better able than men to use fat as an energy source. In addition, during the

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menstrual cycle’s 10- to 16-day luteal phase ­(following ovulation) as well as during all of pregnancy, both times when progesterone levels are high, women’s core temperature is increased about 0.2 degrees Celsius over the follicular phase and over men’s core temperature. This higher core temperature requires approximately 300 kilocalories greater energy intake for weight stability. Thus, energy stores and energy expenditures differ in women compared with men. Studies of insulin and blood sugar have shown that men are more likely than women to develop T2DM. In addition, when men versus women are enrolled because they have initial insulin ­resistance/ glucose intolerance, despite greater randomized controlled trial–related improvements in weight and exercise, men are equally likely as women to develop T2DM over the course of the study. Much more translational work is required to understand sex differences in glucose/energy metabolism. The metabolism of steroid hormones and medications also appears to significantly differ between men (in whom these drugs are traditionally tested) and women. In addition, metabolism of steroids/ drugs and some environmental contaminants is different by race since those of Asian ancestry have faster steroid metabolism/excretion. Steroid/drug metabolism also decreases with aging in both sexes (inadequate research is available on sex differences in metabolism in older people). The precise differences vary by the chemistry and route of delivery of the drug, the metabolic enzymes involved, and many other variables. These metabolic differences, plus those in body size and body weight, however, may be quite clinically important given the documented higher rate of serious adverse drug effects in women than in men.

Brain and Intellectual Functions Historically, women were thought to have less intellectual potential because of slightly smaller brain sizes; however, this notion is no longer believed or supported through science. Increasing neuroimaging studies are reportedly describing within-brain differences in the dominance of certain neural pathways in men versus women. However, to date the lack of instrumental, population, and reproductive cycle standardization of such studies makes any statements on sex differences

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premature. There continue to be debates about particular sex advantages. For example, some ­consider that spatial and three-dimensional constructs are more advanced in men than in women. By contrast, language acquisition and facility are considered to be a sex advantage enjoyed by women over men. None of these alleged sex differences have so far been definitively proven. Addiction and responses to drugs of abuse may also be somewhat different between men and women. Although men are traditionally more likely to be addicted to cigarettes and alcohol than are women, how much of this is related to past cultural acceptance of their use by men but not by women is not clear. There are some data that indicate that women, compared with men, take ­ less time after first use of an agent before they are regularly using it and become addicted to it. In addition, among women, experiences such as the cocaine “high” appear to be greater during the follicular than during the luteal phase. Thus, much of the literature suggests that younger women’s endogenous estrogens may have a role in these probable sex differences in addiction.

Disease Differences by Sex Cancers

There are sex organ–specific cancers, such as endometrial, cervical, and ovarian cancers, that are exclusive to women; prostate, testicular, and vas deferens cancers are similarly seen only in men. However some sex-related malignancies such as breast cancer may occur in both sexes; breast cancer, however, is 100 times less common in men than in women. Although a few rare cancers are sex chromosome related, most of them show no distinct patterns related to X or Y chromosomes. Childhood cancers of many types, however, show a higher prevalence in boys than in girls, and this is unlikely to be related to gonadal hormone production given their young ages. Overall, men are at higher risk for pharyngeal/ laryngeal, lip, and bladder cancers (probably related to cigarette exposure) than are women. Men also are more likely to develop Kaposi’s sarcoma; this cancer occurs secondarily to human immunodeficiency virus infection, which has historically been more prevalent in men than in

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women. Hepatocellular cancer is also more common in men than in women, but in contrast to the previously discussed malignancies, it does not seem to be associated with sex-different environmental or occupational exposures. Women who develop hepatocellular cancer, however, may experience a more rapidly worsening course and higher morbidity than men, perhaps because of the negative hepatic effects of higher levels of exposures to endogenous estradiol within menstrual cycles or to exogenous estrogen (as hormonal contraception or menopausal ovarian hormonal therapy). Women are at higher risk than men for cancers of the gallbladder and biliary tract; they also are more likely than men to develop malignancies of the thyroid. It is not clear whether autoimmunerelated thyroid diseases (which have a much higher prevalence in women than in men) play a role in women’s greater risk for thyroid malignancy. ­Cancer mortality rate ratios adjusted for all relevant variables and for multiple sites of malignancy appear almost universally to be higher in men than in women; the reasons for this remain unclear. Autoimmune Diseases

Autoimmune-related diseases of many organ systems occur in both sexes but have a markedly higher prevalence in women than in men. This sex discrepancy is thought to be associated with the actions of estradiol to up-regulate the immune system. It is also known that progesterone (which is high only in the luteal phase of women and during pregnancy) and testosterone (which is high only in men) act to down-regulate immune function. Thus, ovulatory disturbances and silent anovulation may play a role in risks for these diseases in women. Of the many diseases that predominate in women, rheumatoid arthritis, inflammatory bowel diseases (Crohn’s disease and ulcerative colitis), and both Graves’ disease and Hashimoto’s thyroiditis are most prominent. Much more needs to be learned about the roles of immune function and sex steroids in the susceptibility of humans to a number of diseases and in their responses to vaccinations. Cardiovascular Diseases

With aging, women and men both experience increased risks for CVDs such as coronary artery

diseases (CADs), including acute myocardial infarction, and stroke. Since CADs and stroke differ by age-specific prevalence and morbidity/ ­ mortality, they will be discussed separately. CAD occurs at an age that is about 10 years younger in men than in women; although for both men and women CVD is the major cause of death, the rate of CAD in women never reaches that in men. Although estrogen deficiency (commonly considered to occur in menopause) has been blamed for women’s CAD, its incidence creates a straight line through the 40s to 60s decades, during which menopause occurs for women. Age-specific stroke rates are higher in men than in women, but since women live longer and have strokes at older ages and more events, stroke morbidity and mortality are higher in women. Women are also less likely to receive the potentially preventive early antithrombotic therapies (which likely reflects gender influences in health care rather than sex). Respiratory Diseases

There are two major chronic lung diseases, COPD and asthma. These two common diseases have differing prevalence and, perhaps, pathophysiology by sex. COPD is strongly related to prolonged cigarette use and thus (for largely gendered reasons) has a higher prevalence in men. In women, however, there is a significant increase in the age-specific and population prevalence of COPD related to increasing cigarette exposure; this cigarette dose–related increase in COPD is not seen in men. Dementia

Dementia, defined as a chronic and/or persistent disease of mental processing, in particular with an early inability to remember recent events/experiences, is also associated with personality problems and reasoning difficulties. Dementia and its agerelated type called Alzheimer’s disease are prominent problems in older women and very prevalent in extended care or nursing home populations. However, whether the incidence of dementia differs by sex or the visibility of dementias in older women is related to their longer life expectancy is not known. Several recent studies, one with two different population-based sets of nonidentical

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twins and another a prospective study (5.7-year duration) with a large random, population-based sample, among others, have shown that initially normally functioning men and women are equally likely to develop dementia. The specific subtype of dementia called vascular dementia, however, more commonly develops in men than in women. Osteoporosis

Osteoporosis can be defined as a BMD value in an adult man 50 years or older or in a menopausal woman that is more than 2.5 standard deviations below the normal ranges in people 20 to 30 years of age. Another diagnosis is based on the 10-year risk for a fragility fracture at common sites (i.e., the forearm, called a Colles fracture; the vertebrae in the back; the hip or humerus; or the upper arm near the shoulder), calculated from region/nationspecific rates, based on a set of risk factors (e.g., a parent with a hip fracture), with or without the addition of the BMD relative to normal values for youth. Women accounted for 72% of hospitalizations for hip fractures in one national study, suggesting that osteoporosis is a disease of older women. However, when a random sample of the population was prospectively observed over a period of 10 years, those men and women who were living in the community at baseline had a similar incidence of hip fracture. Since the incidence of hip fracture increases with age and women live longer than men, osteoporosis prevalence in men is competing with their mortality risk. That is, they may not live long enough to fracture. However, in those with hip fractures, the 1-year mortality is higher for men than for women. Jerilynn C. Prior See also Biological Sex and Mental Health Outcomes; Biological Sex and Social Development; Biological Sex Differences: Overview; Sexism; Sports and Gender

Further Readings Buist, A. S., McBurnie, M. A., Vollmer, W. M., Gillespie, S., Burney, P., Mannino, D. M., . . . BOLD Collaborative Research Group. (2007). International variation in the prevalence of COPD (The BOLD Study): A population-based prevalence study. Lancet, 370, 741–750.

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Cook, M. B., McGlynn, K. A., Devesa, S. S., Freedman, N. D., & Anderson, W. F. (2011). Sex disparities in cancer mortality and survival. Cancer Epidemiology, Biomarkers & Prevention, 20, 1629–1637. Gatz, M., Fiske, A., Reynolds, C. A., Wetherell, J. L., Johannsson, B., & Pederson, N. L. (2003). Sex differences in genetic risk for dementia. Behavior Genetics, 33, 95–105. Lynch, W. J., Roth, M. E., & Carroll, M. E. (2002). Biological basis of sex differences in drug abuse: Preclinical and clinical studies. Psychopharmacology, 164, 121–137. Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., . . . Ljungqvist, A. (2014). The IOC consensus statement: Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 48, 491–497. Prior, J. C., Langsetmo, L., Lentle, B. C., Berger, C., Goltzman, D., Kovacs, C. S., . . . CaMOS Research Group. (2014). Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study: Comparing site and age-specific risks in women and men. Bone, 71, 237–243. Reeve, M. J., Bushnell, C. J., Howard, G., Gargano, J. W., Duncan, P. W., Lynch, G., . . . Lisabeth, L. (2008). Sex differences in stroke: Epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurology, 7, 915–926. Tunstall-Pedoe, H. (1998). Myth and paradox of coronary risk and the menopause. Lancet, 351, 1425–1427.

Biological Sex and Language and Communication People believe that men and women communicate differently. Women are thought to be more talkative and affiliative or considerate of others, whereas men are thought to communicate both verbally and nonverbally in a more dominant and assertive manner than women do. But are these differences real? This entry examines the differences and similarities in communication between cisgender men and women and reviews theoretical explanations to account for any differences. The term biological sex will be used to connote physiological differences between cisgender men and

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women, while gender will be used to describe socialized psychological differences.

Sex Differences in Verbal and Nonverbal Communication Many studies have been conducted on gender effects in communication between men and women. Although women are perceived to be more talkative than men, research reveals that, across a variety of social and professional contexts, adult men actually talk slightly more than adult women do, with men producing more sentences and speaking for longer periods of time. The pattern is different for children. Overall, girls are slightly more talkative than boys. Counter to the stereotype, these results do not reveal a clear pattern of greater female talkativeness. Beyond total quantity of speech, there are also sex differences in the content of speech. Consistent with gender stereotypes, when examining broad categories of assertive or affiliative speech, studies have shown that men’s speech is generally more assertive and women’s generally more affiliative or considerate. Looking at particular behaviors, women more often disclose personal information about themselves, communicate approval and praise, show active understanding of others, and express support for or solidarity with others. Women also speak in a more mitigated or indirect manner (e.g., adding tag questions such as “Don’t you think?” to the ends of sentences or adding expressions like “sort of” or “maybe” to statements). Men make suggestions, contribute opinions or directions related to a task, and interrupt others more often than women do. Men and women do not differ in the extent to which they criticize, disagree, issue directives, contribute information, agree with others, or acknowledge ­ that they are listening. The gender differences that have been found are small, except for women’s active understanding and support of others, which were moderate in size. In general, then, women’s communications are somewhat more personal and considerate of others, and men’s communications are somewhat more directed at getting a task done, gaining the floor in the conversation, and speaking more overall. Scholars have also considered men’s talkativeness to be another instance of male assertiveness, giving additional credence to the ­

stereotype that men use language to assert themselves. However, counter to the stereotype, there is no compelling evidence that men’s communications are highly dominant relative to women’s. A considerable amount of research has also been done on nonverbal communication and biological sex, focusing in particular on visual dominance, verbal reinforcement, touching, smiling, and facial expressiveness. Visual dominance is measured as the relative amount of time people maintain eye contact while speaking compared with listening, with higher levels reflecting more assertiveness. Verbal reinforcement, which involves nodding or making minimal vocalizations (e.g., “uh huh,” “yeah”) while others are speaking to encourage them to continue, is affiliative. Smiling is primarily affiliative. Touching and facial expressiveness can be either assertive or affiliative. Observational studies show that men have greater visual dominance and women more often verbally reinforce others, smile, and are expressive. Of all these behaviors, the evidence of a gender effect is especially strong for smiling, where the difference is moderate in size. Finally, there are no differences overall in the rate at which men and women touch the other sex while communicating, but women touch other women slightly more than men touch other men. Research on the speech of children shows results that are very similar to the findings for adults. The differences are quite small, but overall, boys speak more assertively and girls speak in a more affiliative manner. Boys more often brag, issue directives and make suggestions than girls do. Girls are more responsive to others and speak in a more mitigated manner than boys do. Girls and boys do not differ in the extent to which they criticize, disagree, contribute information, agree with others, acknowledge that they are listening, and praise others. In general, girls and boys are more similar to each other than men and women, but girls are slightly more affiliative and boys are slightly more assertive. Overall, women and girls use more affiliative language, and men and boys use more assertive language, but the differences are small, especially for assertive communications. Moreover, there are no gender differences in adults or children in many behaviors that seem stereotypically masculine or feminine, such as criticizing, disagreeing,

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contributing information, agreeing, and acknowledging others.

Moderators of Sex Effects on Communications Communication differences that have been observed between men and women vary as a function of situational conditions. For example, men are especially talkative when communicating with strangers and in groups of people who vary in their familiarity, whereas among people having close relationships, the difference in the amount of speech between men and women is smaller and quite trivial. The same is true of assertive and affiliative speech. Both women and men are more similar in the content of their speech when among friends and family than with strangers. Both men and women behave in a more gender stereotypical manner when with people they do not know well, suggesting that gender differences in language occur in part to conform to social expectations about appropriate gender role behavior. When pressures to adhere to social norms are less pronounced, such as when people are among family and friends, gender stereotypical language diminishes. Another important moderator of language is the sex of the other party in the interaction. A review of a broad range of affiliative forms of speech found that, among adults, both men and women use more affiliative language behaviors when interacting with women than with men. In addition, people smile more at women than at men. Women are also more likely than men to receive compliments, apologies, verbal reinforcement, and disclosures of personal information. Finally, studies that examined the vocal tone present in conversations found that people’s voices are more pleasant and friendly when they talk to women than to men. The pattern of findings demonstrate that people speak more warmly to women than to men and are more affiliative and considerate, both verbally and nonverbally, in interactions with women. Assertive speech also varies as a function of the gender of the other person in the interaction, but the findings are less clear-cut than those for affiliative speech. Using a broad definition of assertive speech, one review found no evidence that the gender of the other person affects the gender difference in assertive language. However, ­

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differences in visual dominance and in mitigated speech do depend on the other’s sex. Both men and women are more visually dominant in interactions with women, and both men and women use mitigated speech more often in interactions with men than those with women. Moreover, both women and men are more talkative in interactions with women than those with men. Overall, the general pattern of findings reveals a modest inclination for people to communicate more assertively with women than with men. Expertise affects assertive language as well. Both women and men contribute more to discussions and exhibit greater visual dominance when discussing topics that are stereotypically associated with their own gender. Moreover, giving women or men extra training on opposite-gender tasks increases their visual dominance relative to the other gender, and giving women greater expertise at some task or even simply telling them that they have superior task-related skills has been shown to increase women’s contributions of opinions and directions, thereby reducing the gender difference in assertive speech. Women likewise use less mitigated or indirect speech when they have greater knowledge of the topic being discussed. Overall, then, having greater expertise or even believing that they do increases individuals’ assertive communications. There is some evidence that power may also affect differences in communication. First, observational research indicates that powerful individuals are more successful at gaining the floor when interrupting and that powerful women show more visual dominance than less powerful women. Second, experiments have demonstrated a causal relation between power and language: Men and women assigned to higher-status roles speak more assertively and use less verbal reinforcement and mitigation than those assigned to lower-status roles. These studies do not demonstrate that men’s greater use of assertive language is due to their greater status, only that having status increases assertiveness in communication.

Theoretical Explanations for Sex Effects on Communication One theoretical explanation for gender differences in language is that women and men communicate

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in ways that are expected of their gender, based on social norms and stereotypes. According to social role theory, these norms derive from the social roles that men and women hold. Because women more often hold domestic roles, such as child care provider and homemaker, and men more often are employed and have higher-status occupational roles than women do, people come to expect men to display the assertive behavior required of their roles and women to display the affiliative language required of theirs. These expectations, which are shared in the culture in the form of gender stereotypes, reflect not only how each gender is thought to be but also how each gender ought to be. Thus, women and men, and girls and boys, are rewarded for presenting the language that is required of their gender. Another model, expectation states theory, attributes gender differences in language to men’s greater status. According to this approach, higherstatus social groups are stereotypically perceived to possess greater competence and importance than lower-status groups and are, as a result, encouraged to communicate in an assertive manner. In contrast, low-status individuals are expected to be more affiliative, especially in interactions with those of higher status, and are penalized for behaving too assertively. Both theoretical models link gender differences in behavior to the power differences between men and women, because men hold social roles that command authority. As a result, both theories predict that men would be especially agentic when they have a power advantage, that is, when interacting with women rather than with men. Likewise, both theories predict that in contexts that favor women, such as those in which women have more expertise, women would communicate more assertively than in less favorable contexts. These predictions are consistent with research on differences between men and women in assertive language. On the other hand, both men and women are more affiliative in interactions with women than with men. This finding is not consistent with expectation states theory, which predicts that ­people use affiliative language primarily in interactions with those of higher status. Social role theory, which posits that the particular behaviors displayed by men and women should be normative for the particular roles they are enacting, does not explicitly lead to a prediction that people would be

more affiliative with women than with men, but such a finding is not incompatible with the theory. Thus, the theoretical explanation for why people use affiliative language particularly in interactions with women is unclear. Perhaps people are especially warm in communications to women because women are seen as more genteel and polite and more responsive to affiliative language. The contrasting findings for affiliative and assertive speech suggest that while assertive language may be associated with power and status, affiliative language may not be. People may use affiliative language to strengthen social bonds more than to appease others of higher status. In conclusion, communications by women and girls are more affiliative and mitigated and less assertive than communications by men and boys, but these differences are quite small for the most part and vary greatly by context. Moreover, not all assertive and affiliative forms of language reveal gender differences, but those that do, with the exception of talkativeness, seem consistent with gender stereotypes. In general, it appears that both genders exhibit language that is expedient, adapted to particular situational demands, and attuned to each individual’s power, social roles, and relative position in his or her interactions with others. Linda L. Carli See also Biological Sex and Cognitive Development; Biological Sex and Health Outcomes; Biological Sex and Mental Health Outcomes; Biological Sex and the Brain

Further Readings Anderson, K. J., & Leaper, C. (1998). Meta-analyses of gender effects on conversational interruption: Who, what, when, where, and how. Sex Roles, 39, 225–252. doi:10.1023/A:1018802521676 Carli, L. L. (2013). Gendered communication and social influence. In M. K. Ryan & N. R. Branscombe (Eds.), The Sage handbook of gender and psychology (pp. 199–215). London, England: Sage. Dindia, K., & Allen, M. (1992). Sex differences in selfdisclosure: A meta-analysis. Psychological Bulletin, 112, 106–124. doi:10.1037/0033-2909.112.1.106 Hall, J. A., Coats, E. J., & LeBeau, L. S. (2005). Nonverbal behavior and vertical dimension of social relations: A meta-analysis. Psychological Bulletin, 131, 898–924. doi:10.1037/0033-2909.131.6.898

Biological Sex and Mental Health Outcomes Hall, J. A., & Veccia, E. M. (1990). More “touching” observations: New insights on men, women, and interpersonal touch. Journal of Personality and Social Psychology, 59(6), 1155–1162. doi:10.1037/00223514.59.6.1155 Henley, N. M. (1977). Body politics: Power, sex, and nonverbal communication. Englewood Cliffs, NJ: Prentice Hall. Koch, S. C., Baehne, C. G., Kruse, L., Zimmermann, F., & Zumbach, J. (2010). Visual dominance and visual egalitarianism: Individual and group-level influences of sex and status in group interactions. Journal of Nonverbal Behavior, 34, 137–153. doi:10.1007/ s10919-010-0088-8 LaFrance, M., Hecht, M. A., & Paluck, E. L. (2003). The contingent smile: A meta-analysis of sex differences in smiling. Psychological Bulletin, 129, 305–334. doi:10 .1037/0033-2909.129.2.305 Leaper, C., & Ayres, M. M. (2007). A meta-analytic review of gender variations in adults language use: Talkativeness, affiliative speech, and assertive speech. Personality and Social Psychology Review, 11, 328–363. doi:10.1177/1088868307302221 Leaper, C., & Robnett, R. D. (2011). Women are more likely than men to use tentative language, aren’t they? A meta-analysis testing for gender differences and moderators. Psychology of Women Quarterly, 35, 129–142. doi:10.1177/0361684310392728 Leaper, C., & Smith, T. E. (2004). A meta-analytic review of gender variations in children’s language use: Talkativeness, affiliative speech, and assertive speech. Developmental Psychology, 40, 993–1027. doi:10.1037/0012-1649.40.6.993

Biological Sex and Mental Health Outcomes An individual’s biological sex, or assigned sex at birth, can potentially contribute to a variety of mental health outcomes. Sex and biological sex are terms used to indicate biologically determined characteristics (e.g., chromosomes, reproductive organs, secondary sex characteristics, and hormones). These characteristics usually define whether an individual will be labeled a male or female. On the other hand, gender relates to socially constructed indicators of male and female presentation. According to the gender role

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expectations perpetuated in society, men/boys and women/girls are encouraged to look, feel, and behave in a manner congruent with their gender. The term cisgender reflects an individual whose identity matches the sex assigned at birth, while the term transgender refers to an individual whose identity does not match the sex assigned at birth. Although gender and biological sex have drastically different meanings, sex and gender are often used interchangeably, adding to the stigma felt by those who do not identify as cisgender. This entry examines how biological sex has been represented and understood in different historical periods, how biological sex affects mental health, notable differences in mental health between women and men, and additional cultural factors affecting mental health.

History Although mental health research has been a pervasive and growing field of study, in the 19th to early 20th centuries, it was rare to examine the impact of biological sex on mental health. Limited knowledge of sex and gender further stifled exploration in the field. As a result of the stigmatization of and discrimination against women, many researchers lacked interest in women’s health concerns. Women were virtually invisible during this time and seen as innately deficient. The field of mental health predominately revolved around men. The assumption was that all knowledge related to men would automatically translate to women, with an exception given to women in their reproductive role. The impact of female social roles peaked in the mid-1960s, when women in the United States reported increased rates of depressive and anxiety symptoms. A social role denotes an individual’s expected behavioral or normative presentation as a member of a social group. Social roles also differ depending on context. Women, who spent much of their time in the household, therefore possessed fewer social roles than men, who split their time between the personal and professional environments. Some believed that women experienced greater mental health disadvantages as a result of the limited number of embodied social roles compared with men. The idea was that accumulating multiple social roles actually protects against the development of certain mental health illnesses.

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Subsequently, women were thought to be at risk of developing mental health disorders like anxiety and depression due to idle time spent in one environment. It was later found that the role ­ accumulation hypothesis revealed inconsistent ­ results. In fact, some studies found no mental health difference between employed and unemployed wives, while others demonstrated how employment actually minimized distress in women. It was clear that the role accumulation hypothesis overlooked certain complexities of possessing multiple social roles. The focus eventually shifted from the quantity of social roles to the quality of the same roles by comparing males and females in a similar social context. Employed married ­mothers experienced more physical and anxiety symptoms than employed married men. It appeared that under similar constraints women attributed a ­different level of significance to their employment than men. It is possible that under the pressure of the times women became hyperaware of inequality within the workplace. The pressure associated with being a working woman in male-dominated fields could have placed even greater stress on women to prove themselves. Because gender norms designate women to be below men in the social hierarchy, there is inequality in the division of household labor and in the labor market. Society was now interested in social, structural, and cultural factors, and the interplay of all three factors contributing to different experiences within the home and workplace. So once again, the zeitgeist shifted to explain apparent sex differences. In fact, individuals in the lowest social class were found to be at risk of developing nearly double the negative physical and psychological health outcomes compared with those in the highest social class. The link was now clear between biological sex and societal pressure and their joint impact on mental health outcomes. Historically and throughout most cultures, women have been viewed as inferior to men, and this has added to the social stigma that accompanies women who take on roles outside the home. Even in Western cultures, where women now drive, receive education, and have been given equal voting rights, the stigma and disparate mental health outcomes persist. Today, there are still subtle reflections of gender differences even in approaching health issues. “Men’s health” is generally

concerned with sexual performance and prostate conditions, while “women’s health” continues to relate more to their reproductive system and emotional needs.

Risk Factors In some instances, biology is the primary contributor to health outcomes. For example, researchers have found a biological marker for disorders such as schizophrenia and Alzheimer’s. The science is so sophisticated that sometimes individuals can be tested to find out whether certain disorders will be activated in the future. However, it is extremely rare that genetics and biology are the sole determinants of health outcomes. It is more common that biology works together with a plethora of other factors to result in mental health issues. Three protective factors have been found to work against the development of mental health issues among men and women: (1) some level of autonomy and control in reaction to life stressors, (2) access to resources to make positive life choices, and (3) psychological support from important ­others. It is possible that these protective factors could actually diminish some of the risk associated with many biological factors like genetics and sex hormones. However, women with minimal social support are more susceptible to negative mental health outcomes than men with limited social ­support. It appears that the combinations of certain social influences are differently protective for males and females. Following a distressing event involving their children, housing, or reproduction, women experience greater mental health risk. This could potentially be due to female socialization for a greater investment in issues related to the home and family. On the other hand, following a crisis involving finances, work, or the marital relationship, men carry a greater mental health burden. It seems that men and women are at risk depending on the life stressor. Thus, women and men are differently sensitive to life events.

What Causes the Difference? Men and women have been socialized throughout history, and this affects their life stressor sensitivities. In many cultures males are often socialized to

Biological Sex and Mental Health Outcomes

be confident and independent authorities, whereas women are socialized to be emotional and dependent caretakers. This socialization process begins at birth and comes through several different ­avenues. Parents are far from the only ones participating in the socialization process. Role expectations are constantly reinforced at home, in school, at work, throughout the media, and more. Behaviors outside of these norms are also subsequently punished in many of the same arenas. It is virtually impossible to escape these gender role expectations. Likewise, individuals internalize the norms associated with their gender, resulting in social pressure to behave in a stereotypically gender ­congruent manner. This only further perpetuates the norms themselves. Even in childhood, boys are more likely to command, threaten, and interrupt one another among same-sex peers, while girls are more likely to agree, recognize another’s point of view, and pause to let another speak. Boys are taught to be domineering and independent, whereas girls are taught to be submissive and gentle. In childhood, boys are more likely to experience depressive symptoms, whereas in adolescence, a dramatic shift occurs. Adolescent girls are more likely to experience low to moderate levels of depression and anxiety than their male counterparts. This can be paralleled with the interpersonal changes that also take place during the adolescent years. As young people become more relationally dependent, they also become more aware of other people’s perceptions as well as their own perceptions of themselves. This association could interact in a way that increases interpersonal stakes, leading to decreased self-esteem, which could increase depressive symptoms. Specifically, women have been socialized to be relational beings; the increased rate at which they exhibit depressive symptoms could be the result of the high stakes they hold in their interpersonal relationships. Adult women are more likely to report what they feel in mental health contexts, while men are more likely to report what they do. This speaks to the longevity of internalized socialization. Along these lines, men are described to be less in tune with their emotions and engage in less help-seeking behavior than women. However, studies show that men often engage in more risk-taking behavior than women. This seems to correlate well with the increased likelihood of men to be diagnosed with

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disorders associated with drugs, alcohol, antisocial behavior, aggression, and withdrawal. Socialization persists throughout the life span, affecting feelings and behaviors and subsequently affecting therapy response. Women display increased endorsement of therapy effectiveness, attendance rates, and levels of help-seeking behavior compared with men. This again coincides with female normative behavior strongly aligning with a stake in interpersonal relationships and emotionality. It also coincides with an increased likelihood of female clients to be diagnosed with disorders related to emotional regulation. In fact, studies have shown that doctors are more likely to diagnose a woman with depression than a man, even when they exhibit identical symptoms and score similarly on standardized depression measures.

Mental Health Among Women Although there are negligible differences in lifetime prevalence rates of male and female mental health outcomes, according to 12-month prevalence rates, women aged 16 to 85 years demonstrate a higher rate of mental health disorders (22%) than men (18%). This imbalance in mental health outcomes can largely be attributed to increased rates of anxiety disorders among women. Women are more likely than men to experience most anxiety disorders, including panic disorder, posttraumatic stress disorder, and most phobias. The base rate for generalized anxiety disorder is twice as high for women as for men. Men only display higher rates for obsessive-compulsive disorder and social phobia. These disparate rates are most likely attributed to a combination of biological factors (genetics, hormones, physiological reactivity), cognitive factors (rumination, catastrophizing, worry), and social factors. The key feature evident in an anxiety disorder is fear. Fear is the emotional response to a real or perceived danger, whereas anxiety is an anticipation of future danger. Women, who have been distinguished as more inferior to men, have been conditioned to perceive their very existence as a threat based on their stigmatized identity as women. Women have been taught to be fearful, nervous, and worrisome. Worry, which is the cognitive component of anxiety, is also highly associated with women. Historically, women have

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experienced less control over their lives because of their assigned moderate social status. This lack of control could also be linked to real threats to safety related to rape, domestic violence, harassment, and physical assault—all of which are ­displayed among women more than men. The reality of the situation is that women are placed in a cycle within our society, further exacerbating their symptoms. Battered woman syndrome (recently changed to “battered person syndrome” [BPD]) develops in victims of long-term abuse within the home. The disorder was not coincidentally attributed to women—it is exhibited at a greater rate in women than in men. Unfortunately, women exhibiting BPD symptoms tend to stay in toxic relationships due to learned helplessness or loss of motivation to change a situation after repeated failed attempts to do so. It could be asserted that many women in today’s society fall within the spectrum of learned helplessness after sustained loss of control and the power to make lasting changes in their lives.

Mental Health Among Men Since anxiety and depression are more common among women, the assumption might be made that men rate themselves as experiencing higher rates of well-being than women. However, a study of subjective well-being in later life found no gender differences in subjective well-being over the life cycle. When gender was later factored in, women were found to have higher levels of well-being than men in adult life. This trend reverses as men and women age, except that men 65 years of age and older display the highest suicide rates of any agegroup. This is largely indicative of the increased rates of substance use and social isolation among men compared with women. As discussed earlier, males are more likely to engage in risk-taking behavior. This could be why males display higher rates of drinking and related disorders, because they exhibit lower inhibitions when it comes to high-risk behaviors. Men also display higher rates of substance use than women. In fact, men account for close to three quarters of the emergency room visits related to hallucinogenic drug use. Drug use is often viewed as a coping mechanism for a deeper issue. It falls within the realm of

avoidance coping, or diverting one’s attention from a stressor to mask the feelings related to that stressor. Since men are often socialized to be less in tune with their emotions than women, they may use drugs to achieve the diminished sense of emotional sensitivity needed to address stressors more directly. In fact, greater use of avoidance coping is associated with high rates of alcohol use and abuse. Men report reduced tension and increased social expressiveness as benefits of their alcohol use. Although not all substance use falls within the area of addiction, men may be at greater risk for these disorders due to social and compulsive tendencies.

Cultural Factors One’s experience as a man or woman (or as someone who identifies as both) will undoubtedly differ depending on the context, culture, or community. For example, the role of caretaker experienced as a man or woman will vary drastically within collectivist versus individualistic societies. Therefore, the interconnected meaning and experience of gender and mental health will differ as well. In many cultures, women are viewed as useless when they can no longer bear children. Similarly, in some cultures, men lose their social status if they are unable to provide (direction, financial stability, basic security, etc.) for their family. This can easily affect well-being as society adds pressure to the individual’s lived experiences. Perceived discrimination is associated with negative mental health outcomes or minority stress. Age, race, social class, and sexual orientation are just a few of the identities found to intersect with gender, further compounding this effect. Intersectionality refers to the overlapping effects of one’s social identities on health. To dissect gender alone would be to ignore the interconnectedness of gender and other marginalized identities. For example, African American male suicide is positively correlated to education and wealth. Parsing out one identity falls short of illuminating the combined effect. Finally, the compounded effect of oppression resulting from one’s social identity is commonly referred to as double jeopardy; however, when the oppression is the result of several stigmatized identities, it is generally referred to as multiple

Biological Sex and Social Development

jeopardy. Minority identities appear to have an additive effect on negative mental health outcomes. However, since so little is known about these issues, it is essential that more research be conducted to further understand intersectionality and multiple jeopardy. The hope is to better understand their precise impact on the affected individuals in their daily lives. Dorcas Akinniyi and Stephanie Budge See also Biological Sex Differences: Overview; Gender Roles: Overview; Gender Socialization in Women; Mental Health and Gender: Overview; Mental Health Stigma and Gender

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Simon, R. W. (1995). Gender, multiple roles, role meaning, and mental health. Journal of Health and Social Behavior, 36, 182–194. Umberson, D., Williams, K., Thomas, P. A., Liu, H., & Thomeer, M. B. (2014). Race, gender, and chains of disadvantage childhood adversity, social relationships, and health. Journal of Health and Social Behavior, 55(1), 20–38. Wilhelm, K. A. (2014). Gender and mental health. Australian and New Zealand Journal of Psychiatry, 48(7), 603–605. Zlomke, K. R., & Hahn, K. S. (2010). Cognitive emotion regulation strategies: Gender differences and associations to worry. Personality and Individual Differences, 48(4), 408–413. doi:10.1016/j.paid.2009. 11.007

Further Readings Afifi, M. (2007). Gender differences in mental health. Singapore Medical Journal, 48(5), 385. Altemus, M., Sarvaiya, N., & Epperson, C. N. (2014). Sex differences in anxiety and depression: Clinical perspectives. Frontiers in Neuroendocrinology, 35(3), 320–330. Cyranowski, J. M., Frank, E., Young, E., & Shear, M. K. (2000). Adolescent onset of the gender difference in lifetime rates of major depression: A theoretical model. Archives of General Psychiatry, 57(1), 21–27. Doyal, L. (2000). Gender equity in health: Debates and dilemmas. Social Science & Medicine, 51(6), 931–939. Holahan, C. J., Moos, R. H., Holahan, C. K., Cronkite, R. C., & Randall, P. K. (2001). Drinking to cope, emotional distress and alcohol use and abuse: A ten-year model. Journal of Studies on Alcohol, 62(2), 190–198. Hyde, J. S. (2014). Gender similarities and differences. Annual Review of Psychology, 65, 373–398. McLean, C. P., & Anderson, E. R. (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical Psychology Review, 29(6), 496–505. Seedat, S., Scott, K. M., Angermeyer, M. C., Berglund, P., Bromet, E. J., Brugha, T. S., . . . Kessler, R. C. (2009). Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry, 66(7), 785–795. Seng, J. S., Lopez, W. D., Sperlich, M., Hamama, L., & Meldrum, C. D. R. (2012). Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality. Social Science & Medicine, 75(12), 2437–2445.

Biological Sex Development

and

Social

Biological and social factors contribute to experiences with gender and, thus, to sex differences in childhood and adolescence. Psychologists no longer debate whether nature (often construed as biology) or nurture (often construed as the social environment) was responsible for human behavior. Now, psychologists ask questions about the relative influence of nature and nurture on behavior. For example, they want to know the contexts that maximize sex hormone effects on emotional expression and how the environment can alter the link between genes and conduct disorder. In ­addition, the terms sex and gender are often used interchangeably, which may complicate how ­psychologists understand the differences between men and women. As a result, it may be difficult to know if the observed differences between men and girls are due to their sex (e.g., biological or hormonal factors) or gender (e.g., socialized or environmental factors). For transgender and gender ­nonconforming (TGNC) people, who have a gender ­identity that does not match the sex they were assigned at birth, there is a dearth of research on how biological factors affect their social development. Accordingly, this entry will concentrate ­primarily on cisgender people (or people who identify with their assigned birth sex) and will refer to those of different sexes as women and men.

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Biological Influences on Social Development Research supports the theory that there are sex ­differences in social behavior. Boys and girls act differently in interpersonal and social situations throughout childhood and adolescence. To understand the physiological mechanisms underlying the differences, the basic principles of biological sex will be reviewed. Some biological and social processes that contribute to the development of the differences will then be considered. Biological Sex

Biological sex is complex, with both genes and sex hormones contributing to male and female phenotypes, or observable physiologies. Biological sex is determined genetically at conception, with girls having two X chromosomes and boys having an X and a Y chromosome. Without a Y chromosome, all fetuses have a female-typical pattern of genital development, resulting in ovaries, a uterus, labia, and a clitoris. But a gene on the Y chromosome called SRY alters this developmental course by instigating the release of hormones such as androgens (i.e., the class of hormones that includes testosterone and typically has masculinizing effects in human beings), resulting in a male-typical pattern of genital development, with testes, a scrotum, and a penis. Thus, prenatal hormones organize the biology by establishing the anatomy. Sex Differences in Social Development

There are sex differences in several dimensions of social development. They are generally small to moderate in size. This means that researchers consistently find that the average girl differs from the average boy, yet the social behavior of the sexes overlaps, so that some girls and boys behave similarly or even in ways considered typical of the other sex. Social sex differences are often discussed in terms of instrumentality and expressivity. Boys are more instrumental than girls, displaying behaviors such as dominance and self-assertiveness. They generally socialize in large groups, with their ­so-called rough-and-tumble play characterized by high levels of activity and physicality. In extreme degrees, this sex difference in rough-and-tumble

play extends to child and adolescent aggression. Compared with girls, boys display more direct aggression (i.e., behaviors intended to physically harm another person). Direct aggression is, in turn, associated with externalizing behavior problems, such as conduct disorder and antisocial behavior— both of which are more likely to be found in boys than in girls. Girls are more expressive than boys, displaying behaviors such as kindness and sensitivity to others’ emotions. Girls generally socialize in small groups, with play characterized by cooperation, affiliation, and positive emotionality. Compared with boys, girls are stereotypically believed to display more indirect aggression (i.e., behaviors intended to socially harm another person, e.g., exclusion), but empirical evidence for this is inconsistent. In fact, girls’ low levels of direct ­ aggression are associated with prosocial behavior and empathy—two social behaviors that show a sex difference that favors girls. Social sex differences are also manifest in the activities and occupational interests of children and adolescents. Compared with girls, boys are more interested in playing with trucks, engaging in physically competitive activities (e.g., sports), and performing occupations involving work with objects or things (e.g., carpenter, mechanical engineer). Compared with boys, girls are more ­ interested in playing with dolls, engaging in social activities (e.g., talking on the phone), and performing occupations involving work with people (e.g., elementary school teacher, social worker). Explanations for Sex Differences in Social Development

There are several explanations for sex differences in social behavior. Unsurprisingly, some seem to result primarily from socialization. For example, parents discuss emotional events in different ways with their daughters and sons. They use more emotion-laden words, interpersonal descriptions, and references to positive emotions with their daughters, whereas they are more likely to discuss the causes of emotions, such as anger, with their sons. Other sex differences in social behavior are linked to biology. Just as early hormones organize anatomy, so too do they organize behavior.

Biological Sex and Social Development

Experimental research with animals has shown that early androgens permanently masculinize the brain and behavior. This can be studied in human beings by using a natural experiment—girls with congenital adrenal hyperplasia (CAH). CAH is a disorder of sex development (i.e., a medical condition in which chromosomal, gonadal, or anatomical sex is atypical) in which girls are exposed to high levels of prenatal androgens but are reared and identify as female. Thus, biology and socialization are uncoupled for girls with CAH, providing an investigation of the effects of masculinizing hormones without the confound of male-typical socialization. Girls with CAH are, indeed, masculinized in several domains compared with unaffected girls (usually their sisters), including some social behaviors: They have higher activity levels, self- and parent-rated aggression, and interest in male-typical toys, activities, and occupations. The degree to which these behaviors are masculinized is related to disease severity, such that girls with the highest prenatal androgen exposure (i.e., the most severe form of the disease) show the greatest behavioral masculinization. These hormonebehavior links are also resistant to some types of socialization, as the presence of parents and parents’ encouragement to act in sex-typical ways appear not to influence the masculinized play behavior of girls with CAH. It is important to note that the results of prenatal hormone links to social behavior uncovered in samples of girls with CAH generalize to typical samples, providing evidence that aspects of the disease or having a disorder of sex development are not responsible for the effects; for example, prenatal androgen exposure assessed via amniotic testosterone has been associated with masculinized play in childhood. Hormones can also have activational effects on the brain and behavior; these effects are transient, with sex hormones activating biological pathways established (organized) in early development. Pubertal and adult circulating hormones have activational effects and have been linked to social behavior. For instance, testosterone in male adolescents and adults has been associated with increases in dominance, aggression, and antisocial behavior. Beyond hormones, genes are an aspect of ­biology that have also been linked to sex differences in social behavior. Twin studies are often used to calculate genetic influences on behavior:

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Researchers compare identical twins (who share 100% of their genes) and fraternal twins (who share 50% of their genes) to determine heritability, that is, the extent to which behavioral variation can be attributed to genes. An example of genetic influences on social behavior concerns conduct disorder. Not only is it heritable, but twin studies also show that different genes likely underlie the disorder in girls and in boys, suggesting that there is a sex difference in the etiology of the disorder as well as in its prevalence. Considering a single explanation for sex differences in social development is misleading, however, because influences do not operate in isolation. Social influences are moderated by biology. Even though parents use more emotion-laden words with daughters than with sons, some girls are more receptive to parental socialization than others, due, for example, to their biologically predisposed temperament. Similarly, the social environment moderates biological influences. Girls with CAH are thought to play differently with female and male peers (even though parental encouragement does not influence the gendered nature of the play), testosterone levels in adolescent and adult males fluctuate with the context (e.g., they decrease when a person loses an athletic competition), and twin studies reveal environmental as well as genetic influences on conduct disorder (even though environmental influences explain less variability than do genetic influences). Thus, sex differences in social development are best understood by considering the interplay between biological and social processes.

Biosocial Influences on Gender Development Sex differences in social development result from the combined effects of biology and socialization. Considering either biological or social influences in isolation provides only a partial, and possibly inaccurate, picture of the developmental processes contributing to behavior. The first two examples below showcase how the effects of hormones and genes on behavior are moderated or mediated by gendered parent and peer contexts. The final example highlights opportunities for integrating biological and social influences on sex-typed interests.

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Adolescent Hormones, Parents, and Peers

Adolescent sex hormones influence sex-typed social behaviors in collaboration with the environment. This can be seen in individual differences in typical and atypical behavior. Regarding typical behavior, the levels of expressivity and instrumentality displayed by girls and boys depend on their hormone levels and the gendered context of their social environments. Quick developmental changes in biological processes, such as hormone levels during pubertal development, are posited to mark periods of resistance to socialization; in other words, social factors are thought to have the greatest influence on biology-behavior links in relatively homeostatic systems. Thus, girls and boys who have hormone levels that change slowly throughout adolescence may be more susceptible to socialization than those who have rapidly changing hormone levels. This hypothesis has been borne out by data: Compared with adolescents who had quickly increasing testosterone levels (regardless of gender), adolescents who had slowly increasing testosterone levels were more expressive when they spent a lot of time with their mothers, and they were more instrumental when they spent a lot of time with their fathers. Parents only mattered as models of gendered behavior when adolescents were gradually (not rapidly) developing; that is, socialization only mattered for adolescents with certain biological profiles. Regarding atypical behavior, the conduct disorder of girls is associated with pubertal timing and the social environment. The stage termination hypothesis of pubertal development states that girls with early puberty are at the greatest risk for behavior problems, especially externalizing problems like conduct disorder and aggression, due to a complex interplay of biological and social (and cognitive and emotional) factors. These girls develop not only before their on-time and latematuring same-sex peers but also before all of their male peers due to the sex difference in puberty, with girls maturing about 2 years before boys. Sometimes, puberty-related characteristics elicit differential social responses in early-maturing girls, and thus, social influences partially explain the link between early biological maturation and externalizing behavior. For example, early maturation often leads to associations with older, deviant

peers and to participation in romantic relationships; both of these social factors facilitate externalizing behaviors. Other times, puberty-related characteristics mark responses to social circumstances. For instance, early maturation in girls can be instigated by social factors, including aspects of the home environment such as father absence and maternal harshness. Together, these examples highlight bidirectional associations between biology and socialization. Biological Sensitivity to Context

Research in the developmental psychopathology literature supports the notion that behavior problems result from the combined influences of biology and the environment. In fact, the longstanding diathesis-stress model posits that biological factors (e.g., temperament, nervous system reactivity, and genes) confer risk for behavior problems and that risk is actualized under stressful environmental conditions; in other words, biology loads the gun, and environment pulls the trigger. But this model has been recently modified. Now the prevailing hypothesis concerns sensitivity to context, or that biological factors mark plasticity instead of risk: Individuals with certain biological profiles are generally more susceptible to environmental influences than are individuals with other profiles. For the former, so-called orchids, behavioral outcomes are particularly good in ­ positive environments and particularly bad in ­ negative environments; they are sensitive to social influences. For the latter, so-called dandelions, behavioral outcomes are moderate regardless of environmental conditions; they are robust to social influences. Specific genes that contribute to externalizing problems have been identified, extending understanding of the heritability of conduct disorder and antisocial behavior. For example, the monoamine oxidase A gene reduces the activity of several ­neurotransmitters involved in arousal and reward. As is true of most links between genes and behavior, there is no one-to-one association between ­variants of this gene and externalizing behavior; the link depends on the context. Individuals with the ­low-activity variant of the gene generally show the most behavior problems under poor environmental conditions (e.g., child maltreatment

Biological Sex and Social Development

and maternal insensitivity), but they show the fewest behavior problems in optimal environments (e.g., maternal sensitivity). Meanwhile, the externalizing behavior of individuals with the highactivity variant of the gene does not depend on the context. This example of a gene-by-environment interaction clearly illustrates that both biological and social factors are necessary for delineating the origins of externalizing behavior and that consideration of either factor in isolation leads to faulty conclusions. One example of how biological and environmental factors may influence development is the paucity of women in science, technology, engineering, and mathematics (STEM) careers. This can be seen from the number of undergraduate majors to the number of full professors. There are many factors that contribute to this effect. Family socialization is one. Parents influence the careers of their children, with their expectations predicting the occupational expectations of their adolescent children and the actual careers of their adult children. Also, women prefer occupations that allow them to spend time with their families and to give to their communities (consistent with the sex difference in expressivity), whereas men prefer to work long hours to advance their careers (showing agency, which is consistent with the sex difference in instrumentality). Occupational interests are another factor contributing to the sex difference in STEM careers. Girls are more interested in occupations that involve working with people than in STEM occupations, which involve working with things. These interests manifest in actual career choices: When mathematically gifted youth were followed into adulthood, more men than women became engineers and physicists and more women than men became physicians and social scientists. These interests are also related to biological factors, such as prenatal androgens. For instance, girls with CAH are not only more interested than their sisters in male-typed occupations, but they are specifically more interested in occupations involving work with things, with interest in things-related occupations being linearly associated with the degree of prenatal androgen exposure. Despite investigations into both biological and social influences on career interests and outcomes, little is known about how these influences combine to predict women’s underrepresentation in STEM

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careers. Nevertheless, findings from both types of investigations converge to suggest that women’s participation in STEM can be increased by demonstrating how the biologically influenced interest in people is compatible with STEM careers; for example, biomedical engineering concerns the ­creation and manipulation of objects to increase people’s health, and client interaction is an important, albeit underappreciated, element of software design and programming. There is emerging evidence that this approach will be successful: Girls who believe that science is altruistic are more interested in science careers than girls who do not believe that science is altruistic. Thus, both biological and social perspectives (and their combination) are important for revealing ways to minimize ­gender disparities. Adriene M. Beltz See also Biological Sex Differences: Overview; Congenital Adrenal Hyperplasia; Gender Socialization in Adolescence; Gender Socialization in Childhood; Gendered Behavior; Puberty

Further Readings Belsky, J., & Pluess, M. (2009). Beyond diathesis stress: Differential susceptibility to environmental influences. Psychological Bulletin, 135(6), 885–908. doi:10.1037/ a0017376 Beltz, A. M., Blakemore, J. E. O., & Berenbaum, S. A. (2013). Sex differences in brain and behavioral development. In P. Rakic & J. Rubenstein (Series Eds.), Comprehensive developmental neuroscience: Vol. 3. Neural circuit development and function in the healthy and diseased brain (H. Tager-Flusberg, Vol. Ed., pp. 467–499). Oxford. England: Elsevier. doi:10.1016/ B978-0-12-397267-5.00064-9 Berenbaum, S. A., Blakemore, J. E. O., & Beltz, A. M. (2011). A role for biology in gender-related behavior. Sex Roles, 64(11/12), 804–825. doi:10.1007/ s1199-011-9990-8 Blakemore, J. E. O., Berenbaum, S. A., & Liben, L. S. (2009). Gender development. New York, NY: Psychology Press/Taylor & Francis. Booth, A., Granger, D. A., Mazur, A., & Kivlighan, K. T. (2006). Testosterone and social behavior. Social Forces, 85(1), 167–191. doi:10.1353/sof.2006.0116 Boyce, W. T., & Ellis, B. J. (2005). Biological sensitivity to context: I. An evolutionary-developmental theory of the origins and functions of stress reactivity.

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Development and Psychopathology, 17(2), 271–301. doi:10.1017/S0954579405050145 Ellis, B. J. (2004). Timing of pubertal maturation in girls: An integrated life history approach. Psychological Bulletin, 130(6), 920–958. doi:10.1037/0033-2909 .130.6.920 McHale, S. M., Kim, J.-Y., Dotterer, A. M., Crouter, A. C., & Booth, A. (2009). The development of gendered interests and personality qualities from middle childhood through adolescence: A biosocial analysis. Child Development, 80(2), 482–495. doi:10.1111/ j.1467-8624.2009.01273.x Negriff, S., & Susman, E. J. (2011). Pubertal timing, depression, and externalizing problems: A framework, review, and examination of gender differences. Journal of Research on Adolescence, 21(3), 717–746. doi:10.1111/j.532-7795.2010.00708.x Robertson, K. F., Smeets, S., Lubinski, D., & Benbow, C. P. (2010). Beyond the threshold hypothesis: Even among the gifted and top math/science graduate students, cognitive abilities, vocational interests, and lifestyle preferences matter for career choice, performance, and persistence. Current Directions in Psychological Science, 19(6), 346–351. doi:10.1177/0963721410391442 Watt, H. M. G., & Eccles, J. S. (2008). Gender and occupational outcomes: Longitudinal assessment of individual, social, and cultural influences. Washington, DC: American Psychological Association.

Biological Sex

and the

Brain

Research interest in sex differences in the human brain has been fueled in part by a desire to better understand the well-documented gender differences in psychopathology. For example, women are more likely to experience depression or anxiety disorders than men, whereas males are more likely to be on the autism spectrum than females. Prior to the 1970s, studies of sex differences in human brains were mostly limited to autopsies. Since then, the increased availability of neuroimaging techniques, such as structural and functional magnetic resonance imaging, positron emission tomography, and diffusion tensor imaging scans, has allowed researchers to compare sex differences in both structure and function (sexual dimorphism) in living brains across the life span. However, because these techniques are costly, studies typically have small numbers of participants. Furthermore,

studies vary considerably in how they measure brain areas, in terms of both size and activity. On average, males have larger brains than females, but there is little consensus about sex differences in size within more specific areas of the human brain. This may be because studies vary as to whether and how compensations have been made for nonlinear relationships between individual regions and overall brain size. Finally, when interpreting sex difference data, it is also important to remember that there is a publication bias in science; studies with null results (no sex differences) are frequently not published. Therefore, even meta-analytical investigations, which draw on the results of many smaller studies, may be unrepresentative of the general population. With these caveats in mind, this entry attempts to present the most consistent findings about sex differences in the brain, and as a result, it focuses on those obtained using large samples (>100 participants) or meta-analyses.

Early Developmental Sex Differences in the Brain At conception, the combination of sex chromosomes from the mother and the father determines whether an embryo will develop male (XY) or female (XX) sex organs. The SRY gene on the Y sex chromosome programs the development of testes, and its absence in females inhibits testes development and promotes the development of ovaries. About 6 to 8 weeks after conception, the testes begin to produce male sex hormones known as androgens, which promote further development of male sex organs and inhibit female sex organ development. Yet sex differences do not seem to be noticeable in the developing brain until later in pregnancy. It has long been suggested that sexrelated differences in the brain are largely due to the influence of gonadal sex hormones, especially testosterone. However, more recent studies that have genetically modified the absence or presence of the SRY gene show that chromosomes in themselves are also important. Artificial insertion of the SRY gene, which is normally found on the Y chromosome, causes genetically female rodents to develop testes, whereas SRY gene removal promotes ovary development in genetically male animals. Therefore, although these genetically altered animals predominantly have genes that can be

Biological Sex and the Brain

thought of largely as female (XX) or male (XY), they develop gonads that produce hormones that are typically seen in the opposite sex. Both chromosomal differences and hormonal exposure contribute to sex-related differences in brain structures and behavior. For instance, XX mice show a female pattern of pain perception in that they respond to painful situations more quickly than XY mice, but this occurs regardless of whether they have ovaries or testes. Prenatal hormone levels have also been shown to affect ­ gender-typical behavior during early childhood in humans. Androgens are produced by the testes, and so typically developing males are exposed to more testosterone than females. However, both the placenta and the developing baby’s adrenal glands also contribute to interindividual variability in prenatal hormonal levels during pregnancy. High levels of prenatal testosterone are related to a preference for rough-and-tumble play, whereas lower levels are associated with greater empathy toward others. These early experiences also play a crucial role in shaping connections in the brain and so may also contribute to sex-related differences in the brain and in behavior.

Sex-Related Differences in Brain Structure Adult brains are about 10% larger in males than in females, even when allowing for the fact that males typically have larger bodies. This size difference is present from birth and increases during childhood and adolescence. The brain is made up of both gray matter (neuronal cell bodies, glial cells, and synapses) and white matter (myelinated nerve fibers that allow neurons to transmit information rapidly and efficiently). Gray matter volumes increase from birth to around puberty (10.5 years in females, 14.5 years in males) and then decrease thereafter as unnecessary neurons are pruned away and the brain becomes more efficient. In contrast, white matter volumes increase throughout the first 40 years of life. Not surprisingly given their larger brains, males have 9% to 14% more gray matter than females. Larger brains have a greater white to gray matter proportion, which means that males also typically have more white matter than females. However, even when similarly sized male and female brains are

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compared, male brains have greater amounts of white matter. In contrast, there is no consistent evidence for sex-related differences in the size of the corpus callosum (CC), which is the major white matter tract that connects and allows communication between the two hemispheres of the brain. Smaller brains have larger CC volumes in general, but when similarly sized brains are compared, there is no significant sex difference in CC size. There are relatively few consistent sexual dimorphisms within specific regions of the brain. The most consistent finding across studies is that certain nuclei (collections of cells) within the hypothalamus are disproportionately larger in males than in females. One of the interstitial nuclei of the hypothalamus is related to sexual behavior and is typically twice as large and contains double the number of cells in males as in females. It is also smaller in homosexual than in heterosexual males. During adolescence, the amygdala (an almondshaped structure deep within the brain, which is associated with the processing and experiencing of emotion) increases in size in males but not in females; this may be because, as nonhuman primate studies have shown, the amygdala has a large number of androgen receptors. In contrast, the hippocampus (a part of the brain that is important for memory) increases in size in females but not in males during adolescence. Several studies have shown that the amygdala continues to be larger in men than in women after adolescence. Many (but not all) studies have also shown that the area within the basal ganglia known as the caudate tends to be proportionally larger in females than in males.

Sex Differences and Cognitive Performance Many have pointed out that sex differences in the brain are not hard-wired (i.e., the brain has the ability to change, especially as a function of experience). Psychosocial factors influence those ­ experiences, which then shape brain anatomy, functioning, and behavior. A growing number of studies have shown that male advantages in math skills that were well documented during the latter part of the 20th century are less likely to be found in the 21st century. This is especially true in

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societies that have been particularly mindful of previous disparities and have made concerted efforts to ensure gender equity in education. With this caveat in mind, neuroimaging studies have found that males and females sometimes show group differences in patterns of neural activity during various kinds of cognitive tasks. In many ways, male and female brains seem to be more alike than they are different. There are only a few consistent, but very subtle, differences in cognitive performance between males and females. Males perform better than females on a specific visuospatial task called mental rotation, especially if performed under time pressure. In this task, participants are shown a picture of a threedimensional object and then have to identify that object in a different orientation from a series of pictures. Three-month-old boys do better than girls on some, but not all, baby-friendly versions of this test. This has been interpreted as evidence of an innate sex difference, which may be driven by prenatal sex hormones. In support of this, mental rotation skills are better in females exposed to higher levels of androgens, such as those with twin brothers or with a condition known as congenital adrenal hyperplasia. The environment also plays a role in sex differences in this skill. Studies with older children and adults have shown that having more male-typical activities, like playing with videos and construction toys, can improve mental rotation abilities. So if children engage in gendertypical play, this early male advantage is likely to increase. Functional magnetic resonance imaging studies that examine changes in oxygen levels in the blood across different parts of the brain suggest that males and females use different types of strategies when performing a mental rotation task. Although results vary across studies, when men and women perform at a similar level, women tend to show greater activation in the frontal cortex than men. This suggests that men may be using more holistic or automatic processes whereas women approach the problem in a more analytical fashion, which requires greater top-down processing. Other studies have also shown that males and females often have different patterns of neural activity across different tasks, even when they perform similarly, which adds further support for sex differences in cognitive strategies over a wider range of tasks.

Females tend to outperform males on tests of verbal fluency, but this effect is even smaller than that for the mental rotation task. In verbal fluency tests, participants are given a short period of time in which to name as many items as possible from a particular category (e.g., animals) or to think of as many words as possible starting with a particular letter. Interestingly, meta-analytical studies have shown that males and females do not differ in the size of their vocabularies, so sex differences in verbal fluency may be related to the ability to produce words under time pressure. Perhaps a more robust finding is that there is an early language learning advantage in girls in the first few years of life, but this disappears around the age of 6 years. Structural imaging studies have shown that individual differences in intelligence may be linked to increased gray and white matter volumes in specific parts of the brain. However, the specificity of these areas differs between males and females. In females, intelligence quotient (IQ) has been correlated with greater gray matter volumes in Broca’s area in the frontal lobe, which is associated with language production. In contrast, IQ in males has been correlated with increased gray matter in other parts of the frontal lobe and in the parietal areas of the brain. This suggests that males and females who perform similarly on IQ tests may be using their brains differently to achieve the same outcomes.

Sex Differences in Lateralization of Brain Function A much-cited study by Shaywitz and colleagues in 1999 provided early support for the idea of sex differences in hemispheric activation for language tasks, but this supposition has not been confirmed in subsequent meta-analytical studies. Hemispheric asymmetries in neuronal activation have been found more consistently in relation to ­handedness than to sex. However, left-handedness is slightly more prevalent in males than in females. Hand preference is determined by a combination of genetic and prenatal factors and appears to emerge very early in prenatal development. Most 7-week embryos have more developed right than left hands, and future left-handers are more likely to suck their left thumb in utero than right-handers.

Biological Sex and the Brain

Handedness has been related to asymmetries in brain anatomy and activation in adults. The hemisphere corresponding to the dominant hand has greater cortical surface area due to more enfolding in the motor cortex (the part of the brain that controls movement) than in the opposite hemisphere. Also, there is more activation in the sensory cortex of the hemisphere corresponding to the dominant hand than in the opposite hemisphere. Given the increased incidence of left-handedness in males, it is possible that, in general, males have greater variability in the structure and function of the sensory and motor cortices than females.

Empathy and Emotional Processing In comparison with men, women are often reported to be more emotionally expressive, feeling emotions more intensely, being more physiologically responsive (in terms of skin conductance and heart rate), and having a better memory for emotional events. Perhaps not surprisingly, meta-analytical studies show that processing emotional information activates different brain areas in men and women. These sex-related differences depend on the valence (positive or negative) of the stimuli designed to produce the emotion. Stimuli used in such studies have included photos, movie clips, words, or smells. Negative emotional stimuli produce greater neural activation in women compared with men in a number of different brain areas, perhaps most notably in the left amygdala, an area commonly associated with emotional processing. In contrast, this area is activated more in men than in women in response to positive emotional stimuli. There are also hemispheric sex differences in patterns of brain activity that are associated with better memory for negative events depicted in films. Men are more likely to remember details if there was right amygdala activity when they watched the film, but women show better memory if the left amygdala was activated as they watched. This suggests that there are sex differences in the ways men and women process and encode emotional information. Women show greater activation in the anterior part of the hippocampus and in the mamillary bodies than men; these brain areas are associated with memory, which may explain in part why women have better memory than men for negative emotional events. Women also show

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greater activation to negative stimuli than men in the anterior cingulate and the medial frontal cortex. Increased activity in these areas has been linked to depressive symptoms, which may be why women are more susceptible to depression than men. In contrast, men show greater activation than women in the lateral prefrontal cortex and the insula for both positive and negative emotional stimuli; these areas are frequently activated when someone inhibits a response. Therefore, men could be trying to suppress their reactions to emotional material. This is in keeping with sociocultural norms that discourage men from openly expressing their emotions.

Gender Differences in Psychopathology Boys are more prone to early neurodevelopmental disorders, such as autism, dyslexia, and attention deficit disorder, than girls. However, females are more vulnerable during adolescence and in later life to depression, and anxiety and eating disorders. The underlying causes for sex differences in psychopathology are multifaceted, and in general, neuroscientific study findings may be inconclusive because they tend to use small (and often sex biased) samples and there is considerable interindividual variability in brain anatomy and ­ function. This section briefly reviews current neuroscientific findings about depression and ­ attention-deficit/hyperactivity disorder (ADHD). These are probably the most common disorders during adolescence/adulthood and childhood, respectively, and there is strong evidence for gender differences in their prevalence. More people seek mental health advice for symptoms of depression than for any other psychological disorder, and females are about twice as likely as males to suffer from unipolar depression. However, it is clear that this gender difference is due to complex interactions among several biopsychosocial factors. Although some individuals are more genetically predisposed to suffer from depression than others, puberty increases the incidence of depression disproportionately more in females than in males. Moreover, stress also plays an important role in the etiology of the illness. Animal models have shown that increased levels of e­strogen increase hypothalamic-pituitary-adrenal axis activation and the subsequent release of stress-related hormones,

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such as cortisol. This may explain why adolescent girls who are exposed to stressors are more susceptible to clinical depression than boys. Furthermore, sociocultural factors increase the likelihood that adolescent girls rather than boys are exposed to sexually related stressors, such as abuse. Similarly, psychosocial factors may amplify female vulnerability to the effects of problematic peer relationships (e.g., peer rejection). Gender differences in temperament may also contribute to depression; girls may be more anxious than boys, which in turn may heighten the tendency to ­ruminate and exacerbate depressive symptoms. In general, people with depression have smaller brain areas in the thalamus, hippocampus, and frontal lobe. They also show increased activity in response to negative stimuli in the limbic regions, such as the amygdala, anterior cingulate, and insula, but decreased activity in cortical control areas, like the dorsolateral prefrontal cortex. Depression is also associated with increased activity in a part of the thalamus called the pulvinar, which sends messages to the amygdala about potential environmental threats. Longitudinal data suggest that the onset of adolescent depression may be associated with atypical patterns of amygdala growth during adolescence. During adolescence, females who develop depression show rapid growth of the amygdala, whereas males show slow growth; these patterns are in the opposite direction to that seen in control participants. ADHD is characterized by inattention, hyperactivity, and impulsivity, and it affects about 8% to 12% of 6- to 12-year-olds. It persists into adulthood in about half of these cases. The disorder is highly heritable and affects twice as many boys as girls. ADHD has been linked to deficits in ­frontal-striatal-cerebellum circuitry, which is rich in dopaminergic neurons. Animal models suggest that there is a sexual dimorphism in dopamine circuitry development and function, especially during adolescence, and changes are more dramatic in males than in females. Sex differences in dopaminergic circuitry maturation may also explain why risk taking and sensation seeking during adolescence are more prevalent in males than in females. ADHD has been linked to prenatal exposure to teratogens, such as nicotine as a by-product of maternal smoking, and male brains are particularly vulnerable to suboptimal prenatal ­ environments. Longitudinal data suggest that, in

general, the brain develops more slowly in children with ADHD, especially in prefrontal areas associated with cognitive control. Children with smaller caudate nucleus volumes during preadolescence are more likely to have ADHD symptoms that ­persist through adolescence. During normal development, females typically have larger caudates than males, which may explain in part some of the sex differences in the prevalence of the disorder. The caudate nucleus connects to cortical control areas in the prefrontal cortex and has been linked to flexibility and adaptable responding. In summary, neuroscientific studies are beginning to shed some light on sex differences in the brain, which may help us better understand the impact genes and the environment have on brain function, behavior, and psychopathology. Jillian Grose-Fifer and Danielle diFilipo See also Behavioral Disorders and Gender; Biological Sex and Cognitive Development; Biological Sex and Mental Health Outcomes; Fetal Programming of Gender; Neurosexism

Further Readings Cahill, L. (2014). Fundamental sex difference in human brain architecture. Proceedings of the National Academy of Sciences, 111(2), 577–578. Hyde, J. S. (2014). Gender similarities and differences. Annual Review of Psychology, 65(1), 373–398. Miller, D. I., & Halpern, D. F. (2014). The new science of cognitive sex differences. Trends in Cognitive Sciences, 18(1), 37–45. Mills, K. L., Lalonde, F., Clasen, L. S., Giedd, J. N., & Blakemore, S. J. (2014). Developmental changes in the structure of the social brain in late childhood and adolescence. Social Cognitive and Affective Neuroscience, 9(1), 123–131. Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187. Ruigrok, A. N. V., Salimi-Khorshidi, G., Lai, M.-C., Baron-Cohen, S., Lombardo, M. V., Tait, R. J., & Suckling, J. (2014). A meta-analysis of sex differences in human brain structure. Neuroscience and Biobehavioral Reviews, 39, 34–50. Sommer, I. E. C., Aleman, A., Bouma, A., & Kahn, R. S. (2004). Do women really have more bilateral language representation than men? A meta-analysis of functional imaging studies. Brain, 127(8), 1845–1852.

Biological Sex Differences: Overview Stevens, J. S., & Hamann, S. (2012). Sex differences in brain activation to emotional stimuli: A meta-analysis of neuroimaging studies. Neuropsychologia, 50(7), 1578–1593.

Biological Sex Differences: Overview Genetic, anatomical, hormonal, and neurochemical differences between cisgender males and females underlie some of the distinctive behaviors, conditions, and health outcomes seen in men and women. Of course, neither “nature” nor “nurture” entirely explains all the differences between the sexes; rather, these differences are caused by an interaction between biological factors and environmental influences. This entry includes information about some of the physiological differences between cisgender males and females, the psychological and behavioral differences between men and women, as well as the diverse factors that underlie these disparities.

Gender Versus Sex Although the terms are sometimes used interchangeably, gender refers to the behaviors, roles, expectations, and activities of men and women in society, while sex describes the biological factors that make one male, female, or intersex, such as chromosomes, hormones, and anatomy. Because of the dearth of literature on transgender people, this entry will concentrate on cisgender men and women, or people who identify with their assigned birth sex.

Evolutionary Sex Differences Evolutionary psychology is a way of explaining the behavior of men and women today based on thousands of years of evolutionary forces. For instance, cross-cultural evidence suggests that males are more sexually promiscuous than females. The evolutionary explanation for this is that males produce hundreds of millions of sperm at a time. A man could (theoretically) impregnate a different woman every day and not stay to raise any of the offspring. Evolutionary psychology suggests that a

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man who is genetically predisposed to promiscuity might produce hundreds of offspring while a more sexually selective man would only pass his genes on to a few children. In a short amount of time, the gene for promiscuity in men would become more prevalent. According to the theory, different forces drive females. Females invest more time, energy, and risk with each offspring than males do. In contrast to the billions of sperm produced by males each month, females produce a single egg. If that egg is fertilized and the woman becomes pregnant, she would need to commit significant time and resources to carry the child to term and to raise it. In contrast to promiscuous males, the theory says it is adaptive for females to be selective and to wait to have sex with the male with the best possible genes and who is most likely to stick around to help her raise her child, thus giving the child his or her best chances for success. Some critics of evolutionary psychology maintain that it highlights the Western, white, male, heterosexual point of view to the exclusion of others. Others feel that it oversimplifies the foundations of complex human behaviors, since social and environmental factors play a significant role in men and women’s behaviors.

Biological Sex and Cognitive Development There is a prevailing stereotype that women are superior in reading comprehension while men excel in science, math, and spatial abilities. There may be some small, innate biological differences that underlie these cognitive differences; for example, some studies suggest that testosterone may improve performance on tests of spatial relationships and hinder verbal abilities. However, any cognitive differences in men and women are most likely related to societal factors such as one’s learning environment, income level, or encouragement by others. In the 1980s, thirteen times more boys than girls scored more than 700 on the math portion of the SAT; by 2007, that number had plummeted to about three to one. Such a rapid change is powerful support against a biological difference in male and female math ability. Additionally, in more gender-equal countries, the gap in math scores between boys and girls has disappeared.

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Cognitive Disorders Some disorders related to learning, language, and cognition affect males and females at different rates. Attention-deficit/hyperactivity disorder (ADHD), autism, and dyslexia are three cognitive disorders that affect men at a significantly higher prevalence than women. Attention-Deficit/Hyperactivity Disorder

ADHD is a chronic behavioral disorder in which a person shows developmentally inappropriate levels of inattention, impulsiveness, or hyperactivity. ADHD was previously considered a disorder of childhood, but recent findings suggest that it often persists into adulthood. Boys are ­diagnosed with ADHD at about two to three times the rate of girls. This may be because boys are more prone to the underlying biological or psychological causes, or it may be a matter of ­ ­overdiagnosis in boys or underdiagnosis in girls. Parents and teachers may be more likely to ascribe a young boy’s hyperactive or rambunctious behavior to ADHD and less likely to recognize a girl’s subtler and less disruptive symptoms of inattentiveness. As those with ADHD age, men and women receive ADHD diagnoses in roughly equal proportions. Women are more likely to be diagnosed as adults, often through self-referrals when one of their children is diagnosed and they recognize the symptoms in themselves. Autism

Autism spectrum disorder includes a group of complex disorders of brain development, typically present from early childhood. These disorders are characterized by difficulties in verbal and nonverbal communication, social interactions, and understanding of abstract concepts. In the past, ­ autism was reported to affect four times as many males as females, but more recent investigations report an even greater gender disparity—7:1 overall and as high as 12:1 for Asperger syndrome. This disparity may be related to genetic differences, prenatal stressors, the effects of testosterone on the brain, or environmental pollutants, such that male brains are more vulnerable to disruptions than female brains. Overdiagnosis may play a role as well.

Dyslexia

Dyslexia is a learning disability in which people with normal intelligence have trouble reading. Dyslexia is at least twice as common in males as in females. Dyslexia may have different neural foundations in males and females. Males with dyslexia have less gray matter in the language areas of the brain, while females show less gray matter in the areas of the brain involved in sensory and motor processing. Environmental factors play a role as well, since the brain’s neural pathways are altered by experiences. Mothers talk more to girl infants than to boy infants, and stereotypical ideas of boys’ and girls’ verbal abilities can influence a teacher’s expectations for his or her students.

Biological Sex and Health Outcomes There are physiological differences in almost every organ system in the male and the female body, and these differences have important medical ramifications. Cardiovascular

Males carry more oxygen in their blood than women, because of their higher blood volume and hemoglobin count. Women have a faster heartbeat and lower blood pressure than males. Men and women even have different symptoms of a heart attack. Men are more likely to experience chest pain and pain radiating down the left arm. Women are more likely to have nausea, indigestion, and back pain. Even when women show the same symptoms, physicians are more likely to ascribe their symptoms to emotional causes and tend to treat women less aggressively. Skin, Bones, and Joints

Women have thinner skin and are less prone to acne than males. They sweat less, and their sweat is more alkaline than that of males. Females have more adipose tissue (fat) than males. Males have denser bones and more skeletal muscle. Female athletes are more likely to have knee injuries than male athletes, due to a woman’s wider pelvis and weaker musculature and joints.

Biological Sex Differences: Overview

Digestion, Basal Metabolism, and Weight

Food moves through a woman’s body more slowly than through a man’s. Men secrete more stomach acid, while women have more cholesterol in their bile and are more prone to gall bladder disease. Men have a higher metabolic rate than women. In part, this is because men have more skeletal muscle than women and muscle burns more calories than adipose. There are also hormonal differences. Estrogen increases fat deposition in the breast, hips, and thighs, while testosterone increases muscle development. Additionally, after weight loss, men have higher levels of leptin, a hormone that causes the stomach to feel full. This may, in part, explain why women are more likely to regain weight after dieting.

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hormonal differences that underlie this phenomenon, as well as cultural and environmental factors. Women report pain with milder stimuli, describe it more fully, feel it longer, and tolerate it less well. However, after surgical procedures, men are more likely to ask for and more likely to receive medications such as morphine to relieve their pain, while women are more likely to be thought to be complaining. Mortality

Male mortality is greater than female mortality at every stage of life: Male fetuses are more likely to be miscarried than female fetuses, male infants are at greater risk of being born prematurely or of stillbirth, males have more developmental disorders, and adult males die at a younger age than adult females.

Drug Metabolism

The same medication may have a different effect on males and females. Women have less of the enzyme that breaks down alcohol and will consequently become more intoxicated on the same amount of alcohol than a man. Yet amphetamines and caffeine seem to exert a more powerful effect on males. Cigarette smoking is more carcinogenic in women than in men: Controlling for the number of cigarettes smoked, women are more likely than men to develop lung cancer. Senses

Females have a greater sensitivity to odors than males. Males tend to be better at locating sounds, but females may have more sensitive hearing at higher frequencies. Compared with women, men are significantly more likely to experience hearing loss as they age. This may be due to greater exposure to high-noise situations—males tolerate significantly louder background noise than females. Men are more likely to be colorblind than women. Female’s retinas may contain more cells that are better at detecting texture and color, and male’s retinas are better at detecting movement.

Biological Sex and Language and Communication Although it is a cultural stereotype that women speak more than men, a 2007 study found no significant difference in the number of words spoken each day. In mixed-gender groups, men actually talk more than women, and men are more likely to interrupt. In conversation, women are more likely to ask questions, but men are more likely to make direct questions of fact. Author Deborah Tannen called this “rapport talk” and “report talk” and suggested that while women see conversation as a means of sharing and connecting men are more likely to see it as a means to transmit information and be seen as an expert.

Biological Sex and Mental Health Outcomes About half of all Americans will meet the criteria for a mental health disorder such as depression, anxiety, or schizophrenia during their lifetime. Men and women are diagnosed with mood disorders, schizophrenia, and addiction at different rates.

Pain

Major Depressive Disorder

Women have a lower threshold for pain than men. There are genetic, cellular, anatomical, and

Major depressive disorder (MDD), also called unipolar depression, is a debilitating condition

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characterized by overwhelming sadness, feelings of worthlessness, and a loss of interest in normally pleasurable activities. About one in five U.S. ­citizens will ever experience MDD—7% to 12% of men and 20% to 25% of women. Over the course of a lifetime, women are 70% more likely to be diagnosed with major depression than men. This discrepancy may be due to genetic, hormonal, or social factors, or it might be related to the diagnostic criteria. Depression manifests differently in men and women. Women show sadness, guilt, and hopelessness, but depression in men may actually manifest as rage, aggression, irritability, risk taking, and substance abuse. When that difference is taken into consideration, the disparity between the depression rates of men and women disappears. Anxiety

Anxiety disorders are the most common class of mental disorders. It is estimated that 29% of Americans will suffer from an anxiety disorder at some point in their lives and 18% will meet the criteria in any given year. Women are diagnosed with anxiety disorders 1.5 to 2 times as commonly as men and have more severe symptoms and functional impairment than men. Compared with men, women who were diagnosed with an anxiety ­disorder at some time in their life are also more likely to be diagnosed with another anxiety disorder, bulimia, or MDD. During the first few months of infants’ lives, boys are fussier and show more anxiety. This evens out by age 2 years, and until puberty, boys and girls are equally likely to develop an anxiety disorder. By age 15 years, however, girls are significantly more likely to have one than boys. This discrepancy in prevalence may be due to biological, societal, or environmental factors. Also, as women are much more likely to seek help from a psychologist, women will be diagnosed more often than men. Schizophrenia

About 1% of the population will suffer from schizophrenia during their lives, and 30% of those will spend a significant portion of their lives in mental hospitals. Men are affected slightly more than women, tend to have symptoms at a younger age, and experience more severe symptoms. Men first develop symptoms in their late teens and early

20s, while women first show signs in their late 20s and early 30s. Addiction

In 2013, 8.2% of those aged 12 years and above in the United States—some 21.6 million persons— were diagnosed with substance dependence or abuse. Men are about twice as likely to be diagnosed with substance abuse or dependence as women. Men and women often enter the road that can lead to addiction via different paths. Men are more likely to take drugs or alcohol as part of a pattern of risky behavior or to enhance their behavior in social situations, while women are more likely than men to begin taking drugs as selfmedication to reduce stress, decrease feelings of social isolation, or alleviate depression. Many men and women with drug or alcohol dependence have been codiagnosed with a psychiatric disorder. Men are more likely to be diagnosed with ADHD and antisocial personality disorder, and women have higher rates of depression, anxiety, and phobias. In men, depression and other psychiatric disorders are usually secondary to the substance abuse diagnosis, but in women, ­depression usually comes first and the drug abuse follows. Compared with men, women also show a faster progression from first use to the appearance of substance-related problems.

Biological Sex and Social Development Although societal stereotypes suggest that women experience more emotions than men, this is not true. Men do experience emotions, but they may not be as able as women to verbalize them due to both societal and physiological influences. Actually, infant boys tend to be fussier and more emotionally expressive than baby girls, but they are socialized throughout their lives to show less emotion. This does not mean that men don’t experience emotions, just that their expression may be more internalized. Compared with women, men undergo greater increases in heart rate, blood pressure, and sweating when confronted with highly emotional situations. Some studies suggest that emotions may be processed differently in the brains of male and female adolescents. Friendships among girls and women are described as “face-to-face,” while male friendships

Biological Sex Differences: Overview

are described as “shoulder-to-shoulder.” What this means is that women’s social interactions are likely to center on conversations and personal self-disclosure but men’s gatherings are more likely to focus on their shared interests rather than on the conversation.

Biological Sex and the Brain Many areas of the brain are sexually dimorphic, meaning they differ in size in men and women. Parts of the frontal cortex (involved in reasoning and decision making) and the hippocampus (important for memory) are larger in women, while males tend to have larger parietal lobes (involved in spatial perception) and amygdalae (important for anger, fear, and sex drive). Some suggest that the corpus callosum, the bundle of fibers connecting the left and right halves of the brain, is larger in females, although this finding is inconsistent. The “real-world” significance of these findings is a source of great controversy and may be related to neurosexism. Neurosexism

Neurosexism is the use of neuroscience research to support preexisting ideas about the differences between men and women. It suggests that sex and gender differences are due to fixed and functionally important disparities in male and female brains, rather than due to societal expectations and behaviors. Scientists may sometimes take small, insignificant, or unrelated findings about the brain and use them to “explain” prevailing stereotyped ideas about men and women. There are some assumptions and biases inherent in almost all research. After all, researchers are men and women who have spent their lives in a gendered world, so their observations may be affected by these deepseated assumptions and biases. Neurofeminism encourages critical examination of the methodological approaches used in studying the neurological differences between the sexes. Neurofeminism

Neurofeminism is the field of study that deals with the relationship of neuroscience and traditional feminist issues. Proponents critically evaluate sex- and gender-related findings in the field of

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neuroscience to discover whether the gender differences are innate, preprogrammed traits, or due to cultural expectations and the environment in which we are raised. When considering whether a behavior is “nature” or “nurture,” it is important to remember that biology and society interact; few, if any, human behaviors can be explained on a solely biological or an exclusively cultural basis. While some of the research is sound, some of the research studies that suggest that the differences between men and women are due to innate, enduring, and substantial differences in the brain have problematic methodologies, fallacies of ­reasoning, underlying biases and assumptions, statistical manipulations, and faulty conclusions. Methodological design has a powerful effect on the results of a study. As an example, when male and female subjects were asked to play a video game in which they could drop bombs on an opponent, the females dropped fewer bombs. However, when the subjects were told that their actions would be anonymous, the females actually dropped more bombs than the males. When assured of anonymity, responses are much less likely to conform to stereotypical gender roles, but when they are aware that they are being observed, both men and women may feel strong pressure to conform to existing gender roles, and their behavior may better represent prevailing social pressures rather than any real biological differences. It is important not to confuse correlation and causation. It may be true that differences in male and female brains cause men and women to act differently, but it may also be that the neurological variations are caused by the different behaviors. Neural pathways in the brain are constantly changing and strengthening based on experience. For example, males may be born with a small, innate advantage over females in their ability to visualize objects rotated in space. But the toys, sports, and games boys are exposed to enhance this natural ability and widen the gap between males and females by the time a boy grows to be a man. So if differences are found in the brains of adult men and women, it is difficult to say if these differences are inborn or if they have developed after a lifetime of living in a gendered world. Researchers are men and women who have their own biases about sex and gender, and these preconceived notions may color the way the research is interpreted. A study was done on

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day-old infant boys and girls. The babies sat in their parents’ laps and were shown a mobile and a person’s face side by side. The researcher reported that the boy babies looked at the mobiles longer and the girl babies spent more time looking at the faces. His conclusion was that males are more mechanically oriented and females are more social. But day-old infants are not only very nearsighted, they can’t hold their heads up by themselves. ­Perhaps, if the babies were “looking” in one direction, it was related to the direction in which their parents were holding them, which may have been influenced by their own ideas of sex and gender. Scientists may expect to see gender-specific behaviors and will be more likely to notice and report these characteristics than results that don’t meet their expectations. A statistically significant difference is not necessarily functionally significant. It may be that one brain region is significantly bigger in males than it is in females but that this difference does not have any real-world consequences. Finally, researchers tend to look for differences rather than similarities. It also may be that a study that reports a neurological difference between males and females is more likely to be published than one that finds no difference.

Intersexuality “Male” and “female” are not opposites; they are points that lie along a continuum. Intersex individuals have a mix of both male and female biological features. Often, intersex individuals will have the gonads (ovaries or testes) that match their chromosomal sex (typically XX for females and XY for males), but their external genitalia are ambiguous or opposite. For example, persons with androgen insensitivity syndrome have male chromosomes (XY) and undescended testes that produce testosterone. However, their bodies do not respond to testosterone, so they don’t develop a penis and scrotum and instead produce the “default,” female genitalia— labia, a clitoris, and a vagina. In 5-alpha reductase deficiency, a genetic male lacks the enzyme that converts testosterone to ­di-hydrotestosterone (DHT). Prenatally, testosterone is responsible for the development of the internal male reproductive pathway, and DHT causes

growth of the penis and scrotum. When someone is born with 5-alpha reductase deficiency, he has a Y chromosome and testes, but since he lacks DHT, he is born with what appear to be female external genitalia. At puberty, however, the surge of testosterone causes the penis and the scrotum to grow. Women who have congenital adrenal hyperplasia have XX chromosomes, ovaries, and a uterus, but they are exposed to high levels of androgens before birth. This masculinizes the genitalia, such that the clitoris enlarges and the labia partially fuse. There is controversy as to whether Klinefelter’s syndrome and Turner’s syndrome should be considered intersex, since there is concordance between the chromosomes, gonads, and genitals. Klinefelter Syndrome

In Klinefelter’s syndrome, a sperm carrying a Y chromosome fertilizes an ovum that has an extra X chromosome, and the boys end up with an extra X chromosome in each cell in their body—XXY. This occurs once every 500 to 1,000 births due to a random mutation during the formation of the egg and the sperm in the parents or after conception. Males with Klinefelter’s syndrome have small and underdeveloped genitalia, less testosterone than normal, reduced sex drive, erection difficulties, and infertility problems. Males with Klinefelter’s syndrome tend to be taller than their peers, with what may be considered a more feminine body shape, including some breast development, narrow shoulders, wide hips, decreased muscle mass, and sparse facial and body hair. They have an increased risk for osteoporosis, breast cancer, lung diseases, and autoimmune ­disorders. Klinefelter’s syndrome is also associated with a greater likelihood of problems with reading, writing, speech, and problem solving. Turner’s Syndrome

Turner’s syndrome occurs when all or part of one of the X chromosomes is randomly lost before or soon after conception. This occurs once in every 2,000 to 3,000 live female births. Individuals with Turner’s syndrome are characterized as XO. Lacking a Y chromosome, they have no testes. But two X chromosomes are needed to produce functional

Biological Theories of Gender Development

ovaries, so women with Turner’s syndrome are usually sterile. They have female external genitalia, but they don’t develop breasts, their hips are not much bigger than their waist, and they don’t menstruate. Some physical characteristics of Turner’s syndrome include short stature (typically under 5 feet), swollen hands and feet, a webbed neck, droopy eyes, low-set ears, and a receding lower jaw. Women with Turner’s syndrome often have heart problems, as well as kidney, liver, and thyroid dysfunction. They do not have intellectual disabilities, but learning difficulties are common; these women may have problems with spatial relationships and sense of direction, nonverbal memory, attention, and social skills. Somatic Mosaicism

Somatic mosaicism occurs when the somatic cells of the body are of more than one genotype. This typically occurs due to a spontaneous mutation that occurs after conception. About 6% of people with Klinefelter’s syndrome are mosaic for the condition, meaning that they have an extra X chromosome in only some of their cells. They are designated as 46,XY/47,XXY. About 20% of those with Turner’s syndrome are mosaic and are designated as 46,XX/45,X. These mosaic forms of Klinefelter’s and Turner’s syndrome tend to have milder signs and symptoms than the classic forms. Martha S. Rosenthal See also Congenital Adrenal Hyperplasia; Developmental and Biological Processes: Overview; Health Issues and Gender: Overview; Mental Health and Gender: Overview

Further Readings Cosmides, L., & Tooby, J. (1997). Evolutionary psychology: A primer. Santa Barbara: University of California, Center for Evolutionary Psychology. Retrieved from http://www.cep.ucsb.edu/primer.html Hyde, J. S. (2005). The gender similarities hypothesis. American Psychologist, 60(6), 581–592. Legato, M. J. (2002). Eve’s rib: The new science of gender specific medicine and how it can save your life. New York, NY: Harmony Books. Rosenthal, M. S. (2013). Human sexuality from cells to society. Belmont, CA: Wadsworth Publishing/Cengage Learning.

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Schmitz, S., & Hoppner, G. (2014). Neurofeminism and feminist neurosciences: A critical review of contemporary brain research. Frontiers in Human Neuroscience, 8(546), 1–10. Tannen, D. (1991). You just don’t understand: Women and men in conversation. New York, NY: Ballantine Books.

Biological Theories of Gender Development To make the discussion of biological theories of gender development behavior categories precise, several definitions are necessary. The term gender was borrowed from language grammars by sexologist John Money in 1955 to refer to behavior categories for the treatment of those who were of indeterminate sex. Today, the term continues to refer to behaviors in cultural gender behavior categories regardless of sex category. Gender has to do with behavior. Culture constructs gender categories that define the behaviors expected of people in these categories, as well as rules, norms, and expectations. Gender is not the same as sex from a scientific point of view, although it is unfortunately often used in public discourse as a polite synonym in binary cisgender cultures. Sex has to do with primary and secondary sex organs that develop through biological mechanisms involving genetics and epigenetics. Primary organs are the organs of reproduction, and secondary organs are those that support reproduction, for example arousal for sex (e.g., the brain and spinal cord). This entry explores evolutionary, genetic, and epigenetic theories of gender development, as well as learning theories of gender development.

Defining Gender Categories In the currently prevailing binary cisgender culture, gender categories are masculine and feminine; categories for sex are male and female. Binary means that there are only two gender categories; cisgender means that one is assigned to a category depending on assigned natal sex. Some cultures have more than two categories, up to five. Some cultures also have allowed or allow free movement between categories, whereas the prevailing

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contemporary culture does not. In this section, genetics will refer to DNA and its expression, and epigenetics refers to non-DNA mechanisms that change the DNA or change its expression. For example, epigenetic mechanisms refer to mechanisms such as those that might be at work in the prenatal environment, such as the effects of hormones or toxic drugs. The biological theories of gender development can be divided into four categories depending on the mechanisms that are emphasized: (1) evolutionary, (2) genetics, (3) epigenetics, and (4) learning. Although alternative gender development ­theories are sometimes characterized in scientific debates as competing explanations, the theories of gender behavior do not conflict with one another as much as each may place emphasis on particular mechanisms.

Evolutionary Theories There are three major types of evolutionary theories: (1) sex-based evolutionary theories, ­ (2) kinship-based evolutionary theories (intrinsic fitness theories), and (3) socio-cognitive evolutionary theories. Sex-based evolutionary theories involve the idea that natural selection in human evolution resulted in different gender behaviors for each sex. Sex differences resulted in a division of labor determined by sex. These behaviors emerged during the time when humans were mainly ­organized into hunter-gatherer societies, 40,000 to 10,000 years ago. This biological division of labor by sex did not appear until near the end of that period and has changed little since then. Sex-based theorists believe that behavior was adapted to fit the human reproduction situation, with females primarily involved in tasks related to child rearing and males involved in hunting and group protection. Females became responsible for gathering food near the home base camp because child rearing impaired their ability to run and go far from the home. Males, on the other hand, were responsible for hunting and protection of the society. Males went far from home to bring back animal meat as a high-calorie source of food. For this reason, males evolved to have higher levels of androgens, which facilitated muscle development, strength, and aggression. Since males could not prove their paternity, they did not invest in child

rearing but instead attempted to impregnate as many females as possible. According to these theories, female hormones evolved to favor estrogen and oxytocin, which facilitated social bonding within the society. Gender within the society was categorized by sex. Masculine gender behavior evolved into a separate category that featured aggression, both physical and sexual. Feminine gender behavior evolved into a separate category that featured child care and maintaining social relations. In the past, evolutionary theories have postulated that gender behaviors were passed on by forbears through DNA genetic mechanisms. But we now know that information is transmitted from parents to their offspring by epigenetic ­mechanisms as well. For this reason, evolutionary theories dovetail with both genetic and epigenetic theories of gender development. The most obvious criticism of evolutionary theories of gender development is the rapid change in gender behavior categories that have occurred over the past century. These changes have occurred so rapidly that they could not possibly have been caused by natural selection. In contemporary ­culture, behaviors that were considered by evolutionary theorists to belong in only one gender behavior category are now in both categories. Both males and females now customarily are involved in child rearing, and some males have become dedicated homemakers. Marriage law has recognized the need to provide economic and legal protection for spouses who do not work outside the home. Due to advances in technology, modern warfare requires less body strength, so that both males and females can participate in defense activities. ­Modern agriculture has largely supplanted the need for hunter-gatherer activities, resulting in a precipitous decline in hunting and fishing for food. The second type of evolutionary theory of gender development is termed “kinship” theory, also called intrinsic fitness theory. The rationale for this type of theory is that early humans lived in family groups for cooperation and protection. Much of the DNA/epigenetic information within such groups was similar. Such theories postulate that it was the fitness of the group, tribe, or clan that was most important for survival. It is the “intrinsic fitness” of the group as a whole that was subject to

Biological Theories of Gender Development

natural selection. Natural selection favored those groups in which survival skills and behaviors had redundant representation within the group. This means that there is a natural advantage in spreading critical behaviors across many members of the group. Critical behaviors, for example, include child rearing or hunting. Individual behavior within the group can be seen in the short run as altruistic but in the long run as maintaining and improving group genes. Because they share the same genes, individuals may pass on their genes, not from direct involvement in reproduction but from facilitating group survival. Much of the anthropological scientific evidence supports kinship theories rather than sex-based theories of gender development. The societies that have been most extensively studied are the Native American tribes, although similar results have been found in other cultures. About 150 of these Native American tribes had three gender behavior categories, and half of them had four categories. Two of the four categories involved males, and two involved females. Some males followed an alternate gender behavior category that included what might be considered “feminine” behavior, such as weaving, child care, and cooking. Some females followed an alternate gender behavior category that included warfare and hunting. Some children were designated as “two spirit” based on their early-childhood behavior and were taught two gender behavior categories and allowed to move freely between them. One day they might present in feminine clothing and pursue weaving, and the next day they might present in masculine clothing and conduct warfare. Having multiple skills facilitated the survival of the group and allowed members to express more than one gender. There is a third type of evolutionary theory that is termed “socio-cognitive” theory. This type of theory posits that as human cognition developed, it changed the human natural selection environment, thus changing the body and behavior. Because it was useful to stand upright to use the newly invented tools, improved cognition established evolutionary pressure for erect posture. According to this theory, the brain and body coevolved, each affecting the other as well as behavior. Because of this interaction, causation of these theories cannot easily be established from the evidence.

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Genetic Theories of Gender Predisposition The concept of genetic gender predisposition features the idea that humans have gender predispositions or temperaments that are present at birth or shortly thereafter. Humans have many kinds of predispositions for things such as handedness, activity level, musical ability, and fear of mathematics. Gender predisposition reveals itself most vividly when people are put in positions where their gender predisposition is incongruent with their assigned gender behavior category. This occurs most frequently with transgender people, but there are a few instances of “natural experiments,” one of which is particularly notorious. Twin studies indicate that traits such as predispositions or temperaments have a genetic basis, especially if objective measures are used, such as child observation. Twin studies attempt to correlate traits between identical twins, who share the same starting DNA. Twin studies on various dispositions generally show that identical twins have higher inheritable correlations than fraternal twins for various temperament predispositions. Studies of transgender or gender nonconforming people indicate that there are genetic predispositions for gender. Many transgender people may seek gender affirming medical treatments to match the gender they most identify with. There is some research that supports the idea that transgender or gender nonconforming identities result from genetic gender predispositions that conflict with culture. First, heritability research or twin studies indicate that if one identical twin is transgender then it is more likely for the other twin to also be transgender (as compared with the rate in the general population). This finding is not true for fraternal siblings or nontwin siblings in the same family. Second, DNA genetic markers have also been found for transgender people, although the entire genome has never been investigated. Third, biomarkers believed to be due to genetic inheritance have been found for transgender or gender nonconforming people, including handedness (transgender people are less right-handed) and body measurements such as tooth shape and hip girdle for female-to-male transgender men. Fourth, transgender or gender nonconforming people ­generally start to tell their parents or those around

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them that they are transgender or gender nonconforming at about age 4 years, although there are some fragmentary reports that transgender identity development can emerge as early as 18 months. This timing is compatible with a genetic phenomenon. There have been several “natural experiments” in which male children with damaged genitalia (from circumcision) or differences in sexual development have had genital plastic surgery to make them appear more female. These children were then raised as girls by their parents. Such children generally do not accept the gender behavior category to which they have been assigned. The case of David Reimer is particularly notorious. David lost his penis as a result of a botched circumcision. He received genital plastic surgery to make his genital organs more like those of a female, and his parents were told to raise him as a girl. From childhood, David behaved like a boy and eventually lived as a man. David rejected his newly assigned gender behavior category, supporting the idea that genetic gender predisposition is fixed at birth. He e­ ventually committed suicide. This case is notorious because the psychologist who treated David deliberately withheld David’s rejection of behaving as a girl or woman.

Epigenetic Theories of Gender Development Epigenetic theories involve non-DNA mechanisms that change the DNA or control its expression. Epigenetic mechanisms can be passed on by ­parents, can occur during the prenatal period, or can occur after birth. Epigenetic theories of interest include prenatal brain hormonal exposure and prenatal exposure to toxic mutagenic substances. Perhaps the most cited epigenetic theory of gender development involves prenatal brain exposure to sex hormones. Sex hormones come from the developing gonads or from the adrenal glands. So the theory goes, exposure to hormones in the prenatal period helps organize brain anatomy and physiology. Later, these hormones activate behaviors such as aggression and sexual reflexes. This theory is called the organization-activation theory. Testosterone is believed to cause the brain to form in a pattern that can motivate aggression in both males and females. Males usually have higher

levels of circulating androgens and thus are more prone to activation of aggressive behavior. Sex behavior is influenced by androgens in males and estrogens/progesterones in females. The effects of prenatal hormones can be easily observed by the differences in the anatomy of the hypothalamus and other brain structures. The hypothalamus is of particular interest with regard to sexual reflexes because it has close anatomical connections to the genitalia. The organization-activation theory is based on animal experimentation with sexual behavior and aggression that was started in the late 1950s. The central idea of this theory is that sex hormones organize the structure and functions of the nervous system during the prenatal period. Once organization takes place, the same hormones later activate aggression, sexual reflexes in rodents, and singing/ crowing in birds. Later investigation indicates that the actual chemical mechanisms of prenatal organization are very complicated. Estradiol, not androgens, actually are the hormones that interact with brain cells to effect organization for aggression and male sexual reflexes. Some regions of the brain are protected from estradiol exposure by active bloodbrain barrier mechanisms. However, testosterone crosses readily into the brain. Androgens are converted into estradiol through a chemical reaction that involves the catalyst aromatase. The chemical reaction can only occur where the aromatase catalyst molecule occurs, and thus estradiol can only be manufactured at locations where aromatase is present. Thus, the aromatase theory for aggression and sexual reflexes states that androgens at sites where aromatase is present will transform into estradiol, which actually does the organization work. There is scientific evidence that both male and female humans respond with aggression and increased sexual motivation when activated by hormones during adulthood. Although we would like to think of females as nonaggressive, they are actually more verbally aggressive than males. Although they are less physically aggressive, they still commit a significant number of violent crimes. According to both organization-activation and aromatase theories, aggression motivation is organized and activated by androgens in both males and females. Given this fact, it may be more

Biological Theories of Gender Development

correct to say that these behaviors fall into an “androgen behavior category” that is not associated exclusively with either masculine or feminine gender behavior categories. There are several criticisms of the organizationactivation theory as it pertains to humans. ­Organization-activation studies have mainly used animals, which do not have a sophisticated gender system. Human gender includes elaborate gender presentation and expression. Information obtained from human studies indicates that androgens do not organize other-gender behaviors in humans. For example, there was a theory that transgender or gender nonconforming behavior is caused by the levels of prenatal testosterone. The idea was that male to female transsexual people did not get enough testosterone in the prenatal period; female to male transgender people got too much. This theory is refuted by studies of humans who have been extensively exposed (female congenital adrenal hyperplasia) or minimally exposed (Kallmann syndrome) to testosterone but who do not become transgender or gender nonconforming at a rate differing from the population rate. The second type of epigenetic theory of gender development involves prenatal exposure to toxic chemicals and drugs that are thought to disrupt normal DNA gender development. The drug diethylstilbestrol (DES) was prescribed for expectant mothers during the years 1947 to 1973. The drug resembles estrogen in chemical structure but has physiological effects that estrogen does not. The drug crosses readily into the brain, unlike estrogens. The drug does not bind with cells at the main cell membrane receptor site for estrogen. More important, DES has the effect of mutating DNA and altering its expression. The drug was taken off the market when it was discovered that female offspring had higher rates of certain cancers, which suggested DNA mutagenicity. These effects were later shown to extend into the third generation, so the mutations persisted in the DNA of children and grandchildren. Because not enough research had been done on DES sons, a group of independent investigators started a website to register these sons and to allow them to communicate about their problems. The results indicated that 10% of the registrants reported that they were transgender or transsexual, and the researchers suspected that this was a result of DES since the

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population frequency of male transgenderism is estimated at 1%.

Biological Learning Theories of Gender Development Although gender “learning” theories are often characterized in debates as being in opposition to “biological” theories of gender development, the truth is that biological learning mechanisms actually underpin gender learning and development. Each of the following five biological mechanisms of learning contributes to gender development: 1. Declarative episodic learning 2. Declarative fact learning 3. Nondeclarative motor learning 4. Declarative procedural learning 5. Nondeclarative emotional learning

Declarative episodic learning of gender involves concept learning by observation and modeling, which starts in childhood. “Declarative” means that children and adults are able to verbally recall such learning. “Episodic” means that the learning occurs through experiences, not exposure to facts. The mechanisms for this type of learning are located principally in the cortex, which receives sensory inputs and mediates language. Children learn gender behavior through observation of other children and adults and even mass media. Declarative fact learning involves the presentation of factual information by other children, ­parents, teachers, and others. It can provide the mental preparation for modeling or its verbal interpretation. Children can verbalize gender behavior differences at an early age, usually by 2 to 3 years. They know about their own gender behavior category assignment and begin to perfect these behaviors. As language functionality matures in the cortex, fact learning and recall progressively improve. Parents, teachers, and others provide factual instruction about appropriate gender behaviors. Mass media also provide factual knowledge. Children are able to verbally recall the gender of people significant to them. In adolescence, this type of learning is extended to learn appropriate

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relationship behavior for the gender behavior categories. The third type of learning is nondeclarative motor learning of gender behaviors. This type of learning requires the development of cerebellar functioning. This type of learning is achieved through motor practice, with contributions from declarative episodic and declarative fact learning. People assigned to the two gender categories are expected to learn certain motor skills. For e­ xample, girls learn how to put on feminine clothing, how to style their hair, and how to walk in heels, all of which require motor coordination. Boys are expected to learn how to shave, tie a tie, and conduct courting behaviors. Episodic modeling as well as factual learning can facilitate learning and rehearsal for this type of learning. This type of learning typically cannot adequately be verbally recalled but can be demonstrated. The fourth type of learning is declarative procedural learning, which is centered in the subcortical striatum structures. Girls learn the correct sequences for dressing, applying makeup, and ­relationship building with boys. Boys also learn relationship building with girls. Although knowledge from this type of learning begins in early childhood, it becomes refined in adolescence and adulthood. The fifth type of learning is emotional learning, which many theorists believe to be centered in the amygdala and hypothalamus. Emotional learning involves behavioral feedback from the family, community, and culture on the success of expressed gender behavior. This mechanism thus supports operant conditioning for motor and procedural learning. Thomas Bevan See also Biological Sex and Cognitive Development; Biological Sex and Language and Communication; Biological Sex and Social Development; Biological Sex Differences: Overview; Gender Development, Theories of

Further Readings Bandura, A., & Bussey, K. (1999, October). Social cognitive theory of gender development and differentiation. Psychological Review, 106(4), 676–713.

Bevan, T. (2014). The psychobiology of transsexualism and transgenderism. Santa Barbara, CA: Praeger. Hamilton, W. (1964). The genetical evolution of social behaviour I. Journal of Theoretical Biology, 7, 1–16. Hamilton, W. (1964). The genetical evolution of social behaviour II. Journal of Theoretical Biology, 7, 17–52. McCarthy, M. (2008). Estradiol and the developing brain. Physiological Review, 88, 91–134. Phoenix, C., Goy, R., Gerall, A., & Young, W. (1959). Organizing action of prenatally administered testosterone proportionate on the tissues mediating mating behavior in the female guinea pig. Endocrinology, 65, 369–382.

Biopsychology The field of biopsychology in essence reflects a centuries-old desire to understand how the mind and body operate in tandem. Psychologists dating back to Sigmund Freud and beyond have recognized the capacity of our behaviors, memories, and cognitions to be affected by neuroanatomical and physiological structures in the body. Though the body-mind link is now commonly recognized, this has not always been the case, and its realization has been promoted by the influx of research based in biopsychology. Researchers in biopsychology strive toward explaining macrolevel cognitive and behavioral functioning through examinations of microlevel biological processes. Thus, biopsychology connects work on genetics, neuroscience, pharmacology, and psychological science, which requires that researchers in the field must employ a broad methodological playbook. One example within the psychology of gender research has been the investigation into the genetic basis of sexual orientation. In recent decades, the field has gained burgeoning interest from policymakers in the form of broad initiatives to study the genetic and brain bases of behavior, though such efforts often bring complicated rather than straightforward results. Indeed, it often proves difficult to find one-to-one connections between parts of the genomic or neurological sequence and behavioral mechanisms, even with remarkably large participant samples, underscoring the complexity and difficulty of conducting biopsychological research. Among the most prominent topics studied in biopsychology is

Biopsychology

how individuals react to stressful situations, which can hold profound implications for a wide array of physical and psychological health concerns. This entry examines biopsychological research into stress reactivity, biopsychological health and wellbeing, and biopsychological research methods.

Understanding Stress Reactivity Using Research on Hormones and Immune Functioning Biopsychological research into stress reactivity often focuses on cortisol. Cortisol is a hormone involved in initiating the stress response. When individuals perceive and appraise an event as a stressor, cortisol is released into the bloodstream, and it interacts with multiple bodily systems to mobilize the body’s resources. A network of neurons and hormone-releasing glands, known as the hypothalamic-pituitary-adrenal axis, regulates the levels of cortisol present in the blood at all times. In the brain, the neurons in the hypothalamus project to the pituitary gland, which releases hormones into the bloodstream. Some of these hormones communicate with the adrenal glands located above the kidneys to trigger the release of cortisol. This axis also is critical in slowing cortisol release when the stress response is no longer needed to address the situation. When a group of neurons in the hippocampus detect elevated cortisol levels in the bloodstream, signals are sent to the hypothalamus and pituitary gland to reduce cortisol release. Thus, this axis acts as a negative feedback loop, and its functioning is critical for both triggering and ceasing the stress response. The same neurons in the hippocampus responsible for detecting circulating cortisol levels are highly susceptible to damage when exposed continuously to high cortisol concentrations. While cortisol release is an adaptive and normative response to a physical or psychological stressor, researchers in biopsychology often are interested in who may exhibit an attenuated or exacerbated cortisol response. Chronically elevated cortisol levels can impair the body’s ability to detect circulating cortisol levels and adjust the release of this hormone accordingly. Such dysregulation of the hypothalamic-pituitary-adrenal axis can lead to a more prolonged and exacerbated stress response and has been observed in a number of common

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psychological disorders such as anxiety, posttraumatic stress disorder, and depression. Under normal circumstances, cortisol levels exhibit diurnal cycles, wherein circulating cortisol peaks shortly after awakening and declines slowly over the course of the day. Notably, men and women show similar daily fluctuations in cortisol, except that average cortisol levels tend to be higher among women. Furthermore, women with depression more commonly show abnormally large cortisol levels in response to a stressful event relative to men with the same disorder. While for most women higher cortisol reactivity may not lead to significant differences in psychological function, in conjunction with other risk factors it may increase their risk for mood and anxiety disorders. Further evidence for differences between men and women in the ways in which they respond to stress can be found in research exploring the impact stress plays on the immune system. For example, it has been shown that females tend to show a stronger immune response to stress than males. In addition, men appear to be more vulnerable to infection after surgery. These differences have led researchers to begin to examine a number of mechanisms that could possibly contribute to the gender dimorphism found in immune function. Psychological states can influence immune functioning by promoting or inhibiting health-related behaviors. For example, an individual suffering from depression is more likely to engage in drug or alcohol use as a means of coping, and the use of these drugs may in turn negatively influence immune function. Moreover, psychological states may also influence hormone production (and vice versa). Sex hormones such as estrogen, progesterone, and testosterone are believed to have important modulatory effects on the immune response. Too little response, and the individual may become ill, and too strong a response, and the individual’s immune system may become overactive and attack healthy tissues, which is the case in many autoimmune disorders. Sex hormones appear to influence this immune response, with women showing stronger responses than men. Although women may seem to be at an advantage over men by having a ­stronger immune response to stress, this ­heightened response also makes them more vulnerable to autoimmune disorders as well as chronic

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inflammation. Women also tend to experience more psychological stress than men in general, which could contribute to making them more ­vulnerable to the negative effects of chronic inflammation. One autoimmune disease, in particular, that appears to be heavily influenced by sex hormones is multiple sclerosis, which is a chronic inflammatory disease where the body’s immune response damages the protective coating around the nerves in the brain. Women’s increased immune reactivity and psychological stress compared with men appear not only to make them more susceptible to developing multiple sclerosis but also to negatively influence the course of the illness over time.

fluctuations in hormones such as cortisol. In addition, accruing research on personality traits has demonstrated linkages between dispositional characteristics and biomarkers of health, some of which do not appear to be immediately explained by individuals’ lifestyle choices (e.g., health behaviors). For instance, research consistently suggests that individuals who score higher on neuroticism, a personality trait defined by greater proneness to anxiety, depression, and vulnerability, tend to exhibit more exaggerated hormonal responses to stressful situations. Such findings support the ­primary tenet of biopsychology, namely that psychosocial variables can affect our daily health and well-being, through either behavioral or more physiological mechanisms.

Biopsychological Models of Health and Well-Being

Biopsychology Research Methods

Researchers in biopsychology frequently strive to build models that incorporate these physiological mechanisms for the purpose of explaining the role of psychosocial variables in health. In one ­frequently cited example, Nancy Adler and Karen Matthews presented a model for health p ­ sychology that discusses how dispositional characteristics (e.g., personality traits, psychological well-being) and one’s social environment ultimately play a role in physical health outcomes. Studies in health psychology often focus on the role of individual behavioral tendencies in explaining the effects of individual and social predictors of health. For instance, conscientious individuals tend to enact healthier behaviors in their daily lives, which in turn increases the likelihood of positive health outcomes. As such, in the Adler and Matthews model, health behavior is suggested as a proximal mechanism of the link between individual differences and health. However, the model also suggests that both individual differences and our social environment can have direct effects on physiological mechanisms such as stress reactivity and immune ­functioning. For instance, several aspects of our social environment, including our cultural contexts and whether we perceive having supportive relationships with others, can influence stress reactivity. Indeed, the role of social environments in stress is so well documented that researchers often employ social-based manipulations for studying

Given the complexity of biopsychology models, research in the field requires knowledge of multiple techniques and methodologies. In most cases, psychosocial variables are assessed via self-report questionnaires, which can provide fairly reliable data depending on the variable of interest. For physiological markers, though, researchers require the use of more complex assessment techniques. When attempting to connect psychosocial variables with brain functioning, neuroscience research can include work with imaging techniques, such as functional magnetic resonance imaging or positron emission tomography. In addition, researchers may measure event-related potentials, which allow an understanding of how quickly participants react when presented with stimuli. A common eventrelated potential study involves presenting individuals with an “oddball” stimulus, or one that differs in format or meaning from those in the given context. Researchers then examine whether such stimuli lead to an exacerbated neural response among certain groups of individuals. In attempting to assess stress reactivity, researchers have developed a number of techniques for examining biomarkers related to the stress process. Among the more frequently employed is the Trier Social Stress Test, which involves bringing participants into the laboratory and telling them that they must prepare and then present a talk to a group of researchers, occasionally in the form of a job interview. In some circumstances, participants

Biphobia

also must complete a verbal math task, wherein participants must restart the task after making mistakes. The researchers in the room are trained to remain largely stoic during the process, in an effort to induce greater social stress. Throughout the process, participants’ cortisol levels are assessed to see which participants release more cortisol as a reaction to the talk or its preparation. If these responses are compared with baseline measures of cortisol, researchers can gain insight into which individuals have higher cortisol output in general, as well as who reacts more to stressful situations. Another example of biopsychology research comes with respect to our understanding of pain sensation and perception. Researchers have developed unique methods for inducing pain without breaching ethical concerns with human or animal participants. For instance, one paradigm involves asking participants to hold their hand in remarkably cold or hot water for as long as possible. In part, this duration is influenced by how quickly one’s sensory receptors identify the experience as painful and motivate one to avoid the stimulus. However, multiple experimental studies have now demonstrated that the social settings involved as well as individual differences, such as personality traits, can greatly influence the ability of individuals to withstand the moderately painful experience. Such studies provide another example of how the true value of biopsychological research is seen when researchers combine multiple methods, allowing for clearer connections between psychological and physiological variables. Patrick L. Hill, Michael E. Parent, and Nathan A. Lewis See also Biological Sex and Health Outcomes; Developmental and Biological Processes: Overview; Health Issues and Gender: Overview

Further Readings Adler, N., & Matthews, K. (1994). Health psychology: Why do some people get sick and some stay well? Annual Review of Psychology, 45, 229–259. Merz, C. J., Tabbert, K., Schweckendiek, J., Klucken, T., Vaitl, D., Stark, R., & Wolf, O. T. (2010). Investigating the impact of sex and cortisol on implicit fear conditioning with fMRI. Psychoneuroendocrinology, 35, 33–46.

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Pariante, C. M., & Lightman, S. L. (2008). The HPA axis in major depression: Classical theories and new developments. Trends in Neurosciences, 31, 464–468. Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601–630. Thayer, R. E. (1989). The biopsychology of mood and arousal. New York, NY: Oxford University Press.

Biphobia Prejudice toward bisexual individuals is driven by negative attitudes, termed biphobia. Biphobia is similar to homophobia in that it reflects nonaffirming attitudes directed toward a marginalized group because of their sexual orientation. Research indicates that bisexual people experience similar levels of sexual orientation–based prejudice and violence as lesbian and gay people. However, biphobia has been conceptualized as unique relative to homophobia as it may come from both the lesbian/gay community and heterosexual people. This entry describes the nature of biphobia and how it can serve as a stressor for bisexual individuals.

The Unique Dimensions of Biphobia Biphobia may manifest in several different forms, but it generally stems from beliefs that bisexual people are indecisive, immature, cheaters, trashy, hypersexual, diseased, or unstable in their sexual orientation. Biphobic prejudice was originally conceptualized to capture two underlying dimensions: (1) an instability dimension, which reflects the degree to which bisexuality is perceived as an instable and illegitimate sexual orientation, and (2) an interpersonal hostility dimension, which reflects the extent to which others are hostile toward bisexual people. The instability and interpersonal hostility dimensions of biphobic ­ prejudice were supported empirically in Jonathan Mohr and Aaron Rochlen’s empirical study of the operationalization of lesbian, gay, and heterosexual individuals’ attitudes toward bisexuality. Follow-up work by Melanie Brewster and Bonnie Moradi on direct experiences of biphobia faced by the bisexual participants not only confirmed the

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existence of the instability and interpersonal hostility dimensions of biphobia but also revealed a third dimension of prejudice termed sexual irresponsibility. Their sexual irresponsibility factor reflected biphobic experiences of being treated as if bisexual people are promiscuous, hypersexual, vectors of sexually transmitted diseases, and disloyal in romantic relationships. The following sections present a thorough review and analysis of these three dimensions of biphobic prejudice. Bisexuality as an Illegitimate and Unstable Sexual Orientation

Research suggests that heterosexuals and lesbian and gay people may regard bisexuality with skepticism and actively try to discredit its existence as a legitimate sexual orientation. Specifically, qualitative research and writing from activist circles relay that some bisexual women and men experience negative interactions with members of the lesbian and gay community when they endorse stereotypes that bisexual people are indecisive, developmentally stunted, or emotionally immature. In these circles, bisexuality is sometimes deliberately erased; people who are not exclusively heterosexual are labeled erroneously as lesbian or gay, yet individuals who are not exclusively lesbian or gay are perceived to have a sexual orientation that is less legitimate than a strictly same-sex orientation. Such views are reflected in ideas such as a “gold-star gay” (or someone who has only slept with people of the same sex) being superior to a person who has heterosexual encounters. Relatedly, perceptions of bisexuality as instable are apparent in biphobic attitudes that consider bisexual people as en route to a fully lesbian or gay orientation or in the belief that bisexual people are acting out their sexual curiosity by engaging in romantic relationships with people of the same sex—as in the derogatory expression “bi now, gay later.” From this vantage point, heterosexual people and lesbian/gay people may believe that bisexual people are only in transition, experimenting, trying to get attention, or being trendy. Biphobic Interpersonal Hostility

Michele Eliason explored the biphobic attitudes of heterosexual college students by administering a questionnaire to 229 undergraduate students. The

participants were asked to rate “how acceptable” they felt bisexual women and men were. Bisexual women were reported to be “somewhat unacceptable” or “very unacceptable” by approximately 50% of the participants, and bisexual men were seen as “somewhat unacceptable” or “very unacceptable” by more than 60% of the sample. While it may manifest in different ways, biphobic interpersonal hostility toward bisexual people also exists among lesbian/gay individuals. Some of these attitudes may be accounted for by the fact that bisexuality represents an uncomfortable blurring of boundaries. Bisexual people, who are a hybrid of gay and straight identities, may be viewed as “heterosexual infiltrators” within lesbian and gay communities or, even worse, “fallen” lesbian/gay people. Thus, the idea of “heterosexual privilege” may be at the root of much of the biphobic interpersonal hostility from lesbian/gay people, as they view bisexual individuals as able to reap the benefits of heterosexuality without fully committing to the struggle against heterosexism. Gender may also factor into how biphobic prejudice is displayed; for example, Mohr and Rochlen found that lesbian women with high levels of anti-bisexual affect were unlikely to express a willingness to be best friends with a bisexual person. Other authors have written about the history of antagonism toward bisexual women in some radical and lesbian feminist circles, purporting that lesbian women biphobically perceive bisexual women as disloyal to feminist causes because they may have sexual encounters with men. Bisexual People as Sexually Irresponsible

As a result of biphobia, bisexual people are often stereotyped as promiscuous, disloyal, and irresponsible in their romantic relationships. In an investigation of these attitudes, Leah Spalding and Letitia Anne Peplau recruited 353 heterosexual undergraduate college students, who were asked to read a description of bisexual, lesbian and gay, or heterosexual adults in the context of a dating relationship and then rate them on various ­ ­relationship-related characteristics. Bisexual individuals were seen as more likely to simultaneously date multiple partners, give a sexually transmitted disease to their partner, and cheat on their partner than were heterosexual people. Biphobic prejudice regarding perceptions of sexual irresponsibility

Bipolar Disorder and Gender

may stem from a number of factors, including a fear of AIDS and deeply engrained sexual taboos. Illustratively, in her study of heterosexual college students, when Eliason asked how likely it was that they would ever have a sexual relationship with an attractive bisexual person, approximately 75% of the students rated this possibility as very or somewhat unlikely. Therefore, biphobic prejudice may inhibit some individuals from seeking romantic relationships with bisexual people.

Psychological Consequences of Biphobia Reported experiences of biphobic prejudice are associated significantly and positively with psychological distress and negatively with psychological well-being for bisexual people. Furthermore, these experiences may result in feelings of confusion, invalidation, and an overall lack of social support. Future research is needed to advance understanding of experiences of biphobic prejudice. Melanie E. Brewster See also Bisexuality; Heterosexual Privilege; Homophobia

Further Readings Brewster, M. E., & Moradi, B. (2010). Perceived antibisexual prejudice experiences: Scale development and evaluation. Journal of Counseling Psychology, 57, 451–468. Eliason, M. J. (2001). The prevalence and nature of biphobia in heterosexual undergraduate students. Archives of Sexual Behavior, 26, 317–326. Mohr, J. J., & Rochlen, A. B. (1999). Measuring attitudes regarding bisexuality in lesbian, gay male, and heterosexual populations. Journal of Counseling Psychology, 46(3), 353–369. Spalding, L. R., & Peplau, L. A. (1997). The unfaithful lover: Heterosexuals’ perceptions of bisexuals and their relationships. Psychology of Women Quarterly, 21(4), 611–625.

Bipolar Disorder

and

Gender

Knowledge about gender differences in the prevalence and clinical characteristics of bipolar disorder may improve its assessment and effective management. In terms of prevalence rates, ­

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epidemiological studies indicate that rates of bipolar I disorder are comparable across genders. Clinical studies suggest (somewhat inconsistently) that bipolar II disorder may be more common in women, which may reflect gender differences in treatment seeking. This gender disparity is less distinctive than it is for major depression, where the female preponderance is 1.5 to 3 times higher and where interpretations range from “real” (hormonal explanations, social and gender roles) to “artifactual” (differential help seeking and reporting) explanatory factors. Gender differences in clinical presentation (e.g., differential symptoms) are potentially important in relation to making a diagnosis and developing an effective management plan. However, the study of gender differences in phenomenology and course of illness in individuals with bipolar disorder has only recently become a research focus, and a major limitation of the research currently is the retrospective nature of data collection and the reliability and validity of patients’ clinical history reports. This entry provides a summary of the research examining gender differences in bipolar disorder. It also considers potential clinical implications and the need for future research to further explore this somewhat neglected area.

Age of Onset Age of onset of bipolar disorder is important since early onset has been associated with more severe clinical symptoms and a poorer long-term outcome. In general, few gender differences have been reported in epidemiological and clinical studies. However, more recent studies employing stricter operational diagnostic criteria have reported a later mean age of onset for women; there are several explanations for this discrepancy. First, the gender differences in age of onset may relate to women seeking assessment or treatment later than men, although most research indicates that women are more likely to seek assessment and treatment than men. Second, and related, there is evidence that there is a longer interval to diagnosis of a bipolar disorder, which may reflect women being more likely to report (and possibly experience) depressive symptoms initially (disregarding hypomanic symptoms) and thus be misdiagnosed with unipolar depression. It is more likely, however, that the patterning of bipolar disorder is less distinctive

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in women—with “highs” perhaps more likely to be viewed as personality style nuances or borderline personality disorder, which is distinctly overrepresented in women. Thus, health professionals may need to screen women who present with depression more carefully for hypomania than men. If there is a valid difference, research is required to examine why women are less likely to report hypomania, with possible explanations including the higher impact of risk-taking behaviors during hypomania and increased post-hypomanic shame. Further research should therefore focus on the nature and impact of risk-taking behaviors for men and women during hypomania.

Polarity Onset and Preponderance Although it is inconsistently reported, there is some evidence that the first bipolar episode is likely to be a manic episode in males and a depressive episode in females. Two pioneering studies reported that bipolar women are more likely to have depressive episodes, while more recent studies found no gender differences in terms of the number of depressive episodes and the proportion of time spent in depression. However, when lifetime experience of low mood rather than discrete episodes is considered, there is some indication that women report higher depression levels. Such studies are limited by their reliance on retrospective accounts, since there may be gender differences in recollection.

Rapid Cycling and Mixed Episodes The generally prevailing view is that women with bipolar disorder show higher rates of rapid cycling (i.e., having four or more mood disturbance ­episodes within a 1-year period) than men. This finding emerged from two meta-analyses, with one reporting that women were almost twice as likely to experience rapid cycling. In contrast, most studies conducted in the past decade have found no relationship between female gender and rapid cycling. For example, a recent prospective study reported an almost equal, 1-year prevalence of rapid cycling in men and women. Further understanding and clarification of mixed episodes (where the individual is both “high” and depressed) is important since there is

evidence that they are associated with an increased suicide risk and poorer long-term outcome. Several studies have found that women may have a higher risk of mixed episodes, with this risk increasing during the course of the illness, which is not explained by potentially confounding variables such as age and comorbid substance abuse. Such findings indicate that clinicians should pay more attention to mixed episodes, especially among women, as they may represent an increasing treatment challenge with illness progression.

Comorbidity Comorbidity patterns (e.g., anxiety disorders, ­substance use disorders, and eating disorders) in bipolar disorder is an important research avenue as the presence of comorbid conditions is ­associated with a poorer treatment outcome. The evidence indicates that men with a bipolar disorder are more likely to have a comorbid substance abuse, pathological gambling, or conduct disorder, and less likely to have an eating disorder, than their female counterparts, while comorbid anxiety disorders are not clearly differentiated. As such conditions show similar gender distinctions in the general community, it is unclear whether such comorbid patterns in bipolar populations are specific to their condition, with few studies having examined the relative risk for each gender. In such studies, there is a suggestion that women are more likely to have a substance use disorder, with the risk for lifetime alcoholism almost eight times greater for bipolar women than for those in the general community, compared with approximately three times greater risk for bipolar men. There are various implications of substance abuse in those with a bipolar disorder, including how clinicians face the challenge of which disorder to prioritize in treatment—with a general consensus that treatment of bipolar disorder (with both psychological and physical remedies) is more difficult when patients are currently abusing drugs and/or alcohol.

Hospitalization and Suicidality In contrast to the general population, where there are distinctively higher (completed) suicide rates in men than in women, most research studies find

Bipolar Disorder and Gender

few gender differences in suicidality in bipolar populations. Such research needs to consider confounding variables as some research suggests that any gender differences in suicidal rates become nonsignificant when important confounding variables are controlled, such as substance abuse and deterioration from premorbid function. The majority of studies do not report a gender effect on suicidal ideation or on rates of suicidal attempts, with the exception of one study that found women more likely to report a greater history of suicidal attempts. Turning to hospitalization, there are some data from clinical samples indicating that women with bipolar disorder are more likely than men with bipolar disorder to be hospitalized for mania, but the reason is unclear. Possible explanations include women being more likely to seek professional assistance during a manic episode (and presenting to emergency departments) and higher number of suicide attempts during (more) mixed episodes leading to hospitalization.

Bipolar Symptomatology The majority of epidemiological and clinical studies report no gender differences in symptom profiles of mania and depression. However, there is some research indicating that men are more likely to report increased sexual interest, problem behaviors, excitement, inability to hold a conversation, and grandiosity during manic episodes. By contrast, women may be more likely to report mood lability, depressed (or mixed) mood states, and hallucinations. Turning to depressive symptoms, while there are few gender differences reported considering depression severity in unipolar depression, women with bipolar disorder tend to score significantly higher than men on depression severity. The symptoms most commonly and consistently ­ ­differentiating by gender (especially for bipolar II) are certain “atypical” symptoms such as appetite and weight changes and middle insomnia during depressive episodes. This pattern is similar to that found in unipolar depression, where women are more likely to report appetite and weight changes. In addition, women are more likely than men to report symptoms such as feeling self-critical, irritable, and tearful.

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The study of gender differences in symptoms of depressive and manic episodes is important as any differences carry implications for effective screening and diagnosis of bipolar disorder and clinical management of symptoms. The extent to which bipolar measures of depression include features more commonly reported or experienced in men or women may also influence the apparent prevalence rates of the disorder. For example, if a depression measure includes symptoms more likely to be experienced by women than by men (e.g., certain atypical symptoms), then women may be more likely to exceed the screening measure’s “threshold.” A similar concern may exist for bipolar ­disorder if any measure includes symptoms more commonly experienced by men or by women. Few research studies have examined the ability of commonly used screening measures to detect a likely bipolar disorder in men and women separately. Psychotic symptoms are generally only observed in bipolar I disorder, with the majority of evidence supporting similar rates in men and women. Of the studies reporting differential gender rates, some have found that men are more likely to experience delusions and hallucinations. However, other studies have reported that women are more likely to have paranoid delusions, delusions of reference, and hallucinations; this is potentially related to the higher prevalence of mixed mania in women. Interestingly, some research has taken these differences a step further and focused on the social and clinical variables associated with psychosis, with suggestions that psychotic women are more likely to be on a disability benefit and to report a higher number of previous depressive episodes and an earlier age of (bipolar disorder) onset.

Treatment Response and Side Effects Among individuals with unipolar depression, there is some indication that women may be more likely to respond to selective serotonin reuptake inhibitors as antidepressant medications than to tricyclic antidepressants and that the converse may hold true for men. There is currently no evidence that women and men respond differentially to treatment medications for bipolar disorder. For example, research using a pooled data analysis involving 17 studies indicated a similar lithium response rate for men and women.

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Regarding medication side effects, few studies have reported significant gender differences, with the exception of hypothyroidism during lithium treatment, which is significantly more common in women. Approximately 30% of bipolar women develop hypothyroidism—a four times greater risk than for their general community counterparts. It should be noted, however, that although men have lower rates of hypothyroidism than women, the relative risks may actually be greater for bipolar men (they are more than seven times as likely to develop this side effect as their general community counterparts). In the past decade, there has been an increasing awareness of the high rates of metabolic abnormalities in those with bipolar disorder, but no distinctive gender differences in the prevalence of metabolic syndrome in bipolar disorder have been reported.

Impact of Life Events on Illness Course One of the main gender differences in bipolar disorder involves a life event that specifically ­ affects women and significantly affects illness course, namely childbirth. Childbirth, including the postpartum period, is a high-risk life event for manic and depressive bipolar episodes (with no comparable event for men), with one study ­estimating that women were more than 23 times more likely to be admitted with a bipolar disorder episode in the first postpartum month. This strong association with childbirth has important clinical implications and is a major factor for women and their partners to consider when starting a family. Clinicians play an important role in educating women with bipolar disorder, and their families, of the risks during this time so that women can make an informed decision. There is also an additional need for increased clinical monitoring of women during the postpartum period. Gordon B. Parker and Rebecca K. Graham See also Depression and Gender; Mania and Gender; Mental Health and Gender: Overview

Further Readings Diflorio, A., & Jones, I. (2010). Is sex important? Gender differences in bipolar disorder. International Review of

Psychiatry, 22(5), 437–452. doi:10.3109/09540261.20 10.514601 Kawa, I., Carter, J. D., Joyce, P. R., Doughty, C. J., Frampton, C. M., Wells, J. E., . . . Olds, R. J. (2005). Gender differences in bipolar disorder: Age of onset, course, comorbidity, and symptom presentation. Bipolar Disorders, 7, 119–125.

Bisexual Identity Development Bisexual identity development refers to the process by which individuals come to adopt a bisexual sexual orientation identity, which reflects attraction to both men and women or to individuals regardless of gender. Models of bisexual identity development often include several stages or tasks that a bisexual individual goes through or attempts to complete during the process of developing a bisexual identity. Bisexual identity development received little direct research attention until the late 1990s. This entry begins by examining existing models of bisexual identity development, including models of homosexual identity development applied to bisexual individuals, bisexual-specific models of bisexual identity development, and a dynamic model of sexual identity development. This entry then examines the impact of binegativity, the stigmatization of bisexuality, on bisexual identity development. Finally, this entry briefly discusses the differences in bisexual identity development among bisexual individuals of color.

Homosexual Identity Development Models From the mid-1970s through the mid-1990s, several linear stage models of homosexual identity development were published by researchers. These models generally consisted of several stages or milestones of homosexual identity development, including first recognition of same-sex attraction, first same-sex sexual contact, first self-labeling as lesbian or gay, first disclosure of a lesbian or gay identity to others, and overcoming negative internalized beliefs about homosexuality (referred to as internalized homonegativity or homophobia). Individuals were theorized to progress through these stages in a linear fashion.

Bisexual Identity Development

Often these models viewed the development of a bisexual identity as a problematic deviation from the process of developing a lesbian or gay identity. The adoption of a bisexual identity was often attributed to internalized homophobia/homonegativity or to other social and psychological barriers. These models discounted the legitimacy of a bisexual identity by stating that individuals who adopt a bisexual identity are developmentally stalled and unable or unwilling to acknowledge their true lesbian or gay identity. Other models viewed ­ the bisexual identity as a transitional identity in the process of developing a lesbian or gay ­identity; these models did not view the bisexual identity as a legitimate permanent identity. Other models of homosexual identity development published during this time were amended to include the adoption of a bisexual identity as a legitimate outcome of the sexual identity development process. However, these models did not examine any of the specific and unique issues that bisexual individuals experience, assuming that the process of developing a bisexual identity was the same as the process of developing a ­lesbian or gay identity. As a result, these models of sexual identity development incorporated bisexual identity development in name only.

Bisexual Identity Development Models Four major models of bisexual identity development have been proposed. Two of these models were based on samples of bisexual men and women and propose general processes of bisexual identity development, while the other two models were developed based on data from exclusively female samples and propose female-specific models of bisexual identity development. The models are discussed in chronological order. The model developed by Martin Weinberg, Collin Williams, and Douglas Pryor is a four-stage model of bisexual identity development based on data from bisexual men and women. The first stage reflects a period of confusion and doubt regarding one’s sexual attractions, which can last several years. During this stage, labeled “initial confusion,” individuals are unsure how to categorize or understand their attraction to both men and women. In the second stage, “self-labeling as bisexual,” individuals discover the label “bisexual” and apply it

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to themselves. Some individuals may already be aware of a bisexual label, and as a result, their identity development process may unfold differently. For these individuals, awareness of their attraction to both men and women and questioning of their heterosexual identity may lead more directly to self-labeling as bisexual. During Stage 3, “settling into identity,” bisexual individuals become more accepting of their bisexual identity and their attraction to both men and women. During this stage, bisexual individuals overcome binegative beliefs about the instability of a bisexual identity and view their bisexual identity as stable. However, bisexual individuals often remain open to the potential of changes in their sexual attractions and sexual identity. These changes are most likely in the context of intense and meaningful long-term intimate relationships, wherein identity and attractions may change to reflect more exclusive attraction to the intimate relationship partner. For example, a bisexual woman in a long-term relationship with another woman may come to be attracted almost exclusively to her partner, leading her sexual attractions to become focused on the same sex. Additionally, she may reidentify as lesbian to reflect her changing attractions and committed relationship. Stage 4 is referred to as “continued uncertainty.” As a result of the lack of social validation and support for a bisexual identity and the prevalence of ­binegativity, this model posits that bisexual individuals continue to experience intermittent periods of doubt regarding their sexual identity. Another model of bisexual identity development was advanced by Alice Twining. This model was developed based on extensive interviews with 10 bisexual women. Twining proposed that bisexual women attempt to complete four tasks during the process of developing a bisexual identity: (1) achieving self-acceptance, (2) resolving societal homophobia, (3) deciding about self-disclosure, and (4) coping with professional concerns. These tasks may overlap or occur in varied order and can be resolved, set aside, or reopened as life ­circumstances change. The task of achieving selfacceptance includes making sense of one’s attraction to both men and women and coping with the adoption of a bisexual identity. Additionally, bisexual women must overcome societal binegativity and homonegativity as well as internalized binegativity and homonegativity. Bisexual women must

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also decide whether or not to disclose their sexual identity to family and friends and how to cope with a bisexual identity in professional contexts. Twining outlines several cognitive mechanisms that are used by bisexual women to aid in accomplishing these tasks, including developing a positive self-concept independent of societal norms, utilizing ideologies to bring positive meaning to a bisexual identity, valuing one’s emotional attachments to women, recognizing the liberalizing trend of society, constructing a positive definition of bisexuality, constructing a story of one’s personal history that is congruent with one’s bisexual identity, self-disclosure and acceptance, and rationalization of keeping one’s bisexual identity secret. Paula Rust presented a model of sexual identity development among lesbian and bisexual women. Rust’s model is based on social constructionist theory, which argues that sexual identity results from the interpretation of personal experiences based on available social constructs. This definition of sexual identity posits that changes in sexual identity are normal and result from changing experiences and social contexts. Results from Rust’s analyses of sexual identity formation among bisexual women and lesbians support the normality of changes in sexual identity among women, with the majority of currently bisexually identified women having once identified as lesbian or ­considered a lesbian identity and the majority of currently lesbian identified women having once identified as bisexual or considered a bisexual identity label. Additionally, Rust proposed that the process of adopting a lesbian or bisexual identity is highly nonlinear. Among Rust’s sample, most participants reported that their first awareness of same-sex attractions preceded or coincided with their first questioning of their heterosexual identity, while a substantial minority of lesbian (25%) and bisexual (14%) women reported questioning their bisexual identity prior to experiencing their first attraction to women. Additionally, the time between these two events varied substantially from less than a year to up to 26 years. Most lesbians and bisexual women then went on to adopt a lesbian or bisexual identity. However, the majority of lesbians and bisexual women continued to consider alternative identities following the initial adoption of their current identity, and many changed their identification at least once following

their initial adoption of a lesbian or bisexual identity. Rust highlighted the prevalence of variation in sexual identity formation, pointing out that the order of milestones, age at milestones, and years between milestones vary considerably among lesbian and bisexual women; that many women skipped milestones; and that many women reidentified or considered alternative identities following their initial identification as lesbian or bisexual and following the adoption of their current identity. The fourth model of sexual identity development relevant to bisexual individuals was proposed by Margaret Rosario, Eric Schrimshaw, and Joyce Hunter. This model was developed to explain sexual identity development among lesbians, gay men, and bisexual individuals and specifically examines the identity development trajectories of bisexual individuals. Rosario and colleagues split sexual identity development into two processes: (1) sexual identity formation and (2) sexual identity integration. Sexual identity formation is the initiation of sexual identity exploration and consists of a series of four milestones: (1) first awareness of same-sex attractions; (2) first questioning of lesbian, gay, bisexual (LGB) identity; (3) first same-sex sexual activity; and (4) first self-labeling as LGB. Sexual identity integration is a multidimensional process focused on accepting and committing to one’s sexual identity. Identity i­ntegration includes four processes: (1) accepting an LGB identity, (2) resolving internalized homonegativity and/or binegativity, ­ (3) becoming comfortable with others knowing about one’s sexual identity, and (4) disclosing one’s sexual identity to others. Rosario and colleagues also argued that the process of sexual identity development is nonlinear, varying from individual to individual. Of interest specifically to bisexual identity development, the bisexual individuals in the authors’ sample were most likely to have consistently low levels of integration, despite a lack of differences between bisexual and lesbian/gay individuals in sexual identity formation. This low level of social integration was longitudinally predicted by lower levels of support from family and friends, more negative relationships, and more sexual ­identity–related stress. This indicates that bisexual ­individuals may be exposed to increased stress as a result of their highly stigmatized sexual identity and have less social ­support than lesbians and gay men.

Bisexual Identity Development

In turn, these factors delay sexual identity integration for bisexual individuals. Similar to Rosario et al.’s model of sexual identity development, other researchers have developed models of sexual identity development and bisexual identity development that focus more on the dimensions of sexual identity development and less on determining the stages of this process. These multidimensional configurations of sexual identity development allow for a high level of variability in the process. One multidimensional model of bisexual identity development was proposed by Ron Paul, Nathan Grant Smith, Jonathan Mohr, and Lori Ross. This model includes four dimensions: (1) belief in the illegitimacy of bisexuality (level of endorsement of the stereotype that bisexuality is not a valid identity), (2) anticipated binegativity (anticipated bias from others based on one’s bisexual identity), (3) internalized binegativity (desire for single-sex attraction and derogation of a bisexual identity), and (4) identity affirmation (pride in one’s bisexual identity).

A Dynamic Model of Sexual Identity Development Sexual fluidity is the capacity for situation dependence in sexual attraction, including changes in an individual’s level of attraction to men and women. Research indicates that women demonstrate more sexual fluidity than men. Based on this finding, Lisa Diamond proposed that the emergence and expression of female same-sex attraction are normally varied. Diamond argued that sexual identity development among women is nonlinear and often includes changes in sexual attraction. Diamond used dynamic systems theory as the basis for her model. Dynamic systems models attempt to explain the emergence of complex patterns, which stabilize, change, and restabilize over time. In a 10-year longitudinal study of 89 sexual minority women, Diamond’s research revealed three patterns in same-sex attractions and sexual identity: (1) nonlinear changes in attractions, behaviors, and identities; (2) the abrupt emergence of novel attractions in specific contexts; and (3) the periodic reorganization of sexual identity. Nonlinear change in attractions over time is reflected by the prevalence of three phenomena: (1) the high variability in the timing of first

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awareness and questioning of sexuality among women, ranging from age 8 to 22 years in Diamond’s sample; (2) the triggering of sexual ­ ­orientation questioning by situational and social factors (e.g., close female friendships, exposure to LGB peers, involvement in feminist politics); and (3) continued change in sexual attraction and sexual identity following the initial adoption of a nonheterosexual identity. Notably, the majority of changes in sexual identity were in the direction of broadened attractions. In other words, women were more likely to change from a lesbian or heterosexual identity to a bisexual identity. Additionally, 80% of the sample of sexual minority women identified as bisexual during at least one time point during this 10-year study. The abrupt emergence of novel attractions in specific contexts is most profoundly demonstrated by the emergence of novel same-sex attractions that arise in the context of a specific emotionally intense same-sex friendship. Women who experienced the abrupt emergence of novel same-sex attractions had had no previous attraction to women, but they developed an attraction to women following the development of an emotionally intense friendship with another woman. This same phenomenon was observed among lesbian identified women who had never been attracted to men prior to developing an attraction to men following an emotionally intense friendship with a man. This abrupt emergence of novel attractions in the context of an emotionally intense friendship demonstrates that women’s sexuality may be particularly reactive to changes in social contexts. The periodic reorganization of women’s sexual identity has been repeatedly documented (e.g., by Diamond, Rust, and Rosario and colleagues). The prevalence of changes in sexual identity following initial adoption of a nonheterosexual identity indicates that sexual identity development may be a lifelong process, in which sexual identity is periodically realigned to reflect current attractions and sexual behavior. Diamond’s research revealed that the most common reasons sexual minority women provided for changing a sexual identity label were changes in attraction and sexual behavior. Therefore, it appears that changes in sexual identity reflect an attempt to realign one’s changing sexual attractions and behaviors with one’s sexual ­identity label.

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The Impact of Binegativity on Bisexual Identity Development Binegativity, the stigmatization of bisexual individuals and bisexuality, is highly prevalent in both heterosexual and lesbian and gay communities. Binegativity includes three components: (1) perceptions of ­bisexuality as an illegitimate and unstable sexual orientation (e.g., bisexual individuals are confused, experimenting, in transition to a gay/­ lesbian identity, or in denial about their true sexual orientation); (2) perceptions of bisexual individuals as sexually irresponsible (e.g., bisexual individuals are sexually obsessed, diseased, promiscuous, or unable to have monogamous ­ relationships); and (3) general hostility toward bisexuality and social exclusion and rejection of bisexual individuals (e.g., bisexuality is immoral, pathological, or a threat to society). In addition to being the targets of negative attitudes, bisexual individuals also tend to have low visibility in society. Together, these issues can make it difficult for bisexual individuals to find an accepting and supportive community and to access resources to help them cope with discrimination and develop a positive bisexual identity. Due to the invisibility of bisexuality and the prevalence of binegativity, bisexual individuals must face several specific barriers to the development of a positive bisexual identity. Bisexual individuals must question the assumption that there are only two sexual identities, heterosexual and homosexual, and often must search for a label for their identity. Additionally, bisexual individuals must deal with people who deny the validity of their bisexual identity. The erasure of bisexuality as a valid sexual identity and the prevalence of binegativity in both heterosexual and lesbian and gay communities make it particularly difficult for bisexual individuals to develop and maintain a positive bisexual identity. Due to these social pressures, some bisexual individuals may (a) switch between lesbian/gay, heterosexual, and bisexual identity labels based on the gender of their relationship partner and other social factors, such as social context; (b) adopt a lesbian/gay or heterosexual identity and suppress their attraction to the opposite sex or same sex, respectively; or (c) identify privately as bisexual but ­ publicly as lesbian/gay or heterosexual to avoid experiences of binegativity. While these identification patterns may reflect strategic relabeling to avoid chronic experiences of binegativity among

some bisexual individuals, other bisexual individuals may adopt a public and/or private non-bisexual identity as a result of internalized beliefs about the illegitimacy of a bisexual identity and the immorality of bisexual individuals. While research has yet to examine the psychological effects of strategic relabeling or bisexual identity concealment or suppression, research on the detrimental effects of concealing a lesbian or gay identity indicates that bisexual identity concealment or suppression is likely to have profound negative mental health consequences.

Bisexual Identity Development Among Bisexual Individuals of Color It is important to note that the majority of research on sexual identity development and bisexual identity development has focused on White, educated, middle-class lesbians, gay men, and bisexual individuals. LGB individuals of color face distinct issues in sexual identity development. For example, in some communities of color, the adoption of an LGB identity may be seen as being at odds with one’s ethnic or racial identity as LGB identities may be viewed as a part of White culture, at odds with cultural values, and shaming to one’s family and/or community. In addition to experiencing tensions between one’s racial or ethnic identity and cultural values and one’s LGB identity, and experiencing homonegativity from members of one’s racial/ethnic group, LGB individuals of color may also experience racism from the LGB community. Additionally, models of sexual identity development are based entirely on research in individualistic Western cultures. The development of a sexual minority identity in more communalistic cultures is likely to differ dramatically. In fact, the entire concept of basing one’s personal identity on one’s sexual feelings and behaviors is a distinctly Western one. Christina Dyar See also Biphobia; Bisexuality; Gay Male Identity Development; Gay Men; Heterosexism; Homophobia; Homosexuality; Lesbian Identity Development; Lesbians; Minority Stress

Further Readings Brewster, M. E., & Moradi, B. (2010). Perceived experiences of anti-bisexual prejudice: Instrument

Bisexuality development and evaluation. Journal of Counseling Psychology, 57(4), 451–468. doi:10.1037/a0021116 Diamond, L. (2008). Sexual fluidity: Understanding women’s love and desires. Cambridge, MA: Harvard University Press. Paul, R., Smith, N. G., Mohr, J. J., & Ross, L. E. (2014). Measuring dimensions of bisexual identity: Initial development of the bisexual identity inventory. Psychology of Sexual Orientation and Gender Diversity, 1(4), 452–460. doi:10.1037/sgd0000069 Rosario, M., Schrimshaw, E. W., & Hunter, J. (2008). Predicting different patterns of sexual identity development over time among lesbian, gay, and bisexual youths: A cluster analytic approach. America Journal of Community Psychology, 42, 266–282. doi:10.1007/s10464-008-9207-7 Rust, P. C. R. (2000). Bisexuality in the United States. New York, NY: Columbia University Press. Weinberg, M. S., Williams, C. J., & Pryor, D. W. (1994). Dual attraction: Understanding bisexuality. New York, NY: Oxford University Press.

Bisexuality The very limited attention to bisexual issues across social science disciplines such as psychology and gender studies has been noted since the 1970s. While literature regarding lesbian and gay sexual orientations is on the rise, understanding of the unique experiences of bisexual individuals remains scant. A deeper analysis of the “bisexual experience” in terms of history, identity politics, and mental health is necessary to inform scientific understanding of and clinical work with this population. Thus, this entry reviews some of the key features of bisexual research within psychology.

Bisexuality Across Modern History In its broadest conceptualization, bisexuality typically refers to a person’s experiences of emotional, romantic, and/or sexual attraction to people of more than one gender. Though bisexual issues have been historically overlooked in the larger body of literature on sexual minority people, long-standing evidence from cross-cultural and biological research supports the fact that bisexuality has existed throughout our human history in diverse cultures and also in nonhuman animal species. While reports

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of bisexuality have existed for centuries, the word bisexual as we use it today is believed to have first been coined by Charles Gilbert Chaddock after he read psychiatrist Richard von Krafft-Ebing’s foundational work Psychopathia Sexualis in 1892. Specific to psychological theory, in the early 1920s, Sigmund Freud—a pioneer of psychoanalysis and early forms of mental health counseling—speculated that bisexuality was a ­ normal component of psychosexual development. Further, Freud posited that all people had some degree of same-sex attractions, an attitude toward sexuality that was notably progressive for the restrictive Victorian era in which he came of age. Unfortunately, later psychoanalysts did not maintain such an affirming stance toward same-gender attractions. Bisexuality and Sexual Identity

Seminal work in 1948 by the Indiana University biologist and sexologist Alfred Kinsey further ­supported the widespread existence of bisexuality. With his Kinsey Scale, he had thousands of participants rate their experiences of sexual behavior from 0 (exclusively heterosexual) to 6 (exclusively lesbian/gay). Participants who responded anywhere in the 1 to 5 range had engaged in sexual behavior with people of both sexes (either occasionally or incidentally), and individuals who reported a 3 on the Kinsey scale were assumed to be bisexual in their behavior. Findings from Kinsey’s work shattered beliefs that human beings were either heterosexual or gay/lesbian. Notably, he found that nearly 12% of White men whose age ranged from 20 to 35 years could be classified as bisexual based on their reported behaviors. However, one notable problem with this early research on bisexuality was that it only assessed sexual behavior. Many individuals may have some degree of same-sex attraction but may feel unable to act on these sexual or romantic desires. Considering this flaw, the American psychiatrist and sex researcher Fritz Klein developed the Klein Sexual Orientation Grid (KSOG) in 1978. The KSOG is designed to be a multidimensional tool to explore how individuals rate aspects of their sexual orientations (e.g., sexual attraction, fantasy, emotional preference, social preference, etc.) in the past, present, and idealized future. Klein’s research further

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normalized that bisexuality was a valid sexual orientation with complex intra- and interpersonal manifestations. Unfortunately, later theorists came to suggest that bisexuality was not a normal manifestation of human sexuality but was instead a transitory state or a denial of lesbian/gay feelings. Scholarly Skepticism Regarding Bisexuality

Expressions of doubt regarding the existence of a “real” bisexual orientation have been voiced by a range of individuals and groups, including researchers, scholars, and activists in lesbian/gay communities. These views of bisexuality persisted for decades and permeated even the earliest forms of sexual identity development models, wherein bisexuality was first presented as a form of “identity foreclosure” or an unhealthy process of halting the formation of a purely lesbian or gay identity. As a result of these skeptical views regarding bisexuality, studies from the late 1980s to the early 2000s often worked to examine the stability of a bisexual orientation, with the expectation that individuals engaging in bisexual behavior would gradually transition to a strictly same-sex orientation. One of the reasons for the persistence of these theories is the notable invisibility of bisexual ­individuals. In a society that tends to judge one’s sexual orientation based on the gender of one’s partner, people who are bisexual are largely erased from view when they are in monogamous relationships. For example, if a woman is in a relationship with a woman, they are both assumed to be lesbians; and if a woman is in a relationship with a man, they are both presumably heterosexual. Such feelings of invisibility may contribute to feelings of marginalization from mainstream cultures. Foundational writing by Gary Zinik in the 1980s explored two theories of bisexuality: (1) the conflict model and (2) the flexibility model. In his conflict model, bisexual people are considered to be ambivalent and anxious about their sexual orientation, therefore the root of this model is that experiencing attraction to more than one gender is unnatural and directly contradicts society’s binary sexual orientation structure. From this perspective, bisexuality is a method of masking or denying one’s strictly same-sex attraction. Yet, in direct contrast to this model, Zinik’s flexibility model set forth that bisexuality is based on interpersonal and

cognitive flexibility, and he suggested that bisexual people have the capacity to experience a broad spectrum of sexual desires. HIV/AIDS and Bisexual Behavior

With the outbreak of the AIDS epidemic in the 1980s up through the early 2000s, bisexuality received widespread attention from mainstream media sources. Several episodes of Oprah Winfrey’s lauded talk show were dedicated to men who engaged in same-sex behavior on the “down low” (without the knowledge of their girlfriends or wives). These behaviorally bisexual men were largely scapegoated for the spread of AIDS and HIV to heterosexual women. Much of the media’s focus on bisexuality was centered on the “secret sexual lives” of Black and Latino men, which led critics to profess that such attention to bisexuality in men of color only served to propagate racism and further pathologize communities of color. This surge of attention on bisexual behavior sparked further dialogue about the difference between sexual behaviors, sexual orientations, and identity politics more generally. For example, authors in the early to mid-2000s, such as Jason King and Keith Boykin, tried to dissect men’s motivation to engage in same-sex behaviors while maintaining a heterosexual front and their hesitancy to claim a bisexual identity. Largely, authors and activists at this time wrote from the assumption that men on the “down low” were not actually bisexual but were instead unable to come out as gay because of heterosexism in their environments. Thus, this period of history served to further stigmatize bisexuality, linking it to the spread of HIV/AIDS and propagating the notion that all individuals who engage in bisexual behaviors are actually gay. Current Attitudes Toward Bisexuality

Since the early 2000s, members of the scientific and psychological communities have increasingly come to view bisexuality as a stable and valid sexual orientation that may have distinct developmental pathways. For example, groundbreaking longitudinal work by developmental psychologist Lisa Diamond demonstrated that bisexuality was a notably stable sexual orientation for many women

Bisexuality

over a period of 10 years. Yet work by Diamond has also indicated that even the categories of lesbian, gay, or bisexual may be too constricting for many individuals, as levels of romantic and sexual attraction across genders often vary fluidly throughout the life span. To acknowledge these complexities, some writers and activists have moved away from conceptualizations of sexual orientation that dichotomize identity to either heterosexual or lesbian/gay. Despite mounting ­evidence that bisexuality is more than a transitory sexual orientation, theorists argue that the historic and present lack of recognition of bisexuality (in contrast to gay or lesbian orientations) might prevent some individuals from sustaining this sexual identity. Affirmative psychological theories since the mid-2000s regarding bisexual identity development now tend to view this identity formation process as complex and open-ended, during which bisexual people may encounter negative societal views about bisexuality and must learn to flexibly navigate pressures from both heterosexual and lesbian/gay cultures to eschew their nonbinary orientation. Taken together, the limited existing literature about bisexuality within psychology has centered on a number of themes including (a) the instability and illegitimacy of bisexuality as a sexual orientation, (b) the relative invisibility of bisexual individuals, (c) stereotypic associations of bisexuality with sexually transmitted diseases and HIV transmission, and (d) views of bisexual individuals as duplicitous, nonmonogamous, and inept romantic partners. Melanie Brewster and Bonnie Moradi argue that these overwhelmingly negative themes evident in the scholarly research reflect the fact that bisexual persons experience a unique form of stigmatization and discrimination termed “biphobia.”

Biphobia and Minority Stress A growing body of literature supports links between biphobic stigma discrimination (e.g., treating bisexual people as if they are inferior because of their sexual orientation) and experiences of minority stress. Studies suggest that attitudes regarding bisexuality are quite negative. In fact, a large-scale telephone survey conducted by Gregory Herek found that heterosexual women and men felt more negative affect toward bisexual

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individuals than toward a wide range of other groups, including lesbian/gay people, various religious groups, racial/ethnic minority groups, prolife groups, pro-choice groups, and people with AIDS. Some bisexual people report experiencing hostile interactions with some members of the heterosexual community (e.g., hate crimes and, in some cases, rejection on the dating scene due to assumptions that bisexual people are more likely to be carriers of HIV) and the lesbian/gay community (e.g., acts of exclusion and verbal accusations that they are traitors for interacting with heterosexuals). Considering that bisexual people may be stigmatized by both heterosexual and lesbian/gay groups, they may experience higher levels of mental health consequences such as depression, negative self-affect, sexual dysfunction, anxiety, marital discord, and social isolation. Such negative psychological sequelae result from a lack of social validation and the dangerous societal view that bisexual individuals are morally, psychologically, and emotionally unstable. Perhaps unsurprisingly, when compared with lesbian women and gay men, there has been some research support that bisexual individuals have higher levels of psychological distress, risky sexual behaviors, and substance use and lower levels of life satisfaction. Furthermore, other research has found that bisexual individuals report more adverse life events, including less positive familial support and more negative attitudes from friends, than lesbian or gay people.

Positive Aspects of Bisexual Identities Recent research has begun to tackle the positive dimensions of identifying as bisexual. Specifically, authors have spoken extensively of the ability of bisexual people to demonstrate bicultural competency in order to navigate life in mainstream heterosexual culture as well as lesbian/gay culture. In this sense, identifying as bisexual places individuals in a “gray area” that may foster an ability to live fluidly and outside the constraints of traditional identities. Scholarly research has begun to focus on exploring fluidity and cognitive flexibility within bisexual populations, yet results have been mixed. Some research suggests that bisexual people are more flexible in the exploration of their sexual orientations and may score higher on

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measures of cognitive flexibility than heterosexual or lesbian/gay individuals. This may be explained by the fact that bisexual people are freer to live outside the traditional relationship scripts set forth by heterosexual and lesbian/gay cultures. Living apart from these social scripts may foster the development of more creative approaches to relationships, innovative methods of coping with stress, and the ability to live life in a uniquely divergent way. A qualitative study by Sharon Rotosky and her colleagues further explored the positive role of cognitive flexibility in the lives of bisexual persons. The authors asked bisexual respondents to describe the positive aspects of their bisexual identities. Compiled data from more than 150 participants revealed that as a result of their bisexuality, they felt they had (a) freedom from societal labels and freedom to love without regard for sex/gender and (b) increased levels of insight and awareness compared with others. Taken together, while bisexual individuals may experience minority stress and psychological consequences as a result of biphobia, they may also display notable levels of flexibility and resilience in the face of such stressors. Melanie E. Brewster See also Biphobia; Kinsey Reports; Kinsey Scale, The; Minority Stress; Pansexuality

Further Readings Brewster, M. E., & Moradi, B. (2010). Perceived antibisexual prejudice experiences: Scale development and evaluation. Journal of Counseling Psychology, 57, 451–468. Diamond, L. M. (2008). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press. Ross, L. E., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100(3), 496–502. Rostosky, S. S., Riggle, E. D. B., Pascale-Hague, D., & McCants, L. (2010). The positive aspects of a bisexual identification. Psychology & Sexuality, 1, 131–144. Zinik, G. A. (1985). Identity conflict or adaptive flexibility? Bisexuality reconsidered. Journal of Homosexuality, 11, 7–19.

Black Americans

and

Gender

While Black American individuals share features based on race, intragroup differences occur around gender. Stereotypes and images of Black American women and men vary, leading to differences in the ways they behave, function, and engage in relationships. The terms racialized gender or gendered race capture the notion that experiences of individuals within the same racial or ethnic group differ according to experiences of gender. Gender and racialized gender are influenced by socialization experiences, gender role expectations, and historical images and perceptions. This entry discusses gender, gender identity, and gender role expectations for Black Americans.

Characteristics and Strengths of Black Americans Black Americans share many values and belief systems that extend from African traditions and their African heritage. These Afrocentric values influence behaviors, beliefs, and relationship choices. Many Black Americans believe in spirituality, harmony, and a sense of connection and intimacy in interpersonal relationships. Afrocentric values attribute great importance to the role of extended family relationships, which includes family, friends, community members, and important religious leaders. Another Afrocentric value is expressive individualism, which holds the importance of self-expression, creativity, and spontaneity in behaviors. Expressive clothing, hairstyles, music, poetry, rap, and other forms of art are outlets for expressive individualism. This also includes an understanding that each individual contributes in a unique way to the society or community. It is considered important for individuals to find their unique call, vocation, or expression of a gift. This value is closely related to the importance of education and hard work. Educational achievement is stressed in many Black American families and is often reinforced through religious institutions and civic and community organizations. The communal nature of some African people groups requires that individuals contribute to the functioning and well-being of the group or tribe. This concept is reflected in valuing

Black Americans and Gender

education and achievement as an adult competency for Black Americans. The communal and collective nature of relationships requires that everyone participate and find a way to contribute to the family, group, community, or society. Members are expected to contribute in multiple ways to the household and are able to engage in a variety of roles. While Black American men share some characteristics of masculinity with White men and other ethnic groups, and Black American women share some traits with White women and other ethnic groups, perceptions around gender for Black Americans differ according to historical images and stereotypes. It is important to explore these images in order to understand the implications of gender and race for Black Americans.

Stereotypes of Black American Men Big Black Buck

Afrocentric values, the role of men in Africa, and the legacy of slavery in the United States have shaped the perceptions and images of Black ­American men. Black American men share the legacy of being providers for families; many perceive them as strong, tough, and independent. Black men’s strength has been both prized and feared. Because of the size and stature of Black men, and as part of the rationale for the exploitation of Black men as slaves, the “big Black buck” is a widely associated image of Black men. Black male slaves were thought to have particular prowess to be able to work the fields and to be breeders with women to produce more slaves. The big Black buck image continues today and can be seen in stereotypes of Black American men being criminals, athletes, and sexually aggressive. The criminal image builds on the notion of Black men being strong but not in control of their impulses. This stereotype highlights the notion that Black men tend to be aggressive, angry, and hostile. Black men are portrayed as sexually aggressive, and this stereotype is perpetuated in the media through news coverage and reports on sexual assault and physical attacks. This remains one difference with White men in terms of masculinity. When news reporters comment on attempted rape, they are more likely to use racial descriptors with Black and Latino men,

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continuing the image of criminality. The criminal image is also reflected in the portrayal of drug dealers and gang members. Gangsters, thugs, drug dealers, and gang members have been elevated in many hip hop and rap music videos, but they continue to perpetuate the notion of criminality in Black men. While some would argue that Black American male youth have embraced the criminality image as a form of consciousness and self-determination, there are still negative associations with this image. Black American men are more likely to be racially profiled by the police based on the criminality stereotype, and there are a disproportionate number of incarcerated Black American men. Black ­American youth living in urban areas plagued by violence may feel the need to develop a tough exterior and criminal persona for personal safety. Middle-class youth may feel a pull toward the criminal image as a way to connect to their sense of racial identity. Endorsement of this stereotype can limit the behavioral choices of Black men. Strength in Black men has also been linked to stereotypes about their natural ability or athleticism. It is assumed that Black men have more athletic talent than other ethnic groups and that they perform better in organized sports. During slave auctions, auctioneers would comment on the physical size and strength of Black American men. This practice was maintained in media coverage of Black athletes, who were often described by the size of their thighs, hands, or other body parts. Black American male athletes were also described in media reports based on their physical abilities and not their intellectual skills or performance. It is widely assumed that Black American male boys will be involved in some type of athletic activity. Black American men who are not athletic are still expected to have knowledge of sports. Finally, the big Black buck stereotype has contributed to the perceptions of the relationship between Black American men and sexuality. While traditional views of masculinity for all men include notions of dominance and control over women, including in sexual relations, these ideas are often exaggerated for Black American men. Black ­American men during the period of slavery were either used to breed other slaves or seen as a threats to White women based on their physical size. More modern manifestations of this stereotype include the hustler and the player. Black

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American men are seen as sexually desirable and attractive. Media portrayals often use their sexuality as a way to control women. Hip hop and rap videos, for example, often depict men as being sexually exploitive. The player engages in sexual activity with multiple women, usually without consequence. Sambo/Coon

While the strength and size of Black men were seen as an asset for slavery and field work, the stature of Black men was also seen as threatening to Whites. Efforts were made to emasculate Black men or reduce the power that they were perceived to have. Two other historical images reflect the ideas of Black men being weak, unintelligent, and slow in reasoning abilities: (1) the coon and (2) the Sambo. Slave owners developed stories on how to “tame” and “control” Black men. It was assumed that Africans, and by extension Black slaves, were uncivilized and unintelligent but with training could be controlled and become productive workers. It was also assumed that Black men would prefer to have someone control them and that structure and discipline pleased them and made them more content and subservient. The Sambo, then, knew his place and became a happy and contented slave. The more modern extension of this image was seen in the “Uncle Tom” image, which reflects a Black American man who serves Whites and has abandoned Afrocentric values and lifestyle. Many youth reject the Sambo image; “acting White” is discouraged among Black American peers. Acting White is sometimes characterized by speaking with conventional syntax and grammar or by preferring foods, music, or clothing generally associated with the mainstream White culture. The coon stereotype is similar to the Sambo image and includes the idea that Black American men are lazy and childish in nature. The coon is always happy and prefers a simple lifestyle that does not require much thought or decision making or expenditure of energy. The coon image was popularized in minstrel shows, where Black ­American men were depicted as lazy, goofy, and having oversized lips, feet, and ears, and bulging or “bug” eyes. Coons in minstrel shows were dumb, tried to avoid work, and were clumsy and prone to accidents (in a slapstick fashion). If a coon was

married in a minstrel show, he was totally dominated by his wife. Good Black Man

Many of the historical images of Black ­American men are based on the history and legacy of slavery and continued oppression in this country. These historical images, however, do not paint a full or accurate picture of Black American men and their success. A more modern stereotype or image of Black American men is the good Black man. The image of the good Black man is more aligned to the definition of masculinity. The good Black man is seen as strong, intelligent, hardworking, and dedicated to family. He may or may not work as a professional, but he can support and provide for his family. The strong Black man is able to share emotions and be emotionally supportive to family members. Black American men such as Colin Powell, Barack Obama, Martin Luther King Jr., and Benjamin Carson would be examples of the good Black man image.

Stereotypes of Black American Women Images of Black American women also extend from the combination of Afrocentric values and the history of slavery and oppression. Women are assumed to be feminine, which includes being submissive, caregiving, emotional, and sensitive. The experience of slavery for women was similar to that for men and included heavy labor and work in the fields. Women were expected to harvest crops in the same way as men. Black American women were also the victims of sexual exploitation. They were forced to engage in sexual ­relations to produce more slaves and were often the victims of sexual assault by White slave owners. Survival of the conditions of slavery have led to Black American women being seen as strong and sexually aggressive. Societal images and expectations of Black American women include characteristics such as dominance, aggression, sexual p ­ romiscuity, and rude and loud behavior. Historically, three stereotypes of Black American women can be traced in the United States: (1) Mammy, (2) Sapphire, and (3) Jezebel. Contemporary Black American women have struggled with images and perceptions derived from the legacy of slavery and

Black Americans and Gender

have often compensated by being strong or adopting the Superwoman image. Mammy

Mammy was the slave who worked in the house serving as housekeeper and nanny. Mammy was allowed to work in the house because she was seen as asexual; she was typically obese, had a darker skin complexion, and had more broad or African features. Because Mammy was nonthreatening and was not deemed physically attractive, she was seen as nurturing and having a selfless devotion to others, particularly to the slave owner’s White children or orphaned slave children. Mammy never complained; being in the house and entrusted with the children would be an honor over working in the field. She was always pleasant and a good problem solver. As a result of the Mammy image, some today perceive Black American women as nurturers, good caregivers, ­ strong, supportive, and selfless. Black American women either reject the Mammy image, resisting being seen as caregivers in the workplace, for example, or they may reject what is seen as negative characteristics of M ­ ­ ammy’s physical appearance, preferring more Caucasian facial features and traits, or straightened or relaxed ­ ­hairstyles. Attitudes associated with internalizing this stereotype may oppositely be related to Black American women’s need to be nurturing and supportive of others, often at one’s own expense. Sapphire

There is a slave legend of a slave girl who sought revenge on slave owners by poisoning them through the food. The slave girl allegedly was ruled by fear and anger, and poisoning the slave owner was the only outlet for emotional expression. The legend points to the complicated relationship between the Afrocentric freedom of emotional expression and the need to repress emotions, particularly anger, due to safety concerns. What emerged from this tension is the image of the angry Black woman, hands on her hips, rolling her neck while yelling and cursing at people. The angry Black woman was popularized through Sapphire, a character from the 1950s’ Amos ‘n’ Andy television show. The Sapphire character in the show was

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always nagging men and arguing with others. She was shrill and loud and made putdowns of others, particularly men as a way to emasculate them. Perceptions of Black American women derived from this character include being arrogant, controlling, loud, hostile, and obnoxious; she is never satisfied with her life or others. Black American women who internalize this image may have difficulty expressing their needs or displaying anger comfortably. They may alternately take on the image, expressing rage and being aggressive or loud. Jezebel

The sexual exploitation and victimization of Black American women slaves were often justified by the idea that Black American women are highly sexualized and animalistic in their desire for men and sex. Slave owners would state that Black Americans needed and craved sexuality and that there is a need to help them control their sexuality. The Jezebel image is a woman who is perceived as unable to control her sex drives, seductive, and manipulative. Jezebel stood in contrast physically to the Mammy image; she was more likely to have a lighter skin complexion, more European facial features, and straighter hair. One modern association of the Jezebel image is the welfare queen ­stereotype, who is promiscuous and loose, and has several children by multiple partners. Another extension of Jezebel is the video vixen seen in rap and hip hop videos; she is the freak, diva, baby mamma or the gold digger. It is clear that the ­modern Jezebel or video vixen knows that she is attractive and sexually desirable, and she uses her sexuality for rewards and to control relationships. Black American women who internalize this image may be at increased risk of engaging in risky sexual behaviors or being sexually exploited. Other women may try to downplay their sexuality. Superwoman

One of the most frequently used words associated with Black American women is strong. Black American women are seen as the keepers of the community, strong mothers, hard workers, and psychologically strong. She is the Superwoman, the “strong Black woman.” There is a tremendous

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pressure in being a strong Black woman. Black American women who internalize attitudes associated with this stereotype may expect to be fully self-reliant, reject help, and become sensitive and embarrassed at any sign of weakness or failure. Women like Oprah Winfrey and Michelle Obama are highlighted as Superwomen.

Racial socialization messages focus more on race, oppression, and stereotypes than traditional gender role expectations or ideas of masculinity or femininity. Gender identity is seen in intersectional terms with race. However, racial socialization messages often do not extend to messages on ­ ­sexual orientation or sexual identity, particularly transgender identity development.

Gendered Racial Socialization Racial socialization is defined as a process in which Black American parents raise children to have positive self-concepts in an environment that is oppressive and includes exposure to cultural practices, promotion of racial pride, development of knowledge of Black American culture, and preparation for bias and discrimination. Gendered racial socialization includes preparation for ­different gendered experiences. Black American boys receive specific racial socialization messages that emphasize strategies for coping with racism. Boys receive messages on the presence of racial barriers, that they will face racism and may need to work twice as hard as Whites to overcome negative stereotypes. They also are likely to receive messages that they are equal to Whites and can accomplish in similar fashion. Finally, boys are given specific messages on overcoming racial barriers. This includes s­ pecific tips on interacting with the police and authority figures, how to physically present themselves around others, how to speak articulately, and managing emotions. Messages are designed to counter the effects of the negative stereotypes and images of Black men. Black American girls receive more messages on racial pride, education, premarital sex and relationships with men, psychological and financial independence, and physical beauty. Girls are taught to be self-determining and independent. Messages that reflect the importance of being strong are often given to girls. Girls are also given messages on self-pride and racial pride as a reflection of the racism and sexism they may encounter. This includes messages on physical standards of beauty and sexuality. Interestingly, messages to girls on independence and sexuality reflect the idea that Black American women are less likely to marry and will need to be able to support themselves psychologically and financially.

Anita Jones Thomas See also Black Americans and Sexual Orientation; Black Americans and Transgender Identity; Criminalization of Men of Color; Dual Minority Status; Exoticization of Women of Color; Gender and Society: Overview; Gender Identity; Gender Role Socialization; Gender Stereotypes; Intersectional Identities; Multiculturalism and Gender: Overview; Parental Messages About Gender; Race and Gender; Racial Discrimination, Gender-Based; Social Role Theory; Women of Color and Discrimination

Further Readings Boyd-Franklin, N. (2013). Black families in therapy: Understanding the Black American experience. New York, NY: Guilford Press. Majors, R., & Billson, J. M. (1992). Cool pose. New York, NY: Lexington Books. Thomas, A. J., Speight, S. L., & Witherspoon, K. M. (2005). Internalized oppression among Black women. In J. L. Chin (Ed.), Psychology of prejudice and discrimination (Vol. 3, pp. 113–132). Westport, CT: Praeger Press. West, C. M. (1995). Mammy, Sapphire, and Jezebel: Historical images of Black women and their implications for psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 32(3), 458–466.

Black Americans and Sexual Orientation There are multitudes of ways in which the sexuality and sexual orientation of Black Americans have been shaped by historical, social, and individual factors. Because the development of Black Americans’ sexuality and sexual orientation and those of their ancestors have historically been defined by those of non-Black origins, this entry includes

Black Americans and Sexual Orientation

definitions of the terms sexual orientation and Black American from the perspectives of those within Black American communities. A brief review of the demographics of Black Americans and their sexual orientation identities within the larger population is provided, along with an overview of the effects of historical factors and religious or cultural strictures on the sexual orientation of Black Americans as a group. Finally, the entry explores the connection between the historical traumas experienced by Black Americans as a whole and current sexually transmitted infection rates.

Definitions and Statistics Sexual orientation refers to one’s affective, romantic, and sexual attraction toward others. Sexual orientation has three components: (1) physical or romantic attraction, (2) behavior, and (3) identity. Individuals may identify as asexual, bisexual, gay, lesbian, straight, or any other self-defined labels. They may also choose not to label their sexual orientation identity. Research indicates that sexual orientation occurs on a continuum and that it is fluid for some individuals. There is also research that demonstrates that women are more likely to have and report same-sex sexual experiences and attractions than men. For this entry, the term Black Americans refers to individuals whose recent ancestry can be traced to the Black racial groups on the continent of Africa. This includes those whose ancestors were enslaved or free in the United States or Caribbean nations and those who migrated to the United States or Caribbean countries from any of the 54 African countries. It is important to note that some individuals and communities that would be considered to be “African American” by others actually identify as something else, for example, Caribbean, multiracial, Nigerian, Black, or ­Jamaican American. As a result, Black American communities consist of individuals of different ethnicities, nativity statuses, levels of acculturation, languages, migrations, and economic classes. Individuals who identified as Black (either alone or in combination with one or more other races) on the 2010 U.S. Census constituted 13.6% of the total population, and 5% of those individuals also identified as Latino/a. When it comes to the sexual

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orientation of Black Americans, a Gallup survey found that 3.7% of Black American adult ­respondents identified as lesbian, gay, bisexual, or transgender. It is important to note that much of the literature that surveys the lives of lesbian, gay, bisexual, and transgender individuals in the United States aggregates their responses; this is not helpful when one is solely looking at sexual orientation as a variable. Given the continued social stigma around being lesbian, gay, and bisexual (LGB) in the United States, many Black Americans may be unwilling to disclose their sexual orientation in a survey. U.S. Census data from 2010 also revealed that 84,000 Black American adults were in samesex couples and that 33.9% of those couples were raising children.

Cultural and Historical Factors Many of the enslaved Africans who were brought to the Americas came from societies that had a collective social orientation and a strong connection to family or fictive kin. Although slavery under the trans-Atlantic slave trade was designed to break down and destroy the sense of collectivism among enslaved Africans and their children, research indicates that this consciousness and perception of oneself as part of a larger whole persists more than 350 years later. While slavery in the United States officially ended on December 1, 1865, it had a long-lasting impact on the sexuality of Black Americans from the years of slavery to the present. The historical trauma of slavery and its conditions, the reactions of European Americans when enslaved Africans were emancipated, and the continued portrayal of Black American bodies and sexuality as deviant combine to negatively shape Black Americans’ gender role ideology and sexuality. In several of the societies from which enslaved Africans were taken, individuals who practiced same-sex behavior were integral members of the community. Reports from European explorers who visited East, West, and Central Africa ­document same-sex patterns and roles that existed and were widely accepted prior to their arrival. Before the introduction of Muslim and European restrictive standards of morality, same-sex relationships in African nations took one of three forms: (1) relationships based on a nominal age

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difference, (2) relationships where one person takes on the role of a different gender (e.g., in social role, dress, mannerisms), or (3) relationships where both parties are equals. The cultural ­influence of Arab and European colonists resulted in increased intolerance of same-sex behavior, ­creating systems of surveillance to it. This influence stigmatized Africans who practiced same-sex and cross-gender behavior, which contributed to the stigma that persists to the present.

The Impact of Slavery in the United States In the United States and Caribbean, enslaved ­African men, women, and children were the property of slave owners, and their lives and bodies were not their own. Enslaved girls and women were frequently raped by overseers, their owners, friends of their owners, and slave traders. Additionally, enslaved boys and men were often forced to have sex with enslaved women and girls to reproduce workers for their owners, and they were also forced to have sex with their female and male owners and overseers. One obvious consequence of this sexual violence was pregnancy, and enslaved women and girls were often not allowed to keep their newborns. Many of these children were sold in a slave market or to a slave owner in the same county or town. Another form of sexual violence against enslaved Africans came in the form of medical experimentation. Enslaved women and men were subjected to various unnecessary and involuntary surgeries and medical procedures on their reproductive systems. As a result, the sexuality of Black Americans has been unconsciously affected by the centuries-long history of sexual violence that occurred during slavery. After the abolition of the transatlantic slave trade, sexual violence was one of the primary means used by European Americans to subjugate and control Black men and women. Other methods included lynching, Jim Crow laws in the Southern states, and continued de facto segregation in the Northern states. When Black American men and women sought to claim their legal rights to employment, a free education, and full citizenship, the threat of European American mob violence in the form of lynching was ever present in the lives of those who remained in the South, until the mid- to late 1960s. While Black American women and

other individuals were also lynched, the vast majority of lynching victims were Black American boys and men. Lynching, the threat of lynching, and the rapid enactment of Jim Crow laws, which codified racial segregation, served to suppress Black Americans’ efforts to become full citizens. One of the ways in which many Black Americans survived was by being hypervigilant of one’s behavior and the subsequent collective self-­monitoring of Black American communities. To ensure that community members’ mores and appearance did not lead to European American sanctions or violence, some Black Americans worked to appear and be as “normal” as possible (i.e., heterosexual and nonthreatening to European Americans).

The Role of Mass Media Since the early 1800s, Black American men and boys were often depicted in the U.S. media as savage, hypersexual individuals who needed to be kept away from European American women and girls by any means necessary. Alternatively, they were depicted as weak, emasculated coons and sambos. Black American women and girls were portrayed as either oversexed beings who deserved the sexual violence they were continuously threatened with or as sexless mammies. While there have been significant changes in the way Black ­Americans are portrayed in the U.S. media, some media continue to offer a distorted image of the sexuality and gender roles of Black Americans. Research findings suggest that the consumption of these images negatively affects not only the ­European American public’s understanding of and attitudes toward Black Americans but also the self-esteem and expectations of Black American ­ children and adolescents. Fortunately, racial socialization and parental monitoring can provide a buffer for Black American children and adolescents and enhance resiliency. Many Black ­American parents consciously prepare their children for the personal and social realities of being Black in the United States, which in turn prepares them to navigate potentially hostile contexts and manage their feelings about these contexts.

The Role of Religion A review of 30 years of national surveys found that Black Americans were the most religiously

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committed ethnoracial group surveyed. A Pew Forum survey found that Black Americans were significantly more religious on a variety of m ­ easures than the general population—level of affiliation with a religion, attendance at religious services, frequency of prayer, and religion’s importance in one’s life. Other studies show that Black American LGB individuals tend to be more religious and spiritual than their LGB peers from other ethnoracial backgrounds. This finding appears to contradict the oft-repeated theory that homonegativity is higher in the Black American community than in other ethnoracial groups in the United States. Most of the Africans who were enslaved came from tribes and regions where indigenous religions were practiced; a small number were adherents to Islam or Christianity. For those who were brought to the United States, forced conversion to Christianity was used a means of social control. Christian ideology gradually became a tool used by capitalists and governments to justify chattel slavery of Africans and Black Americans, and by owners as a mechanism to control the thoughts, perceptions, and behavior of enslaved people. However, ­Christianity also helped many enslaved Africans and Black Americans survive the brutal physical and sexual violence they experienced at the hands of European American overseers, strangers, owners, and slave traders. From the Reconstruction period (1865–1877) to the present, the racial socialization of many Black Americans has been imbued with traditional Christian religious strictures around sexuality and gender roles that have been passed down from previous generations. Eventually, these religious rules became cultural rules that created culturally specific gender role ideologies for Black ­Americans. In these contexts, same-sex sexuality, extramarital sex, and having children without being married tend to be seen as transgressive. Efforts to adhere to Christian and Muslim religio-cultural norms and values about respectability, being a reflection of the Black American community, and avoiding any appearance of deviancy can cause internal conflict for those for whom sex is a form of relationship building and/or recreation. These culturally specific gender role ideologies also affect the sexual orientation and sexuality of Black ­Americans who are gender nonconforming. For example, Black American lesbians who identify as AG (aggressive) or stud and display masculine gender

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expression and racial identity may face sanctions and interpersonal challenges within their communities of origin if there are expectations that girls and women behave in stereotypical feminine ways and seek male sexual and romantic partners. Black Americans who are more religiously observant are more likely to oppose bisexuality and homosexuality; however, surveys indicate that they are more likely to support laws prohibiting antigay discrimination than their European American peers. Also, Black Americans who are less religious and have attained higher levels of formal education are more likely to be supportive of LGBT civil liberties. In addition, there are many traditionally Black ­American churches in which LGB individuals are not only “out” to members of the congregations but also hold leadership positions. It has been suggested that this level of acceptance on the part of some religious Black Americans exists because of an acknowledgment that most Black Americans share the experience of racial oppression and as such do not want to perpetuate oppression.

HIV and Other Sexually Transmitted Diseases Since the beginning of the U.S. HIV epidemic, Black Americans have been disproportionately affected by HIV and other sexually transmitted diseases (STDs). In 2014, the infection rates for chlamydia and gonorrhea were highest in Black American men and women. According to the ­Centers for Disease Control and Prevention, the factors that place Black Americans overall at a higher risk of acquiring HIV and other STDs are higher community STD rates; higher poverty rates, which lead to a lack of access to quality health care, stable and good-quality housing, and HIV prevention education; homonegativity; higher l­evels of crime and drug trafficking in their neighborhoods; HIV-related stigma and discrimination; low educational attainment; higher levels of incarceration; and the fact that many Black Americans have Black American sexual partners who live in communities where there is a high community HIV load. While the risk factors for HIV and other STDs are the same, HIV has had a much more devastating effect on the Black American community than other STDs. In 2011, the Centers for Disease Control and Prevention included racism in the U.S. health care system and homonegativity as risk

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f­actors for the continued increase in HIV infections and AIDS diagnoses in Black Americans— especially young men who have sex with men (age 13–29 years). These two factors combine to fuel the spread of HIV because they both can lower self-esteem and affect one’s decision to engage in sexual behaviors that place one at risk of contracting HIV. In 2010, Black Americans accounted for 44% of all new HIV infections in the United States among those aged 13 years and older, and men accounted for 70% of the new HIV infections among all Black Americans. Men who had sex with other men constituted 72% of Black American men who were newly diagnosed in 2010, and in the same year, there were more new infections among Black American gay and bisexual men aged 13 to 24 years than in any other ethnoracial group of gay and bisexual men. As for Black American women, the infection rate for this group as a whole was more than the combined infection rates of all other ethnoracial groups. The primary mode of transmission for Black American women is sex with men who engage in multiple high-risk sexual and substance use behaviors. There is research that suggests that the reasons for the sexual orientation and gender disparities in STD/HIV infection rates among Black Americans are rooted in the historical and religio-cultural factors that differentially influence the sexuality and sexual orientation of all Black Americans. Like their Black American heterosexual peers, Black American LGB individuals are more likely to be connected with their families and communities of origin than their European American LGB peers. However, it has been posited that LGB individuals who are members of Black American religious communities that are homonegative and heterosexist are more likely to experience internalized homonegativity and lowered self-esteem. The normative, psychosocial reliance on the concrete support of other Black Americans for acceptance may lead to some LGB individuals feeling internal or external pressure to hide their sexual orientation and modify their gender presentation. For these individuals, engagement in sexual behavior that places them at risk of acquiring HIV and other STDs may serve as a coping mechanism to deal with stigma and discrimination. For heterosexual and some homosexual Black American men, it has also been found that

sociocultural perceptions of masculinity influence the likelihood of their engaging in behaviors that place them at risk of acquiring or transmitting HIV or other STDs. For some, these conceptions have been shaped by individual trauma; for others, they are reactions to homonegativity, the emasculation of Black American men during slavery and the pre–Civil Rights era, and the hypersexualization of Black American bodies. Examples of sociocultural conceptions of masculinity for Black American men include an exaggeration of traditional masculine roles through sexual prowess, physical dominance of others, aggression, and anti-­ femininity. Black American men who feel compelled to adhere to these gender role ideologies as a way of proving their Blackness and/or their manhood may be placing themselves at risk of acquiring HIV/STDs. In the case of heterosexual Black American women, previous research demonstrates that as a result of the widespread incarceration of Black American boys and men, some Black American female young adults and women are more willing and likely to engage in risky behaviors and withstand intimate partner violence in order to maintain their relationships with male partners. For some Black American girls and women, their gender role ­ideology includes putting a male partner’s sexual needs first. Despite these data, for Black Americans, there may be global protective factors against HIV and other STDs—religiosity and religious involvement. Although the findings are mixed, there is enough evidence to suggest that for some Black American youth and adults of all sexual orientations, church attendance, religious practices (e.g., prayer, reading of religious texts, meditation), and/or engagement in religious activities (various ministries, discipleship courses) lower the risk of engaging in sexual behavior that puts them at risk of transmitting or acquiring an STD. Historically, religious faith has provided Black Americans and their ancestors with resiliency, and active participation in a religious community provides one with a community of like-minded individuals. This religious involvement has been found to serve as a buffer against morbidity and mortality. A challenge arises for LGB Black Americans if homonegativity and heterosexism exist within their religious community. In these instances, some LGB Black Americans are forced to leave a community that had previously

Black Americans and Transgender Identity

provided them with emotional and concrete support. Like their heterosexual peers, some of the LGB Black Americans surveyed reported that their spirituality and religious beliefs empower them and allow them to persevere in the face of life’s challenges (e.g., racism, sexism, homonegativity, work, etc.). As a group, the lives and sexual orientations of Black Americans have been shaped by various historical, social, and individual factors. While many of these factors are negative (e.g., slavery, forced migration, religio-cultural strictures about sexuality and gender), there are also positive aspects to many of them (e.g., religion and spirituality as protective factors, finding support in one’s community of origin, racial socialization). In spite of the negative images of Black Americans and their sexuality in the media, Black Americans continue to create self-empowering narratives about sex and sexuality. Lourdes Dolores Follins See also Black Americans and Gender; Black Americans and Transgender Identity; Cross-Cultural Differences in Gender; Cross-Cultural Models or Approaches to Gender

Further Readings Bowleg, L., Teti, M., Malebranche, D. J., & Tschann, J. M. (2013). “It’s an uphill battle everyday”: Intersectionality, low-income Black heterosexual men, and implications for HIV prevention research and interventions. Psychology of Men and Masculinity, 14, 25–34. doi:10.1037/a0028392 Follins, L. D., Walker, J. J., & Lewis, M. K. (2014). Resilience in Black lesbian, gay, bisexual, and transgender individuals: A critical review of the literature. Journal of Gay & Lesbian Health, 18, 190–212. doi:10.1080/19359705.2013.828343 Gates, G. J., & Newport, F. (2012). 3.4% of U.S. adults identify as LGBT (Gallup Special Report). Retrieved from http://www.gallup.com/poll/158066/special-reportadults-identify-lgbt.aspx Hawes, S. M., & Berkley-Patton, J. Y. (2014). Religiosity and risky sexual behaviors among a Black American church-based population. Journal of Religion and Health, 53, 469–482. Kastanis, A., & Gates, G. (2013). LGBT AfricanAmerican individuals and African-American same-sex couples. Los Angeles, CA: Williams Institute. Retrieved

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from http://williamsinstitute.law.ucla.edu/research/ census-lgbt-demographics-studies/lgbt-africanamerican-oct-2013/ Lewis, G. B. (2003). Black-white differences in attitudes towards homosexuality and gay rights. Public Opinion Quarterly, 67, 59–78. Millett, G. A., Peterson, J. L., Wolitski, R. J., & Stall, R. (2006). Greater risk for HIV infection of Black men who have sex with men: A critical literature review. American Journal of Public Health, 96, 1007–1019. Pew Research Center’s Forum on Religion and Public Life. (2009). A religious portrait of African-Americans. Washington, DC: Author. Retrieved from http://www .pewforum.org/2009/01/30/a-religious-portrait-ofafrican-americans/ Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17, 423–441. Washington, H. A. (2008). Medical apartheid: The dark history of medical experimentation of Black Americans from colonial times to the present. New York, NY: Anchor.

Black Americans and Transgender Identity The term transgender refers to individuals who perceive that the sex they were assigned at birth is an incomplete or incorrect description of themselves. In the Black American transgender ­ community, there are multiple, self-constructed identities. These vary according to the degree to which one embodies the malleability of gender (e.g., trans man, trans woman, full-time crossdresser, part-time cross-dresser, butch). The desire or ability to align one’s physical characteristics to one’s internal experience also varies between individuals. Some transgender people may have little or no interest in hormone treatments or medical procedures, whereas others may be in different stages of transition. Although the identities and lives of all transgender people are complex, the historically disadvantaged experiences of Black Americans in the United States contribute to a uniquely complicated experience. Consequently, within the transgender community, Black ­American transgender people have higher rates of homelessness, violence, homicide, and incarceration.

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This entry discusses these intersectional dynamics and their implications within Black American transgender identities.

Untangling Gender and Race Sex pertains to an individual’s biological traits, such as genital, chromosomal, or hormonal constitution. Two diametrically opposed sex categories, male and female, emerged from the existence of biological differences. U.S. culture is predicated on the assumption of bi-genderism or the presupposition that only two types of appearance, behavior, and roles organically emerge from the aforementioned sex categories. This dualism essentializes the human experience by assuming and reinforcing uniform ways of being a man or woman. Essentialism may undermine the multifaceted, fluid, or spectral ways that gender may be realized. Dualism implicitly alleges that everyone has a cisgender experience, or that one’s gender and personal identity align with one’s biological sex. An essentialist view surrogates the body to identity by positioning gender as fixed, natural, and immutable within the person. For disrupting these perceived biological gender binaries, transgender persons are often described as unnatural or deviant, or with heteronormative pejoratives. Gendered stereotypes can erroneously serve as a reference point or template for transgender people on how to be their authentic selves. In this way, gender binaries can unwittingly be legitimized by the gender variant people who attempt to disrupt them. Further complicating these issues is the notion that U.S. society remains organized according to androcentric and Eurocentric norms. As such, within the Black American community, understanding of masculinity and femininity is ­ simultaneously racialized and gender biased. Because individual understandings of masculinity and femininity coexist with universal ones, gender in the Black American community can share stereotyped markers of what it means to be male and female with the notion of gender in the dominant society (e.g., physical characteristics; a respective ­orientation toward dominance vs. acquiescence). At the same time, the ideal embodiment of gender within the Black American community may also involve culture-specific hallmarks such as skin

complexion, hair texture, and personification. These culture-bound preferences or performances of gender are unshared with the mainstream culture. Moreover, the Black American performance of gender may be rejected in dominant settings, as well as highlighted by other races as inferior or problematic. Another implication of living in an androcentric, Eurocentric context is that White masculine ideals become the arbiter of normalcy. In an implicitly racial and gendered hierarchy of social relations, Black men/masculinities are deemed to be “less human” than White men. Conversely, Black American women, with their simultaneous embodiment of at least two devalued categories (i.e., Blackness and gender), are inevitably subordinated to White men, White women, and Black men. The insidious strain of devaluation to which Black American women are uniquely susceptible has been termed misogynoir by sociologist Moya Bailey. Misogynoir encapsulates the dehumanization that is reiteratively directed toward Black women as a function of the interactions of ­misogyny, racism, and anti-Blackness. While women collectively experience misogyny, the interacting consequences of racialized sexism for Black American women produce specific consequences of debasement to which women of other racial backgrounds are immune. For instance, misogynoir helps explain why Black female sexuality is interpreted as vulgar, amoral, or criminal whereas identical expressions by women of other groups are frequently reinterpreted in relatively progressive terms. Furthermore, because the ideology of anti-Blackness can be internalized by its targets, Black American women are the recipients of misogynoiristic aggression from members of their own racial community, as well as from other racial groups. When Black American transgender women contend with these dynamics, they experience transmisogynoir, the interactive product of anti-Blackness, transphobia, and sexism. Binary gender schemas tend to be organized along dichotomous constructions such as sexuality, which is often confined to heterosexual-homosexual poles. In this way, gender identity (a person’s ­experience of being male, female, neither, or both) has been conflated with sexual orientation (one’s sexual, romantic, and/or emotional interest in others). As such, per the dictates of heteronormative

Black Americans and Transgender Identity

expectations, it is expected that a transgender man will inevitably and solely be attracted to women. With these considerations in mind, the humanity of Black American gender nonconforming people is called into question by those who adhere to the White heteronormative traits with which Black gender nonconforming people contrast. Accordingly, these norms foster an internal process of questioning one’s own legitimacy. Racialized ­bi-genderism acerbates oppression by creating another set of subordinated rungs at the bottom of the social hierarchy. Consequently, the personhood of transgender people is discredited or questioned outright. Racialized bi-genderism also places undue emphasis on transitioning or embodying the external and performative markers of masculinity and femininity. ­Gender dualism conflicts with the fluidity of transgender identity.

The Primacy of an Intersectional Lens for Black American Transgender Clients The Black American community is not a monolith but is composed of various configurations of race, region, class, gender, and other affiliations and identities. Accordingly, there is no singular way in which Black Americans experience and navigate transgender identity. The feminist theory of intersectionality, as articulated by scholar Kimberlé Crenshaw, applies to Black American transgender identities. Crenshaw posits that the multiple and concurrent identities that people hold or endorse (e.g., race, class, gender, ability) are experienced and negotiated ­ simultaneously, not in isolation. On the one hand, therefore, Black American transgender men and women contend with oppressions that inescapably emerge from their different identities (e.g., racism, sexism, transphobia/heterosexism, classism, ableism). On the other, it should be noted that these oppressions intersect in the sense that the function of one oppression may facilitate another. In this way, transphobia can be racialized (e.g., shaming of Black transgender men; perpetuating transmysogynoir for Black transgender women specifically), or racism, gendered. Both transphobia and racism can be mediated by classism, and so on. These dynamics play out in complex ways within the Black American transgender community. For

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example, a female-to-male transgender person may acquire male privilege but may also acquire stereotypes relative to volatility and dangerousness, which may lead to increased targeting by the police. Although their male identity may now align with their internal experience, they may struggle with relating to male privilege. Conversely, maleto-female transgender people may struggle with the loss of male privilege and a new first-hand experience of the societal devaluation of Black women. These interactions produce unique social and psychological outcomes for Black American transgender people. For example, given the stratified architecture of social relations in the United States, where Black Americans have a depreciated racial and social status, an implicit belief in Black American nonhumanity and inferiority governs ­ human interactions. In accordance with this template, Black American transgender people are considered less human and consequently engender less compassion than their White counterparts. In this way, Black American gender variant people have less privilege and visibility than White transgender people, even as the latter group contend with oppressions related to their transgender identity. Researchers V. Purdie-Vaughns and R. P. Eibach explained this phenomenon through the concept of intersectional invisibility. Because transgender people as a whole are considered nonprototypical members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, and because White transgender men and women are more ­prototypical of what it means to be transgender, Black American transgender persons are made invisible due to their multiple identities. Despite this invisibility, Black American transgender people have unique needs and risks—such as their overrepresentation as murder and assault victims. Black American transgender women are simultaneously invisible and hypervisible. This is attributable to their inheritance of the societal debasement of the Black female body within the hierarchy of social relations. Navigating and embodying this paradox may necessarily result in specific, psychologically taxing outcomes. Transgender identity encompasses self-definition, presentation, and representation, as well as varying degrees of internalization or resistance to oppressive systems. Physical characteristics such as ablebodiedness, body size, hair texture, and skin

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complexion carry a social premium for many in the Black American community and also influence how one experiences the self. Personal identity is facilitated and enhanced by the existence and quality of family and community support systems, as these factors can either foster self-acceptance or self-­ ­ deprecation. Furthermore, personal transgender identity involves political decisions relative to disclosure, the use of gender congruent pronouns, or visible embodiment of gender variance and/or gender fluidity. At the same time, there is a reciprocal interplay between these personal considerations and the consequences of social identities. As a result, Black American transgender men and women can simultaneously straddle power or privilege and marginalization. Transgender identity in such instances can simultaneously be a source of personal empowerment against ubiquitous social and interpersonal stressors as well as a risk factor. Because all identity categories rely on one another for meaning, identities such as race, cisgender privilege, socioeconomic status, and others all contextualize the personal meaning of being transgender. As such, transgender identity is not limited to the ways Black American transgender people define themselves but is also defined by their relationship to intersecting social structures and the ways they experience power or marginalization because of their multiple identities. Moreover, transgender identity for Black Americans necessarily involves contending with what scholar Patricia Hill Collins refers to as a shifting “matrix of oppression” involving racism, sexism, classism, homophobia, colorism, and other structurally related as well as internalized impediments. Black American transgender people are compelled to navigate these oppressions within the dominant society as well as within their affinity groups. As psychologist Elizabeth Cole notes, as opposed to being static characteristics, social identities interact with one another. Accordingly, for Black Americans, gender can trigger anxieties about safety, survival, or respectability. Racialized gender can inspire stereotyped ascriptions about Black Americans that transgender people, in turn, may feel compelled to contradict or exaggerate (e.g., hypermasculinity for Black American transgender men). Furthermore, those who identify as transgender navigate considerable external

pressure to align themselves with one and only one gender category.

Minority Stress The simultaneous subversion of gender and the pervasive engagement with multiple oppressions steep Black American transgender persons in minority stress processes, a term coined by Ilan H. Meyer; minority stress occurs both internally and externally as a function of contending with the chronic stress imposed by prejudice and discrimination. Not only does minority stress have a c­ ompounding effect on everyday stressors that all people must negotiate, but also it is contingent on a transgender person’s multiple minority statuses. Furthermore, its social and psychological effects are so pernicious that the appraisal of safety as well as the navigation of multiple symbiotic sites of vulnerability and violence become core, inescapable components of Black American transgender identity.

Violence Crenshaw’s concept of structural intersectionality is a useful lens to understand why the impact of minority stress is so vicious for members of the Black American transgender community. S­ tructural intersectionality refers to the ways an individual is disenfranchised because of his or her legal status or lack of access to social resources. Black American transgender people caught in the specific intersections of class, gender, and race are frequently involved in sex work at higher rates than their counterparts from other racial backgrounds. Transphobic and transmisogynoiristic myths about the sexual deviance of Black American transgender people obfuscate the reality that high rates of exposure to violence, homelessness, poverty, and sudden or chronic unemployment compel this group to rely on sex work for survival. Black American transgender women are overrepresented as victims of violence and homicide in the context of the sex trade. The disproportionately high murder rate of Black American transgender women— most of these murders are uninvestigated and unsolved—creates a valid and omnipresent existential anxiety about safety and the inevitability of violence or death for members of the community, whether involved in sex work or not.

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Law

Interpersonal Dynamics

The current legal infrastructure is tenuous regarding the protections it provides Black American gender nonconforming people. Accordingly, interactions with the legal system exacerbate the distress experienced by this community. In fact, laws can explicitly target Black American transgender women involved in the sex trade, leading to high rates of arrest and incarceration. The pervasiveness of transphobic violence against the Black ­American transgender community remains invisible since it was only near the end of the first decade of the 21st century that violence against transgender people as a whole was legally recognized as a hate crime. By no means does the passage of such legislation inoculate them from daily microaggressions such as verbal harassment and insults. The convergence of the law, race, gender, and cisgender privilege frequently arbitrates over the safety that a Black American transgender person experiences. However, laws have historically institutionalized transphobia by providing scant ­ legal protections for the transgender community. For example, only a few states formally proscribe discrimination in the workplace due to gender nonconformity. The inability to maintain consistent employment due to transphobic discrimination, however, not only increases Black American transgender persons’ risk of relying on sex work for survival, it also intensifies their exposure to rife insecurity and violence. Despite the deep need for more robust legal protections, the current zeitgeist is such that extant legal safeguards are being eroded. For example, as of 2016, an initiative in North Carolina prohibits transgender people from using bathrooms that do not match the gender ­outlined on their birth certificates. Implicit in this legislation are tropes of pathology, sexual deviance, and deception that only serve to further marginalize the transgender community as a whole. However, owing to their intersectional identities, as well as the discrimination and tropes associated with their multiple minority statuses, Black American gender nonconforming people—especially those without cisgender privilege—are more likely to be harmed by the consequences of this new legislation. For instance, discriminatory mind-sets portray Black transgender bodies as dangerous, thereby increasing their omnipresent sense of vulnerability.

A core component of transphobia is being compelled to embrace an identity with which one does not identify. Living a life of authenticity is a core existential objective for gender nonconforming people. Transphobic legal initiatives, as noted ­earlier, however, not only constrain their ability to live authentically, but they require attempts at “passing” for the functional tasks of coping with stigma and increasing their overall sense of safety. The pressure to embody and/or resist the external trappings of masculinity and femininity, however, is a highly stressful process for Black American transgender people. Many who desire sex reassignment procedures do not have the access or resources for this undertaking. Whether one formally pursues this step or not, an inordinate amount of vigilance toward the environment for external threats such as outing, intimidation, harassment, humiliation, and racialized and gendered violence is required. Simultaneously, a range of self-protective strategies against rejection and violence from o ­thers are enacted. These may include monitoring and/or adjusting their behavior for gender nonconformance. While passing may be functional, it may be a source of pervasive anxiety in the ways it encourages hiding of the totality of the self and personal history. For persons who espouse heteronormative ideas, passing connotes ideas of deception and duplicity, which further perpetuates the alleged “unnaturalness” of atypical gender presentations for Black American transgender people. In romantic relationships, the need to secure safety by passing becomes misinterpreted as deception, with violent consequences. Alternatively, due to internalized racialized transphobia, the partners of Black American transgender people can become a proxy for the latter’s alleged abnormality. The challenge to their own identity can trigger confusion, isolation, shame, and anger, which are redirected toward the transgender partner. In this way, romantic relationships can become a site of vulnerability to abuse, outing, and sexual and physical assault. Gizelle V. Carr See also Cisgender; Gender Development, Theories of; Heteronormativity; Intersectional Identities; Transgender People

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Further Readings Bailey, M. (2013). New terms of resistance: A response to Zenzele Isoke. Souls: A Critical Journal of Black Politics, Culture, and Society, 15, 341–343. doi:10.108 0/10999949.2014.884451 Bristol, K. (2014). On Moya Bailey, misogynoir, and why both are important. Retrieved from http://www .thevisibilityproject.com/2014/05/27/on-moya-baileymisogynoir-and-why-both-are-important/ Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Cashore, C., & Tuason, T. G. (2009). Negotiating the binary: Identity and social justice for bisexual and transgender individuals. Journal of Gay and Lesbian Social Services, 21, 374–401. doi:10.1080/ 10538720802498405 Levitt, H. M., & Ippolito, M. R. (2014). Being transgender: Navigating minority stressors and developing authentic self-presentation. Psychology of Women Quarterly, 38, 46–64. McKenzie, M. (2014). Black girl dangerous on race, queerness, class and gender. Oakland, CA: BGD Press. Mock, J. (2014). Redefining realness. My path to womanhood, identity, love and so much more. New York, NY: Simon & Schuster. Nagoshi, J. L., & Brzuzy, S. (2010). Transgender theory: Embodying research and practice. Affilia: Journal of Women and Social Work, 25, 431–443. doi:10.1177/ 0886109910384068 Purdie-Vaughns, V., & Eibach, R. P. (2008). Intersectional invisibility: The ideological sources and social consequences of the non-prototypicality of intersectional subordinates. Sex Roles, 59, 377–391. doi:10.1007/s11199-008-9424-4 Shields, S. A. (2008). Gender: An intersectionality perspective. Sex Roles, 59, 301–311. doi:10.1007/ s11199-008-9501-8

Body Dysmorphic Disorder and Gender Body dysmorphic disorder (BDD) is a psychological disorder in which people become preoccupied with a fictitious flaw in their appearance. This disorder has distinct gender differences in presentation and area of concern. Treatment issues, while not greatly researched, will also vary by gender. This entry introduces BDD and pays specific

attention to how gender affects both its prevalence and its treatment.

Body Dysmorphic Disorder BDD is characterized by a preoccupation with perceived flaws in appearance. Individuals diagnosed with BDD are fixated on and distressed with one or more alleged defects in their physical ­appearance; these alleged defects are either not observable or only minimally apparent to other individuals. Regardless of others’ perspectives, individuals struggling with BDD become fixated on or obsessed with these perceived flaws. These obsessions most commonly present as concern for one’s skin (e.g., acne, wrinkles, or scars), hair (e.g., thinning or excessive hair), or nose (e.g., size and shape). Although these are the most common areas fixated on by individuals struggling with BDD, any area of the body can be the source of obsession. The area of concern tends to differ by gender. While women tend to focus on their weight, hips, legs, and breasts, men are more concerned with their ­genitalia, height, hair, and level of muscularity, particularly in their upper body. In response to these obsessive thoughts, individuals struggling with BDD feel driven to engage in repetitive behaviors or mental acts. These compulsive behaviors are not enjoyable, they are time-consuming but difficult to control, and they often increase i­ndividuals’ levels of anxiety. Common types of compulsive behaviors exhibited by individuals struggling with BDD include comparing one’s appearance with that of others, repeatedly c­hecking perceived defects in mirrors, excessive grooming, or camouflaging (e.g., a person who covers t­hinning hair with a hat or a person who wears concealing clothing to hide asymmetrical abdominal muscles). Many individuals diagnosed with BDD exhibit other associated characteristics. Often delusional thought patterns are associated with BDD; these thought patterns may cause individuals struggling with BDD to think that others are paying close attention and mocking the perceived physical flaws. High levels of anxiety, depression, social anxiety, and social avoidance are common in individuals diagnosed with BDD. These associated symptoms may exacerbate the struggles of individuals with BDD. Because of these struggles, many individuals with BDD may elect to undergo

Body Dysmorphic Disorder and Gender

cosmetic surgery to correct the perceived defects. Estimates suggest that 7% to 15% of patients seeking cosmetic surgery have symptoms of BDD. There has been increased attention to the identification of BDD in the medical field; roughly three quarters of people with BDD seek some form of cosmetic treatment, up to and including surgery, and about half the people with BDD who seek cosmetic treatment obtain it. Although cosmetic surgery may seem like a viable option to help these individuals alleviate some suffering, the benefits obtained from such surgeries are typically minimal or nonexistent. Some individuals’ symptoms actually increase in severity after undergoing surgery, or new areas of concern appear; others may become violent or take legal action if they are dissatisfied with the results of the operation. Prior research offers some explanation for these situations. BDD has been associated with executive dysfunction (i.e., irregular functioning of brain structures in the frontal lobe), abnormalities with regard to visual processing, and an attention bias for negative or threatening stimuli. These factors suggest the powerful role distorted thought processes play in the experiences of individuals ­ struggling with BDD. Until recently, BDD was classified as a somatoform (body related) disorder. However, with the fifth edition of the Diagnostic and Statistical ­Manual of Mental Disorders (DSM-5), the disorder has been reclassified as an obsessive-compulsive related disorder. With the new conceptualization of BDD comes the idea that the repetitive checking behaviors and protective mental acts used to ward off the anxiety associated with the thought that a body part is not formed appropriately are both caused by an underlying obsession-like preoccupation. There is considerable controversy surrounding this new conceptualization, with some authors arguing that BDD is more closely related to generalized anxiety disorder and other anxiety ­ ­disorders than it is to disorders in the obsessivecompulsive disorder section of the DSM-5, such as trichotillomania, hoarding disorder, and excoriation (skin picking) disorder. There is strong research to suggest that BDD, obsessive-compulsive disorder, ­simple phobia, social anxiety disorder, generalized anxiety disorder, and panic disorder all stem from anxiety or fear resulting from being within a specific situation or experiencing particular stimuli.

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Muscle Dysmorphia In addition to changing the classification of BDD from a somatoform disorder to an obsessive-­ compulsive related disorder, the DSM-5 added the specifier of muscle dysmorphia (MD) to the ­disorder. Thus, MD is a subtype of BDD in which muscular individuals perceive themselves as lacking in musculature. MD occurs more often in men than in women and is fairly prevalent within the bodybuilding culture. Individuals with MD are focused on the fact that they are not lean and muscular enough, even though they tend to be ­ more muscular than average. This preoccupation is persistent and brings about clinically significant impairment or distress. Individuals with MD skip important social, occupation, or recreational activities to work out with weights in order to increase their muscularity. They avoid situations in which their bodies are exposed. They experience high levels of distress over their perceived inadequate muscularity. They continue to lift weights, use performance-enhancing supplements, and diet, despite knowing about the adverse physical or psychological consequences of these behaviors. Symptoms of MD have been associated with higher levels of anxiety and depression and lower levels of body satisfaction.

Gender Issues in BDD While BDD has become more well known since it was added to the DSM-III-R (third edition, revised) it has largely been considered a “women’s” illness. Due to its focus on physical appearance, something that, according to societal norms, is a ­feminine concern, men may be reluctant or embarrassed to admit to experiencing symptoms of BDD. However, BDD occurs in men and women at roughly the same frequency. Moreover, because this perception of BDD is also found among mental health professionals, men suffering from BDD are more likely to be misdiagnosed with disorders ranging from depression to social phobia. To ­complicate matters, some aspects of the disorder, while appearing similar in both sexes, may be derived from different sources. Body-based social comparison, for example, appears to lead to body dissatisfaction in women, but in men it may be part of a more complicated emotional process

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involving comparing not only one’s physical appearance but also one’s manliness against that of other men. Historically, women have experienced, or reported, greater levels of anxiety related to appearance and body image dissatisfaction. This trend has begun to change in the past several decades as marketing tactics for products directed toward men have changed. Images of men in the media have become increasingly unrealistic and unobtainable by the average man, much in the same way as idealized images of women have been used. There has been an estimated threefold increase in the rates of body dissatisfaction in men over the past 25 years. BDD is sometimes thought of as underlying transgender issues. This is not the case. Transgender identity involves a sense of being male or female internally and living in a body with other gender characteristics (i.e., identifying as a woman while possessing biological male characteristics). To date, little research has been done to examine the complex roles sexual and gender role ­orientation play in BDD. There is some evidence that gay men experience body image disturbances more often than heterosexual men, about equal to the levels reported by women. Interestingly, women who identify as lesbian report even higher levels of BDD symptomology than heterosexual women. Not to be mistaken for sexual orientation (the part of a person’s sexual identity related to who the person is sexually attracted to), gender role orientation (the part of a person’s sense of sexual ­identity that is about their sense of self as male, female, neither, or both) also appears significant and may account for a greater share of variance than sexual orientation. Men who strongly endorse masculine norms appear to be more likely to experience BDD, and specifically MD. This likely has to do with the conflation of masculinity with muscularity in our culture. Conversely, gender nonconformity appears to be a protective factor in men. Women who identify strongly with traditionally feminine roles may be more likely to have body image disturbance, particularly anorexia nervosa but potentially also BDD. This is called the “femininity hypothesis,” which suggests that stereotypically feminine attributes (i.e., sensitivity, passivity, and dependence) become risk factors for lower self-esteem and seeking social approval and

these then lead to disordered body perception and the pursuit of an unrealistic body ideal. Overall, this area holds promise for additional fruitful research. Due to the differences in areas of body fixation, men and women will approach fixing their perceived defects differently. Men are more likely to feel additional pressure to exercise excessively and use steroids or other substances in order to increase muscle mass. Women are more likely to use cosmetics to conceal unwanted blemishes. Women are also more likely to resort to surgery. According to the American Society for Aesthetic Plastic Surgery, women undergo 90% of the cosmetic surgeries performed in the United States. Because their problems are perceived to be physical in nature, people with BDD are not likely to seek out psychotherapeutic assistance on their own. Often, they will be referred for psychological assistance when they seek a consultation for cosmetic surgery or engage in self-injurious behaviors (ranging from “do-ityourself” cosmetic procedures that go poorly to attempted suicide) leading to the need for medical assistance.

Treatment of BDD Although few research designs have examined the efficacy of treatments for BDD, some initial findings suggest that various types of effective treatments exist. Pharmacological (i.e., medication) interventions may be used; selective serotonin reuptake inhibitors are the most commonly ­prescribed medications, and data currently available suggest that many individuals struggling with BDD are helped by incorporating these medications into treatment. Additionally, current research suggests that many individuals with BDD also benefit from psychological interventions. The psychological intervention most commonly assessed in current research literature related to BDD is cognitive behavioral therapy (CBT). Overall, results from these studies suggest that individuals with BDD can benefit from CBT. Typically, these benefits are derived from focusing treatment on helping i­ndividuals identify and stop automatic thought processes, learn healthier coping mechanisms to address maladaptive urges, and learn other healthy behaviors associated with socialization. Socialization may be a vital component of

Body Image

effective ­ treatment; designing treatment with increased opportunities for socialization may offer additional benefits for individuals struggling with BDD. One research study examined the benefits of CBT administered in a group therapy setting. Findings from this study suggest that the participants benefited from group CBT. However, the sample used in this study was composed exclusively of female participants, so generalizing the effectiveness of group CBT for men struggling with BDD is challenging. Future research should address these needs and better examine the differences between effective treatment for men and women. Brian N. Lee, Thomas J. Reece, and Frederick G. Grieve See also Body Image; Body Image and Adolescence; Body Image and Aging; Body Image Issues and Men; Body Image Issues and Women

Further Readings Abramowitz, J. S., & Jacoby, R. J. (2014). Obsessivecompulsive disorder in the DSM-5. Clinical Psychology: Science and Practice, 21, 221–235. Boroughs, M. S., Krawczyk, R., & Thompson, J. K. (2010). Body dysmorphic disorder among diverse racial/ethnic and sexual orientation groups: Prevalence estimates and associated factors. Sex Roles, 63, 725–737. Chandler, C. G., Grieve, F. G., Derryberry, W. P., & Pegg, P. O. (2009). Are symptoms of anxiety and obsessivecompulsive disorder related to symptoms of muscle dysmorphia? International Journal of Men’s Health, 8, 143–154. Cororve, M. B., & Gleaves, D. H. (2001). Body dysmorphic disorder: A review of conceptualizations, assessment, and treatment strategies. Clinical Psychology Review, 21, 949–970. Crerand, C. E., Franklin, M. E., & Sarwer, D. B. (2006). Body dysmorphic disorder and cosmetic surgery. Plastic and Reconstructive Surgery, 118, 167–180. Grieve, F. G. (2007). A conceptual model of factors contributing to the development of muscle dysmorphia. Eating Disorders, 15, 63–80. Lamanna, J., Grieve, F. G., Derryberry, W. P., Hakman, M., & McClure, A. (2010). Similarities between etiological models for eating disorders and muscle dysmorphia. Journal of Eating and Weight Disorders, 15, e23–e33.

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Body Image Body image refers to an individual’s experiences of his or her appearance. The construct of body image and its components (i.e., subjective and ­attitudinal) have become increasingly important to researchers, educators, and parents. The reason for this interest is that the majority of women and girls, as well as a growing number of men and boys, are dissatisfied with the appearance of their bodies. This is concerning because body image issues have significant implications for numerous physical and mental health outcomes. This entry begins by reviewing the construct of body image and its various subjective and attitudinal ­components. Next, the entry provides an overview of available assessment techniques. The entry concludes with a discussion of the relevant risk factors and theoretical perspectives for the development and maintenance of body image concerns.

Definition Body image refers to an individual’s experiences of his or her appearance and includes perceptual and attitudinal aspects. Perceptual aspects of body image concern the extent to which individuals are able to accurately judge the size or shape of their body or its parts. Distorted perceptions of the body may include the whole body or discrete areas of the body (e.g., the stomach). For example, while a woman with a distorted perception of her stomach may be unable to accurately estimate the size of her stomach, she may demonstrate the ability to accurately estimate the size of her legs. Furthermore, individual differences arise in the extent of distortion. For example, extreme body image distortions may be best represented by individuals with anorexia nervosa, because these individuals often perceive themselves as having excess body fat despite being severely underweight. The attitudinal aspect of body image consists of two distinct components. The first is an evaluative component that captures subjective feelings about the body or its constituent parts—that is, the extent to which individuals feel negatively or positively about their body. Individuals who negatively evaluate the shape, size, and/or appearance of their body are thought to possess body dissatisfaction.

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Body dissatisfaction, or negative evaluations of one’s body, is more common among women than among men. In fact, the prevalence of body ­dissatisfaction among women and girls living in Western societies is so high that discontent with one’s body is considered normative. This is an important issue because body dissatisfaction is associated with an array of negative outcomes including ­disordered eating attitudes and behaviors (e.g., excessive dieting, bulimic symptoms, dietary restraint) and poor psychological functioning (e.g., depressive symptoms, emotional distress). In contrast, individuals with a positive body image demonstrate appreciation of their bodies and/or satisfaction with their bodies, which in turn is associated with positive functioning. For example, individuals who are satisfied with their bodies are more physically active and consume a healthier diet compared with those who report low levels of body satisfaction. Similarly, body appreciation, which differs from body satisfaction in that individuals accept and respect their body while ­ also rejecting socially constructed standards of attractiveness, is associated with more positive functioning, such as high levels of self-esteem, proactive coping skills, and intuitive eating (i.e., eating characterized by a strong connection with physiological hunger and satiety). Appearance investment is the second attitudinal component of body image, and it refers to the investment that individuals make in certain beliefs or assumptions about the importance, meaning, and influence of their appearance in their lives and is expressed as an overvaluation of appearance and excessive effort devoted to the management of appearance. For example, individuals with high appearance investment spend a great deal of time attending to their appearance and/or attempting to maintain or enhance their appearance. Interest in appearance investment has highlighted the importance of individual factors (e.g., beliefs) in how and to what extent external pressures (e.g., the media) influence thoughts, feelings, and behaviors related to the body. Appearance investment is thought to consist of two distinct features, referred to as self-evaluative salience and motivational salience. Self-evaluative salience reflects the extent to which appearance is important to feelings of worth, and beliefs about the degree to which appearance is instrumental in

causing social and emotional experiences. For example, individuals with high levels of self-­ evaluative salience may attribute not getting hired for a job to being less attractive than other job applicants. Conversely, motivational salience reflects the extent to which an individual attends to and manages his or her appearance. Individuals with high levels of motivational salience invest a great deal of time or money in improving their appearance or maintaining a certain level of attractiveness. Although self-evaluative salience and motivational salience are both important to the understanding of appearance investment, one key difference between the two is that self-evaluative salience reflects dysfunctional attitudes whereas motivational salience may not be particularly problematic if the goal is simply to maintain a certain level of attractiveness. That is, the desire to enhance or maintain appearance and the act of doing so may not be associated with negative outcomes (e.g., disordered eating attitudes and behaviors) when these efforts are relatively independent of assumptions about the instrumentality of appearance to self-worth.

Measurement The multidimensional nature of body image has led to the development of various assessment strategies. Instruments have been designed to assess both perceptual and attitudinal aspects of body image because the nature of body image concerns (e.g., self-evaluative salience) has implications for outcome severity. More specifically, measures of body image have been designed to capture global or site-specific body image satisfaction (or dissatisfaction) as well as the behavioral, affective, cognitive, and perceptual aspects of body image. Body image satisfaction/dissatisfaction is generally assessed using a subjective global or site-­ specific measure of body image. Figure rating scales, which are silhouette drawings depicting bodies of different weights, shapes, and/or sizes, are often used to measure global body image. These scales typically represent a spectrum of bodies that range from very underweight to overweight and are gender and age specific. The scale is often completed by instructing individuals to choose the silhouette that best represents their actual body. Individuals may then be asked to

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choose the silhouette that best represents their ideal body (i.e., the way they would like their body to look) and/or their ought body (i.e., the way they believe some external source [e.g., parents, peers, physician] expects them to look). Discrepancy scores are then examined by calculating the difference between the ratings of the actual self and the ideal self as well as between the ratings of the actual self and the ought self. Greater discrepancies between one’s actual versus ideal body image or between one’s actual versus ought body image are thought to indicate greater body dissatisfaction. However, actual/ideal body image discrepancies have been found to be more indicative of dissatisfaction than actual/ought discrepancies. It is important to note that the direction of the discrepancy must be considered to identify whether an individual’s desired body is smaller or larger than his or her actual body. More recently, figure rating scales have been modified to measure specific areas of the body. This is accomplished by holding all but one feature (e.g., the chest) of each figure constant. Self-report questionnaires are also used to assess global and site-specific body satisfaction/­ dissatisfaction through strategies such as asking individuals to rate their level of agreement with statements such as “I am satisfied with my body weight.” Questionnaires designed to assess global body satisfaction/dissatisfaction inquire about overall satisfaction with the appearance of one’s body, whereas site-specific questionnaires focus on a specific body part (e.g., the stomach) or aspect (e.g., weight) of interest. Individuals are typically asked to rate their response to each question using ­Likert-type response scales, which are then used to determine the degree of body satisfaction/ dissatisfaction experienced by the individual. Behavioral assessments of body image have also been used to measure body dissatisfaction, by assessing body-checking and avoidance behaviors. Body checking refers to critical examination of the body, such as repeatedly looking in a mirror, pinching areas on the body to examine body fatness, and weighing oneself frequently. In contrast, avoidance behaviors prevent positive or corrective bodyrelated behaviors and include behaviors such as wearing large clothing that conceals the body and avoiding mirrors or scales. Behavioral measures of body image consist primarily of self-reported levels

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of a behavior, which may limit the understanding of the frequency and intensity at which the ­behavior occurs. However, attempts to develop an objective assessment of these behaviors have been unsuccessful. Affective measures of body image capture individuals’ feelings and emotions about their body. Self-report questionnaires are the most common way to assess negative feelings and emotions such as anxiety, shame, and distress about the body. Affective measures have been further tailored to consider situational contexts. For example, measures of body image states have the ability to capture moment-to-moment changes in feelings about appearance. Other measures have been designed to consider specific contexts that may cause body image distress or anxiety, such as wearing a bathing suit in public or being intimate with a romantic partner. The consideration of specific situations or contexts is important because some individuals may only experience negative affect about their body in very specific situations (e.g., wearing a bathing suit), whereas others may experience negative affect regardless of the situation. Cognitive measures of body image assess the importance of appearance for feelings of worth, beliefs about its role in social and emotional experiences, and efforts devoted to managing or enhancing appearance. One example of this sort of measure is the Appearance Schemas Inventory– ­ Revised, which is a self-report instrument that is often used to assess appearance cognitions by considering the self-evaluative salience and motivational salience of appearance. The Appearance Schemas Inventory–Revised is helpful because it addresses both types of cognitions. This is important given that self-evaluative salience is often associated with more negative outcomes (e.g., eating disorders). Perceptual views of the body assess the ability of individuals to accurately gauge the size or shape of their bodies via psychological processes in the brain. Individuals who misperceive the size or shape of their bodies are believed to have a distorted body image due to disruptions in the psychological processes that recognize and interpret information about the body. A variety of software programs have been developed to measure perceptual body image. These programs allow individuals to adjust the size and/or shape of a digital image of themselves using a computer. This technique has

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been particularly useful in identifying cognitive distortions in individuals with anorexia nervosa. However, due to the cost and time requirements of these computer programs, figure rating scales are more commonly used to measure body image distortions.

Etiology There has been considerable interest among researchers and health care professionals concerning the development and maintenance of body image concerns. It has often been suggested that the development of body image concerns involves biological, sociocultural, and psychological r­isk and protective factors. A risk factor refers to internal or external influences that increase the ­ likelihood that an individual will experience body dissatisfaction, whereas a protective factor ­ decreases the likelihood that an individual will experience body dissatisfaction, despite the ­presence of risk factors. It is important to note that risk and protective factors may be causal or correlational. The role of biological factors in the development of body image concerns has recently received increased attention. One biological factor that has been shown to be associated with body image ­concerns is body mass index (an indicator of body fatness). Body mass index is believed to promote body dissatisfaction, particularly among women and girls, due to sociocultural pressures to ­conform to the thin ideal. That is, greater deviation from the thin ideal, evidenced by a higher body mass index, is associated with body dissatisfaction. Similarly, the body image concerns of male-to-female transsexuals often exceed those of nontransexual women and men, likely because these individuals tend to have a higher body mass index than nontransexual women. Other biological factors such as early menarche and age are thought to influence body image; however, findings of these associations have been mixed. Sociocultural factors associated with body image concerns have generally focused on peer, parent, and media influences. Peer experiences represent an important social context in which ­ appearance norms and ideals are communicated, modeled, and reinforced. Numerous peer experiences have been shown to influence body image,

such as appearance conversations, criticisms, and teasing. Appearance conversations are potentially problematic because they provide a context for ­ attending to body image concerns and facilitate the construction and acceptance of appearance norms and ideals. Appearance-related criticisms and teasing have also been shown to be associated with body image concerns. This is likely due to the fact that these interactions with peers call attention to the imperfections in an individual’s appearance. Parents are another important sociocultural factor that influences body image, both directly and indirectly. Direct influences include parental verbal communication or verbal influence, for example, encouraging a child to diet or use other weight loss strategies, among other behaviors. In contrast, indirect influences include parental dieting, parental expression of body dissatisfaction, and other observable parental behaviors aimed at reducing or maintaining their weight. Last, emphasis on appearance in the media has been shown to negatively influence body image. Images of the ideal body depicted in the media are often unrealistic and unattainable for most individuals. Thus, individuals who accept and adopt these appearance ideals as normative may experience body dissatisfaction if their appearance deviates from these ideals. Although sociocultural influences serve as a risk factor for body image concerns, not all individuals develop body image concerns, even when exposed to similar social contexts. Thus, it has been suggested that individual differences may explain why some individuals tend to respond more negatively to societal factors. That is, some individuals may be more susceptible to the adverse effects of sociocultural influences such as appearance-related teasing due to unique individual factors such as sexual identity, low self-esteem, negative affect, perfectionism, gender roles, and internalization of the thin ideal. Sexual identity, which refers to a domain of selfconcept used to organize one’s gender identity and sexual orientation, is one individual characteristic that appears to be particularly important for understanding body image. Although the term is not inclusive, individuals often describe their ­sexual identity as heterosexual, gay, lesbian, or bisexual. Individuals’ sexual identity may be important for understanding body image concerns because

Body Image

differences among sexual identities likely affect the degree to which individuals internalize socially constructed gender norms of femininity and masculinity. For instance, individuals who identify as lesbian often do not readily accept pressures to adhere to Western cultural ideals of the feminine body (e.g., the thin ideal), which may be due to immersion in both mainstream Western culture and the lesbian subculture, which rejects dominant gender norms. Conversely, individuals who identify as gay may have an increased risk for body image concerns due to the increased emphasis on attractiveness in the gay subculture.

Theories of Body Image A number of theoretical perspectives have been proposed to account for the nature, development, and effects of body image concerns. Of these theories, sociocultural perspectives of body image have received the most theoretical and empirical attention. The basic sociocultural model proposes that constant exposure to sociocultural influences that emphasize unrealistic and unattainable standards of attractiveness may lead individuals to accept the appearance standards as normative. In turn, individuals internalize these appearance standards such that failure to meet these standards results in body dissatisfaction. Sources of sociocultural pressures include parents, peers, romantic partners, and the media. These influences are often reflected as pressures to conform to a certain body type, social comparisons, and appearance teasing. It is important to note that this theory suggests that individual differences (e.g., biological and psychological characteristics) explain why not all individuals experience body dissatisfaction. Objectification theory has also received considerable empirical attention. This theory focuses on the negative impact that emphasizing physical appearance has on women and girls. According to this perspective, the feminine body has been socially constructed as an object to be admired in Western culture, which often leads women and girls to measure their worth primarily by evaluating their physical appearance. Similar to sociocultural perspectives, socially constructed standards of attractiveness are believed to develop as a result of societal pressures, such that women accept these standards of attractiveness as

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normative and incorporate them into their daily lives. In turn, women often personally identify with these social values, which they then use to construct their self-concepts. That is, women and girls who are constantly exposed to societal standards of attractiveness become preoccupied with their appearance. As a result, their perceived attractiveness may become a primary means for determining how they feel about themselves. It is notable that although objectification of the masculine body is far less common in mainstream Western culture, increased exposure to sexual objectification within the gay subculture may put individuals who identify as gay at an increased risk for body dissatisfaction. The cognitive behavioral theory of body image provides a slightly different perspective and has been used to form the basis of empirically supported treatment interventions for body image concerns among community and clinical samples. According to this perspective, historical and proximal events shape and maintain body image attitudes (i.e., evaluations and investment). Historical influences refer to past events that influence how individuals think, feel, and act in relation to their body and include cultural socialization, interpersonal interactions, physical characteristics, and personality features such as perfectionism. Historical influences are believed to instill fundamental body image attitudes that include dispositional body image evaluations and the extent of appearance investment, whereas proximal influences refer to current life events that trigger and maintain body image concerns and include self-dialogues, information processing, and self-regulatory actions. Amy E. Noser and Virgil Zeigler-Hill See also Body Image and Adolescence; Body Image and Aging; Body Image Issues and Men; Body Image Issues and Women

Further Readings Cash, T. F. (2002). Cognitive-behavioral perspectives on body image. In T. F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 38–46). New York, NY: Guilford Press. Cash, T. F., & Henry, P. E. (1995). Women’s body images: The results of a national survey in the USA. Sex Roles, 33, 19–28.

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Fredrickson, B. L., & Roberts, T. A. (1997). Objectification theory. Psychology of Women Quarterly, 21, 173–206. Furnham, A., Badmin, N., & Sneade, I. (2002). Body image dissatisfaction: Gender differences in eating attitudes, self-esteem, and reasons for exercise. Journal of Psychology: Interdisciplinary and Applied, 136, 581–596. Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies. Psychological Bulletin, 134, 460–476. Lawler, M., & Nixon, E. (2011). Body dissatisfaction among adolescent boys and girls: The effects of body mass, peer appearance culture and internalization of appearance ideals. Journal of Youth and Adolescence, 40, 59–71. Martins, Y., Tiggemann, M., & Kirkbride, A. (2007). Those speedos become them: The role of selfobjectification in gay and heterosexual men’s body image. Personality and Social Psychology Bulletin, 33, 634–647. Moradi, B., & Huang, Y. P. (2008). Objectification theory and psychology of women: A decade of advances and future directions. Psychology of Women Quarterly, 32, 377–398. Morrison, M. A., Morrison, T. G., & Sager, C. L. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A meta-analytic review. Body Image, 1, 127–138. Rodin, J., Silberstein, L., & Striegel-Moore, R. (1984). Women and weight: A normative discontent. In T. B. Sonderegger (Ed.), Psychology and gender: Nebraska symposium on motivation (pp. 267–307). Lincoln: University of Nebraska Press. Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53, 985–993. Thompson, J. K. (2004). The (mis)measurement of body image: Ten strategies to improve assessment for applied and research purposes. Body Image, 1, 7–14. Tiggemann, M. (2004). Body image across the adult life span: Stability and change. Body Image, 1, 29–41. Vocks, S., Stahn, C., Loenser, K., & Legenbauer, T. (2009). Eating and body image disturbances in male-to-female and female-to-male transsexuals. Archives of Sexual Behavior, 38, 364–377. Webb, J. B., Wood-Barcalow, N. L., & Tylka, T. L. (2015). Assessing positive body image: Contemporary approaches and future directions. Body Image, 14, 130–145.

Body Image

and

Adolescence

Our body image is the picture of our own body, which we form in our mind. In other words, body image is what you think you look like. Body image dissatisfaction is dissatisfaction with one’s size, weight, and shape. Recent research suggests that college-age students experience a great deal of body dissatisfaction, with 90% of women and 80% of men not liking what they see when they look in the mirror. But if body image dissatisfaction becomes normative in one’s early 20s, when and how does it develop? This entry examines the development of body image dissatisfaction, the impact and prevalence of body image dissatisfaction, and some of the specific factors that promote body image dissatisfaction during adolescence and early adulthood.

Developmental Trajectory of Body Image Body image is thought to be a subcomponent of the self. Thus, as young children begin to develop a sense of self as distinct from others, they also develop a perception of their own bodies. According to social comparison theory, humans learn about themselves by comparing themselves with others. Thus, our differences rather than our similarities with our peers may have a profound influence on our feelings about ourselves. Body image dissatisfaction appears to begin around 5 or 6 years of age for girls, as 60% of girls aged 5 to 10 years rate their ideal figure as significantly thinner than their current figure (only 17% want to be bigger than they currently are), regardless of their actual weight. As girls begin to become dissatisfied with their bodies, their desire to go on a weight loss diet increases. By 10 years of age, 80% of girls have already been on a weight loss diet. Boys are not immune to this pressure to meet a certain ideal. However, body dissatisfaction may manifest differently in boys, with 35% of 5- to 8-year-old boys wanting to be thinner and 35% wanting to be larger. This trajectory continues as children enter ­adolescence. For example, the timing of growth spurts in adolescence—whether one is “early” or “late” in aspects of physical development—is known to have an effect on body image. Similarly,

Body Image and Adolescence

the onset of puberty is known to affect body image s­ atisfaction. Thus, it is perhaps not surprising that females’ and males’ body dissatisfaction increases between middle and high school and continues to increase during the transition to young adulthood.

The Importance of Body Image in Psychosocial Development Not only is body image considered a key aspect of psychological adjustment in adolescence due to its relationship with adolescent self-esteem, but also body image is now thought to play an important role in adolescents’ identity development. This is believed to occur for two reasons: (1) humans learn about themselves in part from comparing themselves with others (social comparison theory) and (2) once a comparison is made and individuals decide that they are “lacking,” they will be motivated to “fix” the discrepancy between who they think they are (or look like) and what they wish they were (self-discrepancy theory).

Prevalence Rates of Body Image Dissatisfaction in Adolescence Although there are some inconsistencies in prevalence rates depending on the study and the way body image dissatisfaction is assessed, body image dissatisfaction appears to begin in the preteen years and increases over time. Although, as indicated above, body dissatisfaction may manifest slightly differently in boys and girls, with girls being more likely to report wanting to be thinner and boys reporting both wanting to be thinner and  wanting to be bigger than they are in equal numbers. By the time children reach adolescence, these gender differences in the way body dissatisfaction manifests are even more profound. While more than 80% of teenage girls want to be thinner, 70% of adolescent boys want to be more muscular. Even more interesting is the fact that nearly half the females and 10% of males classified as normal weight describe themselves as heavy. Thus, it is perhaps not surprising that half the teenage girls (age 14–18 years) have made serious efforts to lose weight, whereas only 20% of male adolescents have done so.

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Factors That Affect Body Image in Adolescence Parental Influence

Many teens report feeling pressure from parents to look a certain way. For example, teen boys who display the drive for muscularity often feel pressure from their parents to achieve this “muscular ideal.” Similarly, adolescent females who report maternal dieting and emphasis on appearance will often report more body dissatisfaction than their peers whose parents do not emphasize weight and appearance. Research suggests that the influence of same-sex parents may be even more powerful than the influence of opposite-sex parents. For example, girls’ level of body dissatisfaction tends to be more influenced by their mothers’ behaviors than their fathers’, whereas boys report the opposite pattern. Research also suggests that parents may have differential impact on the outcome of body dissatisfaction in teens, with mothers having a greater impact on dieting behaviors and fathers having a greater impact on exercise behaviors. Peer Influence

As children age, peers have an even more powerful influence than parents on adolescent body image. Most adolescents are preoccupied by what their peers think about them. Unlike parental influence, which is often more based on modeling parental behaviors than on parental comments on weight, peer influence appears to occur more often through direct appearance-related feedback than modeling, although modeling certainly occurs. Teasing

Many teens receive negative comments about their weight, especially if they are overweight. These comments then lead to a drive for thinness (a desire to be thinner than one actually is), a prevalent form of body dissatisfaction in female and male adolescents. Some research suggests that teasing has an even more harmful effect on males than on females. Body Mass Index

Numerous studies suggest that having a higher body mass index is related to body dissatisfaction

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in adolescents and that this factor may be an even greater risk for girls than for boys. Physical Activity and Dieting

If weight is correlated with body dissatisfaction, one might assume that doing something to lose weight (e.g., physical activity or dieting) might help decrease body dissatisfaction. That does not appear to be the case. Dieting is correlated with body dissatisfaction, but it does not seem to help improve body image. Physical activity displays mixed results, which may depend on ethnicity. For example, Hispanic girls are more likely to report that physical activity/exercise helps them feel good about their bodies than are White girls. Self-Esteem

Efforts to increase self-esteem appear to also increase body satisfaction. For some adolescents, physical activity may be one such way to increase self-esteem, as long as body image is not their motivation to be physically active. Other types of extracurricular activities appear to help improve self-esteem and body image as well. In fact, the total amount of time spent on extracurricular activities is a significant predictor of body image, regardless of the number or type of activities in which one is involved. Media

Today’s adolescents have grown up with media influence in a way previous generations did not experience. Be it magazines, television, video games, or the Internet, media exposure seems to matter when it comes to body image. For example, the more time female adolescents spend online, reading magazines, and watching television, the more likely they are to internalize the idea that they should be thin. Those who spend the most time online are also more likely to report frequent body surveillance (e.g., checking their body shape and size), low body image, and increased dieting. Furthermore, the type of media exposure may also matter, with some studies reporting more harmful effects from using popular online social sites (e.g., Myspace, Facebook) than from overall Internet exposure. Regardless

of the type of exposure (e.g., magazines, TV, Internet), the more time teens spend watching “idealized” images in the media, the more likely they are to report weight dissatisfaction, drive for thinness, internalizing the media’s ideal images, and objectifying themselves. Sexual Orientation

Similar to the finding in adults, homosexual male adolescents are more likely to report body dissatisfaction and weight loss behaviors (e.g., frequent dieting, binge eating and purging behaviors) than heterosexual male adolescents. On the other hand, homosexual female adolescents are less likely to report body dissatisfaction than heterosexual female adolescents. However, sexual orientation does not appear to be related to weight loss behaviors in adolescent females. Preventing Body Dissatisfaction in Adolescence

With body image dissatisfaction becoming an increasingly common and worrisome phenomenon, researchers are beginning to investigate ways to prevent body image dissatisfaction in children and adolescents. Results show promise but have been mixed. For example, interventions with the mothers of teenage girls have shown that mothers who receive a body image intervention put less pressure on their daughters to be thin. As a result, the daughters report lower levels of drive for thinness. However, such interventions do not appear to help with other types of body dissatisfaction. Other programs such as those that target the adolescents themselves rather than their parents have shown some promise. For example, programs that emphasize increasing physical activity while simultaneously teaching positive body image foster an increase in body image satisfaction. On the other hand, physical activity programs lacking the positive body image component tend to increase body dissatisfaction. Finally, programs that directly target body image issues in teens have also shown some promise. The awareness that these programs bring to body image issues alone seems to be beneficial to teen body image. Mary E. Pritchard

Body Image and Aging See also Body Dysmorphic Disorder and Gender; Body Image; Body Image Issues and Men; Body Image Issues and Women

Further Readings Corning, A. F., Gondoli, D. M., Bucchianeri, M. M., & Salafia, E. B. (2010). Preventing the development of body issues in adolescent girls through intervention with their mothers. Body Image, 7(4), 289–295. doi:10.1016/j.bodyim.2010.08.001 Daniels, E. A., & Gillen, M. M. (2015). Body image and identity: A call for new research. In K. C. McLean & M. Syed (Eds.), The Oxford handbook of identity development (pp. 406–422). New York, NY: Oxford University Press. Dion, J., Blackburn, M., Auclair, J., Laberge, L., Veillette, S., Gaudreault, M., & Touchette, É. (2015). Development and aetiology of body dissatisfaction in adolescent boys and girls. International Journal of Adolescence and Youth, 20(2), 151–166. doi:10.1080/ 02673843.2014.985320 Haibach, P. S., Reid, G., & Collier, D. H. (2011). Motor learning and development. Chicago, IL: Human Kinetics. McCabe, M. P., & Ricciardelli, L. A. (2003). Sociocultural influences on body image and body changes among adolescent boys and girls. Journal of Social Psychology, 143, 5–26. Neighbors, L. A., & Sobal, J. (2007). Prevalence and magnitude of body weight and shape dissatisfaction among university students. Eating Behaviors, 8, 429–439. doi:10.1016/j.eatbeh.2007.03.003 Neumark-Sztainer, D., Goeden, C., Story, M., & Wall, M. (2004). Associations between body satisfaction and physical activity in adolescents: Implications for programs aimed at preventing a broad spectrum of weight-related disorders. Eating Disorders: The Journal of Treatment & Prevention, 12(2), 125–137. doi:10.1080/10640260490444989 Ricciardelli, L. A., & McCabe, M. P. (2003). Sociocultural and individual influences on muscle gain and weight loss strategies among adolescent boys and girls. Psychology in the Schools, 40, 209–224.

Body Image

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Aging

Body image refers to the way in which people see themselves with regard to their bodies and the way

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they feel about their bodies. Body image can be either positive or negative. Positive body image means that the body is seen accurately and the individual is reasonably comfortable with his or her bodily appearance. People with negative body images have inaccurate perceptions of all or part of their bodies and struggle with uncomfortable feelings about them. At least within Western cultures, negative body image is related to eating disorders and other mental health problems. A person’s body image might be related to his or her physical appearance, though the two do not necessarily coincide. Additionally, body image appears to be related to images in the media, social pressures, cultural standards of beauty, family upbringing, age, and gender. Much of the research in this area has focused on adolescence and emerging adulthood (specifically among women) in relation to eating disorders and body image dissatisfaction, particularly among White people in the West. There is growing interest, however, in understanding how body image functions and relates to psychological well-being across the life span in diverse groups, particularly among older adults. This entry focuses on the emerging research in this area.

Body Image The psychological understanding of body image is still evolving, but there are a number of factors that have gained traction in the empirical literature regarding the development and maintenance of body image over time. Some examples are family dynamics, a biological predisposition toward a certain body type or weight category, mental illness, and the media. It is noteworthy that the “ideal body” differs across cultures. In the West, the ideal weight and size have diminished greatly in the past 100 or more years. In non-Western ­cultures, on the other hand, thinness is sometimes viewed as relatively unattractive. For example, among Punjabi Indians, fatness is seen as a ­positive; African Americans are generally more accepting of larger body sizes; some Middle Eastern cultures associate bigger bodies with womanliness and ­fertility; and some Chinese associate large body shapes with affluence and longevity. Body image is thought to be related to selfesteem and mental health. Theoretically, every individual has a body image, and it coincides to a

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greater or lesser degree with the person’s physical body. Especially in Western cultures, many individuals experience body image concerns, and these concerns are not predicated on having a particular body type: Both over- and underweight individuals can have body image concerns. Often, individuals with dissatisfaction about their body image will attempt to alter their physical shape in some way, whether via exercise, dieting, or cosmetic surgery. For some individuals, the shape of their physical body may not relate to their body image, while for others, the two are more concordant. There has been a prevailing sense in popular media that women in general, and young women in particular, are especially vulnerable to media depictions of ideal body types and are at highest risk for body image concerns. One of the reasons for this is that most body image research has not taken a life span approach, partly because of ageist beliefs that thinness and beauty are no longer important to older adult women.

Body Image and Psychopathology Although the data are inconsistent about the extent to which exposure to the media and sociocultural pressures to be thin affect body image and, subsequently, the development of eating disorder pathology, there is evidence to suggest that sociocultural factors such as the current standards of beauty increase vulnerability to eating disorders. Indeed, research shows that among women in ­professions in which there is a strong social pressure to be thin, such as ballet dancers, gymnasts, models, equestrians, and lawyers, to name just a few, there are higher rates of eating disorder pathology—these women are more likely to develop anorexia over the course of their working career than women in other professions. The link between media representations of ideal bodies and eating disorders has been considered to be established enough so that some governments, such as the government of Israel, have banned the appearance of clinically underweight individuals in television advertisements. The goal of this initiative is to prevent people exposed to the unhealthy images from seeing an underweight body as “ideal” and striving to emulate it through unhealthy means. In addition to the hypothesized link between body image and eating disorders like anorexia,

bulimia, and binge eating disorders, there have been some studies yielding results that negative body image can also lead to depression and anxiety. Because of some astonishingly high estimates of negative body image among people living in the United States (one survey in Psychology Today found that 56% of women and 40% of men were dissatisfied with the overall appearance of their bodies), it is increasingly important to investigate the correlates of body image across the life span as a possible protective factor against psychopathology of various types.

Measurement of Body Image Because there are currently more than 40 instruments being used in research to measure body image, it is difficult to make meaningful generalizations about the outcomes of these studies in relation to one another. This challenge is in addition to those already present with regard to trying to measure such an elusive concept, which may mean something different to each person. Broadly, however, measurement tools for investigating body image fall into three categories: (1) figure preferences, (2) self-report questionnaires, and (3) video projection techniques. Although these methods differ somewhat, they all involve asking participants to rate their subjective perceptions of various figures, either larger or smaller, in addition to how they feel their actual body compares with their ideal body. Some researchers have tried to introduce behavioral measures, such as measuring eye blink startle responses after viewing computer-manipulated images of the self as either slimmer or heavier, but for the most part, measurement techniques remain subjective and flawed. Indeed, all three techniques mentioned could potentially be biased by factors such as cultural expectations of body type, gender, and age. These challenges should be a focus of future measure development and hopefully lead to a more nuanced study and understanding of this construct across the life span.

The Aging Body As individuals age, the physical body undergoes many changes, and the impacts may have psychological ramifications as well. Certainly, in late life,

Body Image and Aging

one’s physical body is not the same as it was during middle age and younger adulthood, and the inevitability of this change may or may not coincide with an updated body image to match the new physical realities. This adaptation to the new physical realities of one’s body may be important for the development and maintenance of one’s healthy body image adjustment. Indeed, some research suggests that the biggest risk factor for older women in relation to the development of disordered eating in late life is a fear of aging and concerns about the effect of aging on physical appearance. It is possible that for those individuals who had a drive to be thin in their younger years, there will be greater body image dissatisfaction with age. Some researchers claim that culture is an important variable here, with older adults from cultures with more ageist values (particularly youth-obsessed Western cultures) having more body image concerns. There are likely many factors that are biological, psychological, and social that affect the degree to which individuals retain concern about maintaining an ideal body image in late life and how much acceptance an individual is able to have about the inevitable physical effects of aging on the body. Because there is a loss of a youthful body in addition to other loss experiences inevitable in late life, there may be an increased risk for depression, which is also associated with eating pathology in late life. The complex interplay of the physical and psychological effects of aging on the body, and subsequently on body image, is a continued focus of investigation in various subfields of psychology.

Body Image Dissatisfaction in Late Life Research on eating disorders in late life has been limited for a variety of reasons. There have been some ageist assumptions that older adults may be less concerned about their physical appearance than their younger counterparts due to the natural effects of aging on body shape, and diagnostic clarity has been difficult due to previous criteria in the Diagnostic and Statistical Manual of Mental ­Disorders, fourth edition, text revision (DSM-IV-TR) that listed a normal aspect of female aging as a symptom of anorexia (i.e., the absence of one’s menstrual period, or amenorrhea). Some researchers have

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stated that as women age, their physical bodies move farther from the social and media ideal of beauty, thus their body image dissatisfaction may increase as they age, and remain stably low in late life. Several studies have shown that middle-aged and older women report levels of body image dissatisfaction similar to that of younger women, suggesting that dissatisfaction with one’s body image may remain stable across the life span. For example, the results of a study on eating pathology in middle age suggested that the variables related to eating pathology in midlife were similar to those variables affecting eating pathology in younger individuals. Of these variables, body image dissatisfaction was a significant predictor of eating pathology in middle-aged women. Another study of women aged 66 years and older also indicated levels of body dissatisfaction akin to those of younger women. Although body dissatisfaction in itself does not mean an individual has or will develop an eating disorder, it is described as an important factor in the development and maintenance of eating ­disorders over time, in addition to other variables investigated in conjunction with body image in the literature on eating disorders across the life span— such as depression, perfectionism, and sociocultural pressures to be thin. Some research has failed to find a link between body image dissatisfaction and eating pathology in late life, although the ­levels of body image dissatisfaction were as high as in younger and middle-aged women. Thus, it is clear that the relationship between body image and eating disorders in late life merits continued exploration.

Gender, Body Image, and Aging Though much of the research on the body image throughout the life span has focused particularly on women, mostly due to the extent of media pressure on women’s bodies as well as the gender discrepancy in the incidence of eating disorders, there is increasing awareness that men too experience body image dissatisfaction. With amenorrhea having been removed from the DSM-5 criteria for anorexia, men across the life span (as well as older women) are now less excluded from study by diagnostic criteria than was the case with the DSM-IV-TR.

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Some life span research has shown that body image dissatisfaction for women tends to be stable and higher than it is for men, with older women in one study being significantly more likely to prefer line drawings of thinner individuals than were the older men in the same sample. Indeed, older men tend to report more positive body image overall, and less obsessive thoughts about thinness and weight, regardless of their own body mass index, than older women. It is possible, however, that body image for older men may include not only body shape but also perception of strength and other physical ­factors that are likely to change for men as they age. Expanding the definitions of body image in late life to include factors beyond beauty and thinness, which may apply more to aging women, may allow for increased awareness and a more nuanced understanding of how the experience of aging affects older men.

Future Directions Because body image research has only recently begun to consider how body image affects older adults as they age, and how it may differ in important ways or remain the same as body image earlier in the life span, there is still much to be explored. For example, it is possible that cultural factors in late life may differentially affect the body image of older adults. Also, a greater sense of meaning, and the developmental tasks associated with aging and illness, may affect body image in a different way from how it is affected in an earlier stage in life. All of these questions remain open to future research. Finally, much of the research that has been done in this area has focused on body image dissatisfaction and associated pathology in late life. It is vital to consider the possibility that with aging may come a sense of meaning and self-esteem less related to body image than may have been the case earlier in life. Regardless of individual differences in that area, it is worth considering how to promote positive body image in older adults, especially as the largest-growing segment of the U.S. population are older adults. Since a positive body image has been associated with greater psychological well-being and better mental health in earlier life stages, it is worth investing in both nuanced

measures of body image and the promotion of a positive body image in late life as well. Elizabeth Midlarsky and Ruth T. Morin See also Aging and Gender: Overview; Aging and Mental Health; Body Image Issues and Men; Body Image Issues and Women

Further Readings Berry, E. M., & Marcus, E. L. (2000). Disorders of eating in the elderly. Journal of Adult Development, 7(2), 87–99. Grabe, S., & Hyde, J. S. (2006). Ethnicity and body dissatisfaction among women in the United States: A meta-analysis. Psychological Bulletin, 132(4), 622–640. Keith, J. A., & Midlarsky, E. (2004). Anorexia nervosa in postmenopausal women: Clinical and empirical perspectives. Journal of Mental Health and Aging, 10(4), 287–299. Lewis, D. M., & Cachelin, F. M. (2001). Body image, body dissatisfaction, and eating attitudes in midlife and elderly women. Eating Disorders, 9, 29–39. Midlarsky, E., & Nitzburg, G. (2008). Eating disorders in middle-aged women. Journal of General Psychology, 135(4), 393–407. Tiggemann, M. (2004). Body image across the adult life span: Stability and change. Body Image, 1, 29–41. Tiggemann, M., & Lynch, J. E. (2001). Body image across the life span in adult women: The role of self-objectification. Developmental Psychology, 37, 243–253. Wiseman, C. V., Gray, J. J., Mosimann, J. E., & Ahrens, A. H. (1992). Cultural expectations of thinness in women. International Journal of Eating Disorders, 11(1), 85–89.

Body Image Issues

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Men

Social scientists are increasingly recognizing the importance of attending to issues of body image among men. Although early research on body image focused on body image disturbance as a problem endemic to women, in recent decades, there have been advancements in conceptualizations that incorporate gender-moderated manifestations of body image disturbance. This entry

Body Image Issues and Men

examines men’s body image, including an overview of different manifestations of body image concerns (i.e., thinness, muscularity, and leanness), body image and masculinities, body image and psychological health, and body image and behavioral health.

Thinness, Muscularity, and Tone Early literature on body image focused on the desire for thinness, typically assessed via ratings of silhouette figures that varied in body fat from very skinny to overweight or obese, and did not include varying levels of muscularity. Using this method, researchers typically found that women reported a desire to be thinner than they presently perceived themselves to be while men rated their ideal and current body types to be more similar. Early work focused on this as an indication that men experience little or no body image disturbance. Nevertheless, some men do experience elevated levels of a drive for thinness, though levels of the drive for thinness and prevalence rates of eating disorders such as anorexia are well below those for women. Although research on the drive for thinness and eating disorders such as anorexia has predominantly focused on women, some work has included men. This work has suggested that risk factors for the development of eating disorders may be similar across men and women, though interpretation of the research is hindered by the small numbers of men included in eating disorder research. Some research has indicated that gay and bisexual men may report, on average, higher levels of a drive for thinness than heterosexual men. Also, some work has suggested that eating disorders are more common in gay and bisexual men than in heterosexual men (though this interpretation is limited by the low sample sizes of men in studies of clinical samples of eating disorder patients). More recently, research has examined the drive for muscularity among men. In contrast to the drive for thinness, the drive for muscularity focuses on a desire to have more lean muscle mass. Men demonstrate markedly higher levels of the drive for muscularity compared with women, on average, and gay and bisexual men also appear to have higher average levels of the drive for muscularity compared with heterosexual men. Like body

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dysmorphia disorder, muscle dysmorphia has also recently been added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This disorder is characterized by pervasive beliefs that one’s body is insufficiently muscular, resulting in marked functional impairments (e.g., missing classes, work, or major life events due to exercising). Finally, recent research has also explored the drive for leanness—that is, a focus on muscle tone rather than thinness or bulky muscularity. Extant research on the drive for leanness suggests that it may be related to body monitoring, greater levels of exercise, and dieting among men. The drive for leanness has also been indicated to be related to, but distinct from, the drives for thinness and muscularity.

Muscularity Masculinity influences men and boys to think, feel, and behave in particular ways. One manifestation of masculinity is appearance. “Masculine” appearance is typified in a physical body that is strong, powerful, and dominant. However, as with messages pertaining to women’s body image, media presentations and cultural ideals of masculine body expectations have become more defined and less attainable. It is possible that for some men these images promote negative self-appraisals of the body and promote body image problems. The drive for muscularity is associated with masculinity and body image. The desire for increased muscle mass can either be a positive or a negative experience for men and boys. For example, the drive for muscularity may promote healthful eating behaviors and regular exercise. However, individuals may become preoccupied with the pursuit of muscularity to an unhealthy degree. Such unhealthful focus may promote unhealthful coping strategies such as excessive exercise or binge eating practices, or use and abuse of ­anabolic-androgenic steroids in an attempt to meet cultural and personal ideals of the masculine body form. One paradigm in the study of masculinity and the drive for muscularity focuses on social i­ nfluence. This paradigm suggests that body dissatisfaction, particularly in Western society, is influenced by the media. Research suggests that the mass media’s current portrayals of men promote a mesomorphic

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body ideal that is perceived as healthy. As a result, men and boys internalize this body image message and become more aware of their own bodies, potentially pressuring them to strive for greater muscle mass. Some research has elaborated on this  idea, proposing that individuals who highly value fitness may be less susceptible to body dissatisfaction. Peers, family, and the media may also encourage individuals to subscribe to cultural body ideals and engage in body comparisons. Men may be less likely to accept and appreciate their bodies when these influences pressure them to meet ideals for appearance that are difficult or, in the case of images that are digitally manipulated or “photoshopped,” literally impossible to achieve. Consequently, failing to achieve the ideal body shape may decrease self-esteem and increase dissatisfaction with body fat and muscularity. Because hegemonic masculinity emphasizes emotional control and the expression of anger, this lower self-esteem can be difficult to express for men. Some individuals may even experience alexithymia, a personality characteristic in which it is difficult to express and define emotions. Recently, research has begun to explore this suppression of emotions in relation to the masculine body image. Findings suggest that alexithymia may lead men to express themselves through weight training and exercise. As with the drive for muscularity, expression through exercise is not inherently problematic; however, such expression may also be associated with problematic coping strategies and negative health behaviors among some men. The majority of literature on the drive for muscularity has focused on samples of White, upperand middle-class, college-age men or on White gay men. It is possible that ethnicity and culture may affect the drive for muscularity. For example, some have suggested that in traditional Asian cultures, masculinity is primarily defined through intellectual dominance rather than physical strength and size.

Psychological Health Body image problems have been associated with myriad psychological health issues, including depression, lower self-esteem, social physique anxiety, and increased social comparison of one’s

body with others’ bodies. Such findings have been replicated among samples of adolescent boys, sexual minority men, and men from different ­ countries. A variety of theories have emerged to explain the association between body image disturbance and psychological health problems. The two primary models that have been explored in the empirical literature are (1) objectification theory and (2) the tripartite influence model. Objectification theory was originally developed to explain women’s body image disturbance as a result of sexual objectification. This model posits that social messages about how one should look become internalized, which leads to monitoring one’s body for adherence to those social messages. Because social messages about body ideals are challenging to meet, body monitoring inevitably results in failure to completely meet those social messages. This failure to meet social messages results in body shame or negative feelings for not having met social expectations. In research with women, the objectification process has been related to myriad psychological and behavioral health problems. Among men, some support has emerged for the model linking some variables to the drive for muscularity or anabolic steroid use. More support has emerged for the model predicting negative psychological variables among nonheterosexual men. The tripartite influence model emphasizes the importance of social messages from parents, peers, and the media in influencing body ideals. Support has been found for links between those variables as well as other social message sources (e.g., dating partners and for gay men, the gay community itself) to body dissatisfaction among samples of college students and gay men. Notably, although muscularity-related body image concerns are related to psychological health concerns, behavioral components of the drive for muscularity (e.g., regular exercise and healthful dietary practices) have been reliably associated with decreased depression, improved self-esteem, and overall better well-being. Indeed, in some studies, exercise alone has demonstrated effect sizes equivalent to psychotherapy and medication for the treatment of depression. It appears that an attitudinal focus on muscularity, or obsession with one’s body, is linked to negative psychological

Body Image Issues and Women

health outcomes, while actual fitness and exercise behaviors are linked to positive psychological outcomes.

Behavioral Health Body image problems among men and boys are associated with health issues. The literature has focused on health issues such as eating disorders, overtraining, and substance abuse. These risks are associated with various health issues, including cardiovascular disease, mood disorders, and sexually transmitted diseases. As previously mentioned, the tripartite influence model has been used to explore the ways in which body image ideals are experienced by both men and women. Peers, family, and the media influence individuals’ perceptions of their bodies and the type of bodies they believe should be maintained. Failing to meet the body ideal promoted by these influences can lead to body dissatisfaction. Research incorporating this model suggests that pressure from social influences and internalization of body ideals is linked to risky body change behaviors in men. Thus, men and boys may engage in unhealthy practices to attain the ideal that society has set for them. Recently literature focuses on the role of substance abuse in men and boys with body dissatisfaction. The pursuit of muscularity, in particular, has been examined, considering that individuals who desire more muscle are more likely to use, or contemplate use of, legal or illegal performanceenhancing substances. Research has found that adolescent boys who perceive themselves to be too thin are more likely to use anabolic-androgenic steroids. Furthermore, boys experiencing depressive symptoms and victimization because of their smaller body type are more likely to use steroids as well. There are numerous health issues that can result from abusing steroids, including cardiovascular disease and infection from sharing or reusing needles. Emerging research on gay and bisexual men suggests that they may be especially at risk of engaging in steroid use and other substance abuse. Because gay and bisexual men tend to report higher levels of muscularity-related body image dissatisfaction compared with heterosexual men, and because gay culture tends to view highly muscular bodies as masculine and desirable, gay

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and bisexual men may use steroids to appear more masculine. Another area of research that has been examined is overtraining to achieve the body ideal. Overtraining involves intense, extended exercise regimens that do not include sufficient recovery time. Such overtraining may result in serious injury and health complications, such as hormonal imbalance, extreme fatigue, injury, and poor athletic performance. However, men and boys who are overly fixated on attaining a highly muscular body may engage in overtraining in an attempt to attain more muscle mass. Mike C. Parent and Travis Brace See also Gay Male Identity Development; Gay Men; Gay Men and Health; Hegemonic Masculinity; Masculinities; Masculinity Gender Norms; Masculinity Ideology and Norms; Men’s Health; Men’s Issues: Overview; Men’s Studies

Further Readings Kanayama, G., & Pope, H. J. (2011). Gods, men, and muscle dysmorphia. Harvard Review of Psychiatry, 19(2), 95–98. doi:10.3109/10673229.2011.565250 Kane, G. D. (2010). Revisiting gay men’s body image issues: Exposing the fault lines. Review of General Psychology, 14, 311–317. doi:10.1037/a0020982 Murray, S. B., & Touyz, S. W. (2012). Masculinity, femininity and male body image: A recipe for future research. International Journal of Men’s Health, 11, 227–239. doi:10.3149/jmh.1103.227 Parent, M. C. (2013). Clinical considerations in etiology, assessment, and treatment of men’s muscularityfocused body image disturbance. Psychology of Men & Masculinity, 14, 88–100. doi:10.1037/a0025644 Parent, M. C., Schwartz, E. N., & Bradstreet, T. C. (2016). Men’s body image. In Y. J. Wong, S. R. Wester, Y. J. Wong, & S. R. Wester (Eds.), APA handbook of men and masculinities (pp. 591–614). Washington, DC: American Psychological Association. doi:10.1037/14594-027

Body Image Issues

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Women

Body image refers to one’s perceptions of and thoughts, attitudes, and feelings about one’s physical appearance. When there is a discrepancy

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between how one would like to look and how one feels one actually looks, strong negative thoughts and feelings result. Negative feelings about one’s physical appearance can be broadly defined as body image disturbance. This disturbance exists in varying degrees, but researchers have found that overwhelming numbers of girls and women experience body image dissatisfaction to some extent. Such dissatisfaction has been associated with depression, anxiety, low self-esteem, substance abuse, and eating disorders. In fact, the connection between eating disorders and body image disturbance has been extensively studied, with researchers concluding that body dissatisfaction is one of the most empirically supported risk factors for developing an eating disorder. It should be noted that body dissatisfaction tends to refer to dissatisfaction with one’s weight; in fact, body image as a global construct has become somewhat synonymous with a focus on the thin ideal. This is due to an overrepresentation of White girls and women (particularly college-age women) in body image research, which has in turn shaped the major measures of this construct. Since the early 2000s, there has been a growing recognition that not all cultural groups idealize a slender shape or low weight. However, racial and ethnic minority women still experience body image issues related to differing cultural body ideals and emphasis on other physical features (e.g., hair texture/ length or skin tone). This entry first reviews the role of the thin ideal in body image issues and presents a sociocultural model for the development of body dissatisfaction and eating-disordered behavior. Then, the entry explores different cultural ideals of beauty and the roles these play in body image disturbance among racially and culturally diverse groups.

The Thin Ideal During the 1980s, there was a noticeable increase in eating-disordered behavior (particularly bulimia nervosa) among women in the United States. Researchers questioned this phenomenon and quickly focused on the media, which had been depicting an ever-thinning ideal female body. This ideal, embodied by female actresses, television stars, and models, represented the thinnest 5% of women; therefore, it was an ideal that 95% of

women were not achieving. Large-scale studies that included girls as young as first graders through adult women supported an acknowledgment of this thin ideal and a desire to be thinner. Numbers as high as 75% of the total sample indicated a lack of satisfaction with their current weight and shape. Furthermore, the degrees to which women were striving for a thin ideal seemed to be related to and even predictive of dieting and exercise behaviors. Those on the most extreme end of the spectrum for dieting (i.e., fasting, severe calorie reductions), exercise, and other compensatory behaviors (i.e., self-induced vomiting to compensate for eating) represent those with eating disorders. However, a multitude of research supports the notion that many girls and women are dissatisfied with their current weight and shape, not just those suffering from a diagnosable eating disorder.

The Link Between the Thin Ideal and Eating Disorders The sociocultural model explains how exposure to the thin ideal can lead to the development of an eating disorder. This model speaks to the different internalization levels of the thin ideal among women. The more a woman wishes to look like the models and actresses she sees in the media, and the more she believes these women to represent ultimate attractiveness and success, the more she has internalized the thin ideal. The model suggests that the more a woman internalizes the thin ideal, the more likely she is to experience body dissatisfaction and negative feelings, which in turn make her more likely to engage in eating-disordered behaviors. The model has received extensive support among White girls and women. The model does not account for the reasons why girls and women are differentially affected by thin-ideal media representations. In other words, why do some women strive for this thin ideal more rigidly or intensely than others, even when faced with the same cultural ideal and media transmission? Researchers have postulated that those who adhere more strictly to traditional gender roles and embrace femininity are more vulnerable to thinideal internalization. These women tend to associate thinness with being more feminine and female appropriate and thus strive to meet a gender role ideal. Another factor implicated in this

Body Image Issues and Women

relationship is social sensitivity: Females who are excessively aware of and sensitive to the actions of others have been shown to internalize the thin ideal to a greater extent and to experience higher levels of body dissatisfaction. Furthermore, those with lower self-esteem, a greater tendency to compare themselves with others, and less familial support have also been shown to be more likely to internalize thin ideals. Racial-Cultural Groups

Some racially and ethnically diverse women do not subscribe to the thin ideal as a cultural beauty ideal. In fact, African American and Caribbean American girls and women consistently prefer a larger body shape and size than their White counterparts. This population is also consistently shown to have a more positive, healthier global body image than most other ethnic groups, due to a lack of focus on and interest in the thin ideal. When sociocultural models have been tested with an African American or Caribbean American population, the samples often endorse minimal, if any, internalization of the thin ideal, resulting in higher body satisfaction and lesser eating-disordered behaviors. The same findings have been shown for Latina groups. However, when studies include measures of racial identity (i.e., how much a person identifies with their racial and ethnic group) and acculturation (i.e., how much a person embraces the Western U.S. culture), racially and ethnically diverse women who are more closely aligned with White, Western culture internalize thin ideals and experience body dissatisfaction and eating disorders at similar rates as their White counterparts. Said differently, when the thin ideal is held as a personal ideal by a woman, regardless of her ethnic and cultural background, she is likely to be vulnerable to the deleterious effects of thin-ideal internalization.

Beyond the Thin Ideal: Cultural Standards of Beauty Women who do not internalize the thin ideal are not immune to negative feelings about their physical appearance. For many groups, appearance transcends weight and shape and

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includes attributes such as hair texture and length (e.g., African, Caribbean, and Asian Americans), skin color and tone (e.g., African, Caribbean, and Latina Americans), eye shape and size (Asian Americans), and height (Asian Americans). For these women, discrepancies between their ideal features and actual features results in dissatisfaction that has been linked to low selfesteem, injured self-concept, depression, anxiety, and eating-disordered behaviors. For example, it has been found that African American women who are less satisfied with their appearance (as measured by feelings about hair, skin, and body) are more likely to experience sadness and anxiety, which may result in overeating behavior. Overeating has been reported by African American, Latina, and low-income women to be a source of comfort and support and even as a mechanism to attract men who prefer largerbodied women. The larger-bodied ideal tends to be one that is as unattainable as the thin ideal. For example, African American and Latina girls and women describe the ideal body as one with large breasts, thighs, and backside but a toned stomach and small waist. This ideal can be seen depicted in African American and Latina models and actresses, the same way the thin ideal is depicted for White women. Social comparison theory suggests that people make comparisons with like others, and the less favorably they fare in these comparisons, the more negative mood states and subsequent body image disturbance they are likely to experience. Therefore, while some groups of racially and ethnically diverse women are unaffected by media depictions of the thin ideal, they are likely influenced by media that showcase their cultural beauty ideals. Very few studies have looked at the internalization levels of these particular ideals or their effect on mood states or subsequent eating behavior. However, the small body of work that does exist suggests that this larger body ideal has a similar effect as the thin ideal: Women use dangerous and potentially self-injurious methods to achieve it. For example, some Caribbean American groups consume “chicken pills” (a drug used to plump up farm chickens) to try and add fat to particular parts of the body, like the thighs or backside. This is an area that is in need of future research.

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LGBTQ Populations

Research looking at body image issues among LGBTQ populations is also in its nascent stages. Though there is a moderate amount of work that studies gay men’s body image, there are far fewer studies that explore lesbian, bisexual, queer, and transgender individuals’ experiences of their bodies. The findings that do exist are mixed, reflecting the diversity and complexity of this population’s lived experiences. For example, while some studies of lesbians show them to be highly critical of traditional gender roles, they have also been shown to endorse personal dissatisfaction with their weight and shape, indicating dieting behaviors and a desire to be thinner. Trans populations have been shown to be particularly vulnerable to body dissatisfaction and body image disturbance due to issues such as birth gender assignment and hormone management. Since the early 2000s, body image and eating disorder research has garnered increased attention. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) now includes binge eating disorder, which is an acknowledgment that overeating behaviors are as dangerous as food restrictions and compensatory behaviors. As the field opens its understanding of embodiment and broadens its horizons with regard to body image, a more diverse understanding of how all women experience their physical appearance will hopefully emerge. Christina M. Capodilupo See also Anorexia and Gender; Body Image; Body Objectification; Bulimia and Gender; Femininity; Gender Role Socialization; Media and Gender

race-ethnicity and gender in psychology (pp. 343–360). New York, NY: Springer. Cash, T. F., & Smolak, L. (Eds.). (2011). Body image: A handbook of science, practice, and prevention (2nd ed.). New York, NY: Guilford Press. Sukhanova, E., & Thomashoff, H.-O. (Eds.). (2015). Body image and identity in contemporary societies: Psychoanalytic, social, cultural, and aesthetic perspectives. New York. NY: Routledge/Taylor & Francis Group. Wolf, N. (2002). The beauty myth: How images of beauty are used against women. New York, NY: Perennial.

Body Modification Body modification refers to either a temporary or a permanent change made to one’s body via the intentional penetration of the skin. These alterations can be self-inflicted or done to one’s body by a third party. Types of body modifications include piercing, tattooing, scarring, stapling, suturing, branding, burning, pulling, stretching, and/or cutting of the skin. In more extreme forms of body modification, some individuals have objects implanted under their skin or have body parts surgically removed. The practice of body modification has existed for centuries across various cultures. Some scholars argue that modern Western practices of body modification are yet another example of cultural misappropriation of practices that were once part of sacred rituals and rites of passage. In the 21st century, motivations for engaging in body modification vary widely; this entry explores some of these motivations.

Motivations for Body Modification Further Readings Brown, H. (2015). Body of truth: How science, history, and culture drive our obsession with weight and what we can do about it. Boston, MA: Da Capo Press. Byrd, A., & Solomon, A. (Eds.). (2005). Naked: Black women bare all about their skin, hair, lips, hips, and other parts. New York. NY: Penguin Group. Capodilupo, C. M., & Forsyth, J. M. (2014). Consistently inconsistent: A review of the literature on eating disorders and body image among women of color. In M. Miville & A. Ferguson (Eds.), Handbook of

Relevant literature includes both pathologyfocused research on the relationships between body modification and risky sexual behaviors and non-pathology-focused research analyzing the motivations for and positive outcomes received as a result of engaging in such behaviors. Some individuals obtain tattoos, piercings, or brandings to achieve some cultural aesthetic beauty standard or to provide physical proof of their affiliation with a certain group, such as a fraternity, sorority, or gang. Such permanent body modifications act as a

Body Modification

symbol of trust or loyalty to another individual or a group of individuals. Others engage in such practices for shock value and to prove their commitment to pushing beyond societal appearance standards. Another motivation for such temporary or permanent alterations to the skin stem from religious or spiritual practices that help one achieve a sense of connection with nature and/or a supreme being or beings. In some religions and/or cultures, body modifications are done to the bodies of children and adolescents as a necessary rite of passage into adulthood. These practices include genital piercings and female genital cutting (FGC), also known as female genital mutilation (FGM). These practices, especially FGC or FGM, are very controversial and can result in very serious negative health consequences, including infection, infertility, and death. FGC or FGM can result in removal of parts or the whole of the clitoris, labia minora, labia majora, and other parts of the external female genitalia. Others are motivated to engage in such practices for both physical and psychological reasons, including sexual enhancement, pain, pleasure, and/ or the desire to be in control of one’s own corporal sensations. The latter are often discussed in terms of self-harm or self-injurious behaviors and are less commonly discussed within the literature in terms of sadomasochistic motivations. As the literature on body modifications is limited overall, self-harm and sadomasochistic motivations are often conflated, and it is difficult for scholars to differentiate between them. Researchers have more often focused on the less extreme forms of body modification and on finding correlations between piercings or tattoos and risky sexual behavior among young adults. Some of these researchers have also made attempts to determine the relationship between piercings or tattoos and religiosity among young adults. Although tattoos and piercings are not discussed in terms of psychopathological self-mutilation in most contemporary research, there is a strong research initiative to connect body modification with other risky behaviors, including earlier initiation of sexual intercourse, having multiple sexual partners, taking intravenous drugs, engaging in sexual activities without the use of a barrier method, and so on. While the motivations for such

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practices are explored in some of this research, little focus has been placed on the potential for pleasure in engaging in more extreme forms of these behaviors.

Extreme Body Modification Extreme body modification practices and emotional reactions to such practices are diverse. The literature on extreme body modifications is very limited. Within the practice of kink or BDSM (bondage/discipline, dominance/submission, and sadomasochism), practices of extreme body modification include, but are not limited to, the following: play piercing and skin pulling, branding, ­stapling, suturing, hook and suspension play, saline infusion, and scarification. Some BDSM practitioners believe that individuals can push past excruciating pain to experience ecstasy and a sensual rush as a result of sharp objects penetrating, cutting, and severely tugging at the skin. Many who practice such behaviors speak of the desire to cross the pain/pleasure threshold, as professed by Fakir Musafar through his “modern primitive” movement.

Fakir Musafar’s Modern Primitive Movement Beginning in the late 1970s, Musafar, the so-called father of modern primitivism, engaged in ancient Western and non-Western ritualistic practices of extreme body modifications, such as rolling on beds of thorns, constricting body parts with belts and corsets, piercings, and suspending with flesh hooks. Musafar’s modern primitive movement and its contemporary manifestations among adolescents and young adults in the United States helps followers become more in touch with their spiritual and sensual selves and to become reconnected with their ancient ancestors through both corporeal and spiritual extreme experiences. In this manner, body modification acts as a rite of passage and helps connect a person to his or her unique cultural experience. Musafar believes that only by engaging in such rites of passage can an individual feel a greater connection to humanity and those civilizations that have come before. Stephanie C. Chando and Eli R. Green

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See also Identity Formation in Adolescence; Self-Injury and Gender; Sex Culture

Further Readings Guéguen, N. (2012). Tattoos, piercings, and sexual activity. Social Behavior & Personality: An International Journal, 40(9), 1543–1547. Kosut, M. (2006, August). “Feels like flying”: Contemporary flesh hook suspension narratives. Paper presented at the annual meeting of the American Sociological Association, Montreal Convention Center, Montreal, Quebec, Canada. Retrieved from http:// www.allacademic.com/meta/p103516_index.html Myers, J. (1992). Nonmainstream body modification: Genital piercing, branding, burning, and cutting. Journal of Contemporary Ethnography, 21(3), 267–306. doi:10.1177/089124192021003001 Nowosielski, K., Sipiñski, A., Kuczerawy, I., KozłowskaRup, D., & Skrzypulec-Plinta, V. (2012). Tattoos, piercing, and sexual behaviors in young adults. Journal of Sexual Medicine, 9(9), 2307–2314. doi:10.1111/j.1743-6109.2012.02791.x Rivardo, M. G., & Keelan, C. M. (2010). Body modifications, sexual activity, and religious practices. Psychological Reports, 106(2), 467–474. doi:10.2466/ PR0.106.2.467-474 Skegg, K., Nada-Raja, S., Paul, C., & Skegg, D. (2007). Body piercing, personality, and sexual behavior. Archives of Sexual Behavior, 36(1), 47–54. doi:10.1007/s10508-006-9087-6

Body Objectification Body objectification is a terminology commonly used to describe the culturally sanctioned dehumanization of individuals into a fragmented assortment of sexualized body parts. This pervasive form of sexist oppression constitutes a harmful cultural practice that disproportionately targets and exacts its toll on women and girls. Sexual objectification manifests itself in myriad ways and is considered a prime socializing agent for acquisition of “the male gaze,” resulting in the virtually inevitable emergence of a bifurcated sense of self. This prevailing self-objectified lens results in girls and women internalizing a view of the self governed by an acute awareness of the value of one’s physical assets and a heightened sensitivity to how one

appears and is scrutinized as an object through the eyes of male spectators. The scope of the present entry is geared toward providing a concise overview of the key theoretical frameworks, psychosocial ramifications, and sociocultural influences of body objectification. This entry also examines the importance of adopting a developmental/life span perspective on body objectification; underscores the need for greater inclusion of multiculturalism and intersectionality in discussions on the topic; and considers some of the factors known to bolster inoculation against body objectification.

Theoretical Frameworks Feminist Philosophical Foundations

The late 20th century marked a pivotal turning point in transforming the collective consciousness regarding gendered conceptualizations of the body. Drawing on the earlier authoritative writings of women’s rights activists such as Mary Wollstonecraft and Simone de Beauvoir, leading U.S. feminist scholars (e.g., Sandra Lee Bartky, Susan Bordo, Martha Nussbaum, Carole Spitzack, and Naomi Wolf among others) challenged the deterministic and essentialist ideology that dominated the then current perspectives on how the male and female bodies were distinguished. These patriarchal frameworks tended to rely heavily on narrowly defined biological and evolution-based distinctions between the sexes that failed to acknowledge how the body is imbued with meaning properties as a social construction. Specifically, these authors persuasively argued that the female body has come to symbolize a sexualized commodity lacking autonomy and personal agency. Framing female body self-relations in this manner effectively strengthens sexist power differentials that primarily benefit the interests of (White) heterosexual men and corporate consumerism. Galvanized by this groundbreaking social critique, two teams of feminist psychologists independently developed synchronous conceptualizations outlining the psychosocial repercussions stemming from objectifying the female body. In 1996, Nita McKinley and Janet Hyde introduced the phrase objectified body consciousness (OBC) to capture the multidimensional nature of the adverse consequences arising from adherence to the thirdperson observer’s vantage point in experiencing

Body Objectification

the body (i.e., self-objectification). OBC is operationalized as encompassing the following three synergistic qualities: (1) self-surveillance, or becoming habitually preoccupied with monitoring the body and worrying over its appearance; (2) body shame, or endorsing the culturally normative belief that shame and low self-worth are ­natural outcomes of having failed to achieve the idealized albeit unrealistic (Eurocentric) standards of beauty (e.g., thinness) promulgated in the broader sociocultural milieu; and (3) appearance control, or holding persistent beliefs in one’s ability to modify one’s appearance given sufficient effort. In 1997, Barbara Fredrickson and Tomi-Ann Roberts put forth objectification theory, which highlights how for individuals inhabiting a female body, sexual objectification translates into increased mental health risks (e.g., eating disorders, depression, and sexual dysfunction) via the principal conduit of self-objectification and the cumulative impact of its cognitive-affective sequelae (e.g., body shame, anxiety—both appearance and safety related, a diminished capacity to experience peak motivational states such as flow alongside a disconnection from optimal interoceptive awareness). In turn, these complementary perspectives have been instrumental in spawning a tremendous growth in both scholarly and clinical interest in the topics of self- and sexual objectification since their inception. Contemporary System Justification Perspectives

Prominent social psychologist Rachel Calogero and colleagues are credited with advancing selfobjectification forward into 21st-century academic discourse surrounding its potential broader implications that transcend beyond contributing to ongoing gender disparities in certain psychological outcomes. Indeed, she and others have invited consideration of the value of integrating original objectification theory within the context of a system justification framework. This social justice stance asserts that members of marginalized groups may come to invest a great deal of energy in ironically upholding the status quo by subscribing to certain instilled, seemingly benign attitudes and behaving in ways that continue to legitimize their disadvantaged social position. As applied to this

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domain of gendered embodiment, experts reason that when elements reflecting the system of sexual objectification are made salient, a heightened motivational focus on appearance evaluation comes at the expense of undermining one’s competence and potential to act in collective resistance to sexism, thereby ultimately perpetuating gender-based oppression. Notably, a compelling body of observational and experimental research primarily conducted with predominantly White female college students provides preliminary support for these overarching premises. Specifically, studies have shown that encountering benevolent and complementary ­ sexist stereotypes amplified reports of self-surveillance, body shame, and appearance management solely for female participants. Comparable negative effects for women observing a subtle sexist act have also been documented. Finally, activating state self-objectification among female participants has been associated with reduced intention of engaging in gender-based social advocacy and greater support for the ­conventional gender hierarchy.

Psychosocial Consequences Objectification theory has positioned sexual objectification as the foremost cultural impetus for the downstream cascade of deleterious psychosocial ramifications inequitably burdening women and girls. These oppressive experiences may be understood as ambient forms of chronic gender-based stressors that are endemic to the overall social fabric. As such, they permeate a vast array of contexts occurring along a wide spectrum ranging from daily micro-aggressions (e.g., anticipating body evaluations, suggestive gazing at one’s breasts, catcalls, etc.) to unwanted advances, sexual harassment, and stalking, to the perpetration of violent sexual assault and sexual abuse victimization. Scholarly support for the direct and indirect pathways for women and girls’ increased mental health risk stemming from sexual objectification as outlined in objectification theory has been mounting. Scientists typically employ an experimental manipulation such as the classic sweater-swimsuit paradigm to situationally enhance participants’ experiences of state self-objectification. Such shifts in body-related self-consciousness alongside other

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predicted psychological consequences (e.g., increased body shame, worsened performance on cognitive tasks, etc.) have been demonstrated among ethnically diverse male and female participants. Survey-based observational designs have additionally been useful in either wholly or at least partially confirming the hypothesized associations in line with objectification theory, particularly in the domain of disordered eating for both genders and to a lesser extent for depressive symptoms and sexual functioning, mostly in college female samples. Emerging evidence also points to the negative impact of modern self-sexualization and related constructs on the authentic expression of sexual intimacy. Previous romantic partners’ pornography use has also been seen to influence young women’s current experience of body objectification and disordered eating. Scholarship additionally supports body objectification’s link to an even wider range of negative psychosocial implications, including in the realms of substance abuse, maladaptive exercise patterns, self-injurious behavior, sexual protective behaviors, and reproductive health. Although objectification theory has clearly garnered a considerable empirical base, there remain important gaps to address in subsequent research efforts (e.g., longitudinal designs, evaluations in culturally and age-diverse groups, etc.).

Tripartite Sociocultural Influences Several sociocultural factors are conducive to creating a toxic climate that condones and promotes the normalization of sexual objectification of the female body. The tripartite model has been advanced as an ecological framework for delineating the multidimensional factors that shape body self-relations. Accordingly, this model would suggest that uncovering the specific influences exerted by the media, family, and peers is paramount in striving to enhance the prediction of vulnerability to and resilience against the hazardous implications that coincide with living under the constant threat of being subjected to sexual objectification. The juggernaut that is mass media intrudes on all aspects of society and constitutes a leading source of acclimating individuals regardless of gender to the acceptability of (and social rewards arising from) treating the female body as a sex

object for men’s appraisal and gratification. Its unmitigated presence, also marked by the extended reach of modern social media, is deemed a prime contributor to the desensitization to the growing “pornification” of Western culture. This insidious phenomenon is marked by strategic efforts to conflate sex appeal with “objectified agency” in media images, such that women and girls are coaxed into believing that behaving in ways that exhibit selfsexualization and/or the enjoyment of being sexualized reflects personal choice and is a sign of empowered, healthy sexuality. Relatedly, the increased emphasis on the drive for muscularity and the resulting objectification among boys and men occur in tandem with shifts from more ­performance-driven to appearance-driven images in ­popular mainstream media outlets. Media representations of professional female athletes and others exemplifying the contemporary ideal of the fit-body aesthetic are also rife with mixed messages equating overt markers of physical strength with sexiness. The pregnant body is no longer protected, with media images frequently featuring models wearing form-fitting, belly-baring attire to convey health corresponding with thinness accompanied by a modest belly bump at this developmental transition. Even progressive female role models on popular children’s television programming combine agentic attributes and intellectual curiosity with the exaggerated phenotype of hyperfemininity (e.g., a large face with prominent eyes, a small nose, and a diminutive body). Children’s television entertainment has also been shown to frequently follow a gender stereotypical script involving greater objectification of female characters. Pioneering work conducted by communications scholar Jennifer Stevens Aubrey and others has revealed how exposure to sexualized media images holds adverse consequences aligned with objectification theory for members of both genders. For instance, among college women, selfobjectification was potentiated following viewing sexually objectified female artists in music videos and disrupted later cognitive processing of visual information in commercials. Additionally, increases in trait self-objectification occurred for  male and  female undergraduates in the year following exposure to sexualized television content. Importantly, analyses confirming the partial

Body Objectification

mediation of the links between sexually objectifying media consumption and negative body-related emotions via self-­surveillance were largely upheld for both male and female participants. While the far-reaching influence of the media has been extensively studied in the context of sexual objectification and its effects, the roles of family and peers are decidedly less well developed. Limited research does nevertheless suggest that in the family domain maternal modeling and paternal attachment, in conjunction with the critical and coercive messages about regulating eating and weight communicated by caregivers, may be implicated in socializing girls and young women in particular to self-objectify. Preliminary evidence has also identified sorority membership as a potential risk factor for emerging adult women to engage in self-surveillance and to experience body shame. Finally, attending middle school with older peers was linked to greater body surveillance and shame for female students relative to their counterparts matriculating in a junior high school environment.

Developmental and Life Span Perspectives Objectification theory originally posited that variability in the female experiences of sexualization and self-objectification may track according to the particular life tasks prioritized at different developmental phases across the life span. For instance, at its earliest stage, scholars contend that modeling may be one developmental process by which sexualization influences young girls’ identities and perceptions of what society considers appropriate ways of engaging in intimate relationships. Girls are not expected to be sexual; rather, they are taught to objectify their bodily appearance (e.g., with training bras and makeup kits) in preparation for the male gaze when they grow older. In preschool, sexualization may begin as an emphasis on attractiveness. Grade school girls demonstrate a preference for provocatively dressed dolls, report a sexualized view of self-ideals, link sexiness with popularity, and exhibit overly mature, appearancedriven behaviors (e.g., wearing high heels and nail polish) that would be expected among adolescent girls. Pubertal timing may confer additional vulnerability for some young women during early adolescence. For example, earlier-developing girls

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may experience greater unwanted attention and pressure to be sexually available imposed on them by their male peers, thereby potentially accelerating the self-objectification process and accentuating risk for its psychosocial consequences. Late adolescence through young adulthood is marked as a critical period for heightened sexualization and its repercussions, corresponding to developmental motives to secure long-term romantic relationships and the socioeconomic advantages afforded by them, whereas women with declining reproductive potential begin to deviate increasingly from the youthful ideal and consequently may have distinct experiences with and differing levels of objectification relative to younger women. Fredrickson and Roberts suggest that objectification in older women may be experienced as receiving evaluative, critical messages from significant others; yet these messages are likely to contain fewer sexualized statements. Thus, sexualization and self-objectification may decrease over time. Despite the perpetual onslaught of cultural messages equating youth with health and attractiveness, not all women experience shame about and aversion toward the aging process. Middle adulthood in particular may be an opportune time for women to realize and embrace new ambitions and to renew their personal and spiritual motivations toward achieving life goals that are unrelated to appearance concerns. Although it is not conclusive, research conducted by Marika Tiggemann, Nita McKinley, and others appears to support these theorized claims, such that the experience and psychological consequences stemming from self-objectification are often less potent among women possessing a greater maturational age. Yet the primarily crosssectional evidence is limited by an almost exclusive focus on the reports of North American and Australian women of European descent. Additional longitudinal work is needed to continue to advance this line of research in order to uncover the possible presence of not only age but also potentially generational cohort effects.

Diversity Considerations Black feminist scholarship has been influential in further refining the understanding of how the intersectional oppression experienced by women

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of color along racist, sexist, and classist lines can compound the impact of their experience of sexualization. The vestiges of slavery have contributed to the propagation of derogatory stereotypes regarding the Black female body as one that is hypersexual, perpetually “in heat,” and sexually receptive. In line with this degrading representation, perhaps as a consequence of internalized racism and sexism (e.g., Black men stereotyped as exuding hypermasculinity, emanating a “hypersexual/predatory gaze”), even media targeting Black audiences are not immune to portraying Black women as overtly sexual and frequently embodying the exaggerated curvy-thin ideal. In step with this trend are the appearancepotent media depictions of the highly sexually objectified images of men found in gay subculture magazines, while other research suggests that images contained in print media directed at lesbian women may portray less sexually objectified content relative to the portrayal of female models in more mainstream women’s magazines. Collectively, these patterns of objectified media representations would suggest that Black women and gay men (targets of the “hypersexual male gaze”) are perhaps most vulnerable to experiencing sexual objectification and its noxious effects. Nevertheless, emerging research comparing members of culturally diverse groups on both the components of as well as the predictive relationships consistent with the principles of objectification theory’s original model has provided mixed support for this assumption. For example, Black women have reported greater sexual objectification and personal safety–related anxiety than their White counterparts. Yet predictive models featuring various forms of psychological dysfunction as key criterion variables have shown comparable relevance for explaining the experience of women representing both racial/ethnic groups, while others have failed to detect racial/ethnic differences in the cognitive-affective effects consequent to situationally augmented experiences of self-objectification. Other studies have yielded contradictory findings for gay relative to heterosexual men. For instance, gay (vs. heterosexual) men have been shown to report higher levels of self-objectification and body shame, the latter of which mediated self-surveillance on disordered eating behavior for the sexual minority

men. Conversely, sexual objectification was found to predict body shame among heterosexual but not gay men. Research has additionally revealed both shared and distinct experiential profiles in this context when comparing the reports of lesbian versus heterosexual women. Both sexual minority women and their heterosexual peers tended to endorse comparable levels of sexual objectification and body shame, yet lesbian women were more likely to subscribe to engaging in less disordered eating and, in some cases, greater self-surveillance. Contrary to reports of heterosexual women, the links between sexual objectification and both selfsurveillance and body shame have not consistently emerged for lesbian participants. Yet in other work, forms of objectification have directly predicted body shame, which itself has accounted for variability in disordered eating among lesbians. Measures of self-objectification have also inconsistently directly influenced reports of disordered eating in lesbian samples. Moreover, research remains to establish the indirect effects of sexual objectification and self-surveillance on dysfunctional eating attitudes via body shame for members of this sexual minority group. Leading multicultural feminist psychologist Bonnie Moradi and others have advocated the utility of integrating minority stress theory within the broader framework of objectification theory. Sensitivity to inclusion of experiences unique to the minority experience of self- and sexual objectification has been fruitful in enhancing the predictive value of extensions of objectification theory for Deaf women (e.g., marginal Deaf identity attitudes), Black women (e.g., skin tone surveillance), bisexual women (e.g., anti-bisexual discrimination stress, internalized biphobia), and Korean women (e.g., face size and shape surveillance). Nonetheless, despite these promising developments, ­additional work is needed to further clarify the applicability of objectification theory in the context of marginalization-related stress for other underrepresented, stigmatized groups (e.g., women with other forms of disability, overweight/obese women, and transgender individuals). For example, these efforts may offer particularly unique opportunities to discover how transitioning from male to female or from female to male could

Borderline Personality Disorder and Gender

differentially shape shifts in the experience of selfobjectification and its psychosocial repercussions.

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See also Benevolent Sexism; Body Image; Feminist Psychology; Gender Socialization in Women; Social Media and Gender

Protection and Resistance Counteracting the systemic and culturally entrenched nature of body objectification to circumvent its pernicious effects will require a multipronged ecological approach. At the individual level, cultivating a critical feminist consciousness in conjunction with a contextual filter and engaging in forms of positive embodiment that nurture appreciation of the body’s functionality versus appearance may hold promise in inoculating girls and women against self-objectification. Within the family and school settings, caregivers and teachers may help girls prioritize strengths and assets that are not appearance related. Parents’ level of engagement in moderating media consumption also seems vital. At the larger systems level, women and men can be encouraged to work collectively to advocate for policies that incorporate greater media literacy and gender equity in a way that frames these changes as more consistent with deeply held cultural values whereas maintaining the status quo would instead threaten those values.

Research Directions A wealth of scholarship confirms the value of objectification theory, and a novel integration with a systems justification framework appears promising in this context. Nevertheless, among the avenues suggested for additional theoretical advancement in the domain of body objectification is continuing to clarify its psychophysiological impact within a chronic stress framework. Pursuing this comple­ mentary route would expand the repertoire of typical psychological and social criterion variables to also include biological markers of stress reactivity, inflammation, and immune function. Additionally, the need for more cross-cultural comparisons that incorporate greater qualitative and mixed-methods designs in this arena appears warranted. Finally, religion and spirituality are two integral cultural entities whose potential protective value in defusing and/or averting the unfavorable effects of body objectification merit further scholarly evaluation. Jennifer B. Webb and Nadia Jafari

Further Readings Calogero, R. M. (2013). On objects and actions: Situating self-objectification in a system justification context. In S. J. Gervais (Ed.), Objectification and dehumanization (pp. 97–126). New York, NY: Springer. Calogero, R. M., Tantleff-Dunn, S., & Thompson, J. K. (2011). Self-objectification in women: Causes, consequences, and counteractions. Washington, DC: American Psychological Association. Fredrickson, B. L., & Roberts, T. (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173–206. McKinley, N. M., & Hyde, J. S. (1996). The Objectified Body Consciousness Scale: Development and validation. Psychology of Women Quarterly, 20, 181–215. Moradi, B. (2010). Addressing gender and cultural diversity in body image: Objectification theory as a framework for integrating theories and grounding research. Sex Roles, 63, 138–148. Moradi, B., & Huang, Y. P. (2008). Objectification theory and psychology of women: A decade of advances and future directions. Psychology of Women Quarterly, 32, 377–398.

Borderline Personality Disorder and Gender Borderline personality disorder (BPD) is a severe psychiatric disorder marked by dysfunction across cognitive, affective, behavioral, and interpersonal domains. Individuals with BPD are disproportionately represented in inpatient psychiatric settings, and it has been estimated that nearly 10% complete suicide. Since its introduction in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), BPD has often been reported to have a prevalence in females, leading to a heightened empirical focus in women. This entry reviews theoretical perspectives and empirical evidence concerning the relation between gender and BPD with regard to prevalence, comorbidity,

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presentation, etiology, and gender bias. The entry concludes with a discussion of future directions for research.

Prevalence The fifth edition of the DSM (DSM-5) reports a female-to-male BPD diagnosis ratio of 3:1. However, epidemiological studies have reported mixed findings regarding gender differences in the prevalence rates of BPD. For instance, data from the National Epidemiologic Survey on Alcohol and Related Conditions study, one of the largest epidemiological studies conducted in the United States, show no gender difference in BPD rates (around 6% for both genders). A second report based on these data, however, revised the diagnostic algorithm to require that personality disorder (PD) criteria were associated with distress/impairment and reported that BPD was significantly more prevalent among women (3.02%) than among men (2.44%). Outside the United States, a study conducted with a Norwegian community sample found that BPD was two times more common among women than among men. In the United Kingdom, BPD (and all other PDs) was more prevalent among men (1.0%) than among women (0.2%). In adolescents, a report published on the Avon Longitudinal Study of Parents and Children, a population-based sample of English children aged between 11 and 12 years, found a trend toward higher prevalence of BPD in girls versus boys, though this difference was not statistically significant. Among clinical samples, a meta-analysis conducted in 1986 found that, compared with controls, BPD patients tended to be younger and were more likely to be White and female. Studies conducted more recently have been less conclusive. For example, a study conducted using data from the Collective Longitudinal Personality Disorders Study, a prospective examination of PDs in treatment-seeking adults, found that women (72.92%) represented a higher proportion of BPD diagnoses than men (27.08%). Among inpatients, a few studies have found no gender differences in BPD prevalence rates, whereas one study found a 3:1 female-to-male ratio of BPD diagnosis in White and Black, but not Hispanic, inpatients. Within adolescent clinical samples, several studies

have consistently reported higher rates of BPD in girls than in boys. Differences in methodology, including sample type and assessment approach, likely contribute to the mixed findings regarding gender differences in rates of BPD. For example, treatment-seeking behavior is associated with the female gender, which may account for the higher percentage of women with BPD in clinical settings. Whether interview or self-report measures are used also may influence the prevalence rates. Nonetheless, findings on gender difference in BPD prevalence rates do not follow consistent patterns, suggesting the need for additional research.

Gender-Based Comorbidity and Presentation Research on BPD comorbidity suggests that men with BPD are more likely to exhibit externalizing behaviors and women with BPD are more likely to exhibit internalizing behaviors. Consistent with this, several studies have shown that men with BPD are more likely than women to be diagnosed with substance use disorders and antisocial PD. In addition, studies report higher rates of narcissistic PD in men with BPD compared with women. Disorders with some (but minimal) evidence for heightened prevalence in men with BPD include intermittent explosive disorder and paranoid, passive-aggressive, avoidant, depressive, sadistic, and schizotypal PDs. With regard to comorbidity in women, the majority of evidence suggests that posttraumatic stress disorder and eating disorders are more prevalent in women with BPD. One study found higher rates of obsessive-compulsive PD in women than in men with BPD. In terms of gender differences in presen­tation, the Collaborative Longitudinal Personality Disorders Study found that women were more likely than men to have identity disturbance, though no gender differences in trait, temperament, or level of functioning were found. In adolescent samples, findings suggest gender differences in the expression of BPD such that boys are more likely to display externalizing, disinhibited, angry, destructive, and impulsive behaviors and girls are more likely to have internalizing behaviors, mood reactivity, abandonment fears, and unstable ­ relationships.

Borderline Personality Disorder and Gender

Gender-Related Etiology BPD is thought to arise from complex transactions between biological and socio-environmental factors. It has been proposed that a child with an emotionally vulnerable temperament is at risk of developing BPD when reared in an environment that neglects, negates, or dismisses the emotional experiences and/or expressions of the child. Etiological theories have traditionally empha­ sized factors that may predispose females, in particular, to develop BPD. For example, genderspecific parenting has been proposed as elevating the risk of developing BPD in girls. It has been suggested that when fathers are unavailable or ­ uninvolved, the separation-individuation process is impaired. This is thought to occur more frequently in the parenting of daughters, based on the assumption that fathers bond more easily with their sons than with their daughters. Gender-specific social expectations are also thought to predispose girls to develop BPD. Scholars argue that girls are often encouraged to value others’ needs above their own and to be emotionally sensitive and expressive. It has been argued that these expectations are at odds with society’s tendency to pathologize expressed emotionality. These messages are thought to impose a conflictual notion of womanhood and impede the individuation process, thus instigating the disturbances in identity believed to underlie much of BPD symptomology. Other factors include gender differences in what is considered normal behavior. For example, behaviors like anger, argumentativeness, and impulsivity may be more acceptable or even desired in men but are considered indicative of a BPD diagnosis in women. Beyond the theorized gender-specific develop­ mental risk factors for BPD, child abuse is thought to place girls at greater risk of developing the disorder. Indeed, there is a correlation between ­ child abuse, particularly sexual abuse, and the development of BPD, although this relation is ­complex. Epidemiological studies reveal that sexual abuse is 10 times more common in females than in males. Within BPD samples specifically, some studies show higher rates of childhood sexual abuse in women than in men. Other studies, however, do not find gender differences in sexual abuse, physical abuse, or witnessing of abuse.

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In addition, gender differences in personality traits have been suggested to underlie the gender differences in the risk of developing BPD. Studies show that women tend to score higher on ­neuroticism than men, particularly with regard to facets of vulnerability, impulsiveness, anxiety, self-­consciousness, and depression, thus increasing the likelihood that they will possess the ­temperamental vulnerabilities implicated in BPD development.

Gender Bias The possibility that the BPD diagnosis is biased with regard to gender is controversial and has sparked considerable debate, leading to a delineation of the various sources and types of gender bias. These include etiological bias, which could include gender differences in child rearing, social opportunities, or occurrence of trauma. Sampling bias occurs when one gender is more likely to be studied in specific research settings (e.g., clinical or community). Finally, diagnostic bias occurs when false-positive or -negative diagnoses are differentially related to gender, occurring at the level of the criteria, the measure, and/or the diagnostician. Several studies on this topic have used fictional case study designs to investigate whether a clinician’s decision to apply a BPD diagnosis is unduly influenced by the gender of the case. Findings from the majority of these studies reveal that clinicians were more likely to diagnose BPD in women than in men. More specifically, in three separate studies, clinicians rated female cases higher than male cases for applicability of a BPD diagnosis. In one of these studies, clinicians tended to misapply a diagnosis of BPD to women instead of the actual diagnosis of antisocial PD. Clinicianlevel factors like age and experience influence biased diagnosing, though little evidence exists for an interaction between clinician gender and case gender. Still, other studies show no evidence of gender bias in clinician diagnosing. For example, one study found no significant relation between diagnosis of BPD and the gender of the case. Another study found that clinicians were more likely to apply the BPD diagnosis to a gender ­neutral case. Some researchers modified the case design and used psychology students in place of clinicians. In one such study, results showed that

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the participants rated fictional PD cases in accordance with known gender base rates. When the association was consistent with social stereotypes, case gender strongly influenced the diagnoses. However, researchers have argued that the aforementioned findings provide evidence of biased clinicians—not biased measures or criteria. To support or reject an argument for the latter, researchers have applied advanced statistical approaches, including item response theory (IRT). One IRT-based study in a nonclinical sample found no evidence for criterion- or disorder-level gender bias in the Structured Interview for DSM-IV Personality. Another IRT-based study in adult inpatients found that anger and impulsivity items were more easily endorsed by men than by women and that, at the level of the test, men were expected to have higher ratings than women at the same level of BPD latent liability. In adolescents, an IRT-based analysis using the Avon Longitudinal Study of Parents and Children sample found that certain DSM-IV BPD criteria functioned differently across gender. More specifically, at the same level of latent liability, boys were more easily rated than girls as exhibiting symptoms of impulsivity, anger, and suicidal behavior. In addition, relative to boys, girls were more likely to be rated as having abandonment fears at lower levels of the underlying trait. Other studies have used measurement invariance approaches. In a large Norwegian twin sample, confirmatory factor analysis revealed that women exhibited higher true levels of BPD compared with men and that BPD criteria were variant across gender, such that affective instability was reported less frequently in men. In addition, impulsivity was gender and age variant, with males reporting more impulsivity than females, and this difference increased with age. Finally, one study using the Diagnostic Interview of DSM-IV Personality Disorders found that of all the PD criteria, BPD criteria displayed the largest functional disparity between men and women. Women manifesting a particular level of a criterion tended to function better than a man manifesting the same level of that criterion, suggesting that BPD criteria may underestimate the level of global functioning in women as compared with men.

Future Directions To meaningfully advance our understanding of the relation between BPD and gender, several directions for future research are suggested. First, valid and reliable assessment is crucial. Multimethod assessment including multiple interview-based and self-report measures, family reports, histories, and clinical observation is the gold standard. Second, caution must be applied when comparing BPD diagnoses across gender, given that findings seem to differ based on the type of assessment, sample, and statistical approaches applied. Third, findings from measurement invariance and IRT studies suggest that current diagnostic assessments and criteria may not adequately capture the way in which BPD is experienced and presented across males and females, and thus a greater focus on using advanced statistical approaches to refine extant measures is needed. Fourth, BPD scholars have more recently argued for the need to better understand BPD in men. Citing gender differences in the experience and expression of distress, it has been suggested that men are more likely to be treated for substance abuse or antisocial PD, or to be imprisoned than to be treated for BPD. Furthermore, given that men are less likely to seek help than women, many men with BPD likely go untreated. Thus, an increased empirical focus on understanding how BPD develops and presents in men is needed. Finally, it has been argued that if BPD prevalence truly differs by gender, then prospective longitudinal studies should be employed to examine the differential role of biological and environmental etiological factors across gender in the development of this disorder. Allison Kalpakci and Carla Sharp See also Antisocial Personality Disorder and Gender; Gender Bias in Research; Gender Bias in the DSM

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: Author. Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., . . . Ruan, W. J. (2008).

Brain Lateralization Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69(4), 533–545. Johnson, D. M., Shea, M. T., Yen, S., Battle, C. L., Zlotnick, C., Sanislow, C. A., . . . Zanarini, M. C. (2003). Gender differences in borderline personality disorder: Findings from the Collaborative Longitudinal Personality Disorders Study. Comprehensive Psychiatry, 44(4), 284–292. Sharp, C., Michonski, J., Steinberg, L., Fowler, J. C., Frueh, B. C., & Oldham, J. M. (2014). An investigation of differential item functioning across gender of BPD criteria. Journal of Abnormal Psychology, 123(1), 231–236. Widiger, T. A., & Spitzer, R. L. (1991). Sex bias in the diagnosis of personality disorders: Conceptual and methodological issues. Clinical Psychology Review, 11(1), 1–22.

Brain Lateralization Brain lateralization refers to the degree to which the brain is divided into right and left halves, each of which has specific anatomical structures and, in turn, functions. Since the 1800s, scientists have studied how the two halves, or cerebral hemispheres, of the brain are different from one another, as well as how they work together to carry out tasks. While individuals’ brains have the same contents and organization overall, each person’s exact brain lateralization is unique. Sex and sexual orientation have been shown to be factors affecting lateralization. This entry discusses the mechanics of brain lateralization, including hemispheric asymmetry and connectivity, and details how sex, gender, and sexual orientation may affect brain lateralization.

Hemispheric Asymmetry The right and left hemispheres are divided by the medial longitudinal fissure, a large indentation that causes the hemispheres to have their separate, mirrored appearance. The medial longitudinal fissure is also a surface marker of the corpus callosum, the large body of nerve fibers that

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connects the two hemispheres. The corpus callosum is located within the brain and is the largest body of commissural fibers in the brain. Commissural fibers are made of white matter and establish connections between the two hemispheres, with the corpus callosum being the largest of these fiber tracts.

Hemispheric Connectivity The corpus callosum allows information to pass interchangeably between the right and left hemispheres through a series of electrical currents. Because of how the human brain is organized, each hemisphere contributes unique functions to the interchange of information. Hemispheric asymmetry is the term used to describe the lateralization of cognitive functions in the brain. Although views of the unique contributions of each hemisphere have varied, there are some general findings that have maintained agreement over time. For example, the left hemisphere is largely responsible for processing the sequential analysis of language and other cognitive information, such as how letters are arranged into words and words into sentences. The left hemisphere is also associated with listening to and comprehending spoken speech. On the other hand, the right hemisphere is responsible for processing of visuospatial information, such as where objects are located in relation to the self. The right hemisphere is also responsible for the processing of emotional facial expressions and other emotionrelated stimuli. Another unique characteristic of the corpus callosum is that it enables contralateral control. Contralateral control refers to the fact that the left hemisphere controls functions on the right side of the body and the right hemisphere controls functions on the left side of the body. For example, sound that is heard in the right ear is processed by the left hemisphere, and vice versa. The motor functions of the right side of the body are controlled in part by the left hemisphere, and vice versa. Contralateral control is also present in the visual fields; things seen in the left visual field are processed by the right hemisphere, and vice versa. Information is able to be passed between the opposite sides largely because of the corpus callosum and other white matter tracts.

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Breastfeeding

Sex and Gender Differences in Brain Lateralization Individual differences such as handedness, creativity, and other factors have been investigated as ways people’s brain lateralization may differ. Sex and gender of individuals have also been investigated in relation to brain lateralization. Male and female brains are more alike than different, overall. However, there is some debate regarding patterns in lateralization and functions of the two hemispheres in men versus women. Some studies have found that men’s brains tend to be more ­lateralized than women’s. This means that c­ ognitive functions are usually carried out by whichever hemisphere is responsible for that particular function for men, whereas women’s brains have been shown to have greater degrees of interhemispheric communication when carrying out a function (also known as bilateral activation). However, other studies have found that only some functions are more lateralized for men than for women, such as some left hemisphere language regions. Further evidence, although contested, has been provided by studies showing that women may have larger corpora callosa on average than men. Interestingly, there is some evidence that brain-based diseases and disorders related to disrupted lateralization, such as autism, may be more prevalent in men than in women due to men’s brains being more lateralized. When considering the effects of sex on lateralization, the brains of both heterosexual and homosexual individuals may also differ in notable ways. Some studies have found that homosexual men and heterosexual women have more similar structural and functional brain characteristics, and a similar trend has been found between homosexual women and heterosexual men, including findings regarding hemispheric connectivity and the corpus callosum. Such findings indicate how differences in the degree of hormone exposure in utero may translate into both physical and social sex identification. As theory and technology develop in the future, more informed views of the relationships between sex, gender, sexual orientation, and brain lateralization will undoubtedly emerge. Rachel H. Messer

See also Biological Sex and Cognitive Development; Biological Sex and Language and Communication; Biological Sex and the Brain; Biological Theories of Gender Development; Biopsychology; Developmental and Biological Processes: Overview; Evolutionary Sex Differences; Fetal Sex Selection

Further Readings Bryden, M. (2012). Laterality: Functional asymmetry in the intact brain. Amsterdam, Netherlands: Elsevier. Levy, J. (1971). Lateral specialization of the human brain: Behavioral manifestations and possible evolutionary basis. In J. A. Kiger Jr. (Ed.), The biology of behavior (pp. 159–180). Corvallis: Oregon State University Press. Molfese, D. L., & Segalowitz, S. J. (1988). Brain lateralization in children: Developmental implications. New York, NY: Guilford Press. Sommer, I. E. C. (2010). Sex differences in handedness, brain asymmetry, and language lateralization. In K. Hugdal & R. Vesterhausen (Eds.), The two halves of the brain: Information processing in the cerebral hemispheres (pp. 87–312). Cambridge: MIT Press.

Breastfeeding The practice of feeding an infant and young child with human breast milk is highly encouraged by health professionals due to the multitude of health benefits conveyed to both infants and mothers through breastfeeding. These benefits include lower rates of ear and intestinal infections in infants and reduced cancer rates in women. However, beyond the health implications, breastfeeding is also a psychological and societal issue. Much debate has arisen, for example, regarding mothers’ perceptions of undue pressures to breast-feed and inadequate support for breastfeeding in the workplace and in public. Furthermore, breastfeeding is also a matter that intersects with gender, as men and women vary in their attitudes, knowledge, and support of breastfeeding. The present entry provides a brief overview of characteristics associated with breastfeeding initiation and duration, the role of men in supporting breastfeeding, and constraints on breastfeeding in the workplace and in public.

Breastfeeding

Characteristics Associated With Breastfeeding Although recommendations for breastfeeding duration include 6 months of exclusive breastfeeding and from 12 to 24 months in total, actual rates of breastfeeding often lag far behind. Among mothers in North America, rates of breastfeeding initiation are high (approximately 75%), but weaning before the recommended 6 or 12 months is quite common. Furthermore, these rates vary by race/ethnicity, with African American mothers being the least likely to breast-feed and White and Latina mothers being the most likely to use this form of feeding. In terms of class differences, women from wealthier backgrounds have higher rates of breastfeeding than those from low-income backgrounds. In general, older, better-educated, and wealthier women are more likely to initiate and sustain breastfeeding for longer periods. In addition to demographic characteristics, several important and related individual factors contribute to the choice to breast- or bottle-feed. These factors include being breast-fed as a child, exposure to breastfeeding, and grandmother support for breastfeeding. Research indicates a robust association between having been breast-fed as an infant and mothers’ breastfeeding intentions, initiation rates, and duration. Similarly, mothers who report greater exposure to breastfeeding—whether through observing family members, the media, or friends—are more likely to hold positive attitudes toward breastfeeding and to themselves initiate and sustain breastfeeding for a longer duration. Last, positive encouragement, support, and valuing of breastfeeding by grandmothers can play a critical role in a new mother’s decision to initiate and sustain breastfeeding. Maternal psychological characteristics also predict the decision to breast-feed. One of the most important predictors of breastfeeding initiation and duration is the strength and timing of a mother’s intention to breast-feed. Mothers who decide early in their pregnancy and who intend to breastfeed for longer are much more likely to breast-feed their infant for a longer duration than mothers who decide late in the pregnancy or who express ambivalence about this feeding choice. Mothers who express positive attitudes about breastfeeding, who have greater knowledge of the benefits of

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breastfeeding, and who are less concerned about embarrassment, shame, or modesty are more likely to breast-feed successfully. Last, a mother’s confidence during pregnancy in her ability to breastfeed also predicts the initiation and duration of this feeding method.

Fathers’ Role in Breastfeeding Broadly speaking, men tend to have less knowledge about breastfeeding and its benefits and tend to hold more positive attitudes about formula feeding than females do. However, positive support from male partners for breastfeeding is highly associated with mothers’ initiation and duration of breastfeeding. Conversely, a lack of support from male partners has been identified as a major barrier to breastfeeding and may contribute to lower rates of breastfeeding.

Constraints on Breastfeeding The role of the larger society in promoting or hindering breastfeeding is also important in understanding rates of breastfeeding. While breastfeeding is highly encouraged from a public health perspective, women often lack support for breastfeeding in the workplace and in public. Such a lack of support may contribute to the dramatic decline in the duration and exclusivity that is observed in women when they return to work, particularly if this occurs during the first 3 months postpartum. Workplaces can hinder breastfeeding in a variety of ways, one of which is a lack of access to spaces where breastfeeding or expressing milk can privately and comfortably occur. Additionally, employers are often reluctant to promote breastfeeding in the workplace, although practices such as longer maternity leave, flexible work schedules, physical access to babies, and more autonomous job duties are all important steps that have been linked to higher rates of initiation, duration, and exclusivity of breastfeeding. Mothers also often feel hindered in breastfeeding due to concerns about disapproval or discomfort with breastfeeding in public. Particularly in Western societies, where breasts are often highly sexualized, breastfeeding women face challenges with how to integrate their daily lives—which frequently takes them out of the home—with the

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needs of their infants, who require frequent feedings. Furthermore, women who breast-feed older infants express heightened concerns about public breastfeeding, as they often perceive a reduction in social approval of breastfeeding when they do so beyond the first year. As a result, many women choose to limit their breastfeeding to private locations or to abandon it altogether, therefore seriously affecting the amount of breast milk their infant consumes. Thus, breastfeeding is highly connected to the larger social context, and our understanding of breastfeeding must take into account not only the health benefits of this feeding practice but its complex social and psychological implications as well. Jennifer M. Weaver See also Health Issues and Gender: Overview; Motherhood; Parental Stressors; Pregnancy; Women’s Health; Workplace and Gender: Overview

Further Readings Smith, P. H., Hausman, B., & Labbok, M. (Eds.). (2012). Beyond health, beyond choice: Breastfeeding constraints and realities. New Brunswick, NJ: Rutgers University Press. Thulier, D., & Mercer, J. (2009). Variables associated with breastfeeding duration. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(3), 259–268. Vaaler, M. L., Castrucci, B. C., Parks, S. E., Clark, J., Stagg, J., & Erickson, T. (2011). Men’s attitudes toward breastfeeding: Findings from the 2007 Texas Behavioral Risk Factor Surveillance System. Maternal and Child Health Journal, 15(2), 148–157.

Buddhism

and

Gender

Buddhism is a philosophy or guiding religion that influences and informs prescribed gender roles, interactions between genders, and the representation of gender through symbols. There are many different perspectives of Buddhism that affect the conceptualization of gender, typically resulting in a more androcentric view. Despite the challenge of unifying these various beliefs into one viewpoint, the core principles of Buddhism include compassion, kindness, a sense of detachment, harmony,

and karma (the idea that thoughts and actions influence reincarnation). This entry includes a general discussion of the ways Buddhism and gender intersect. Challenges to these prescribed conceptualizations of gender are explored. The entry concludes with a discussion about the implications of these conceptualizations.

Buddhism and Gender Roles Buddhism’s beginnings are linked to the story of a young prince’s path to enlightenment through detachment, renouncement of a royal lifestyle in favor of a life of moderation, meditation, and the practice of positive thoughts and behaviors that consider all living beings, including compassion. Coinciding with the first Buddha being male, the conceptualization of gender tends to be androcentric. Specifically, gender is prescribed in a binary fashion between men and women. Generally, the different Buddhist perspectives tend to discuss female gender roles in the context of male gender roles; females play a submissive role to the male. Females are viewed as caregivers and nurturers, maintaining the household and family, whereas men are the heads of household and are encouraged to engage in monastic activities/pursuits. It is notable that these gender roles may vary based on perspective. For instance, on one end of the ­continuum, Areewan Klunklin and Jennifer Greenwood note that in Thailand, these gender roles are reinforced by monastic rules. Specifically, all monks are male, and women cannot be ordained. They can become nuns, but they do not have the ­opportunity to assume the higher status of a monk. Typically, women maintain the temples, ensuring cleanliness, and cook for the monks. As a result of restricted gender roles, it follows that women cannot become fully enlightened as a Buddha or bodhisattva, for this status is reserved for men. Even in some perspectives where it is deemed possible for a woman to become a bodhisattva, the prerequisite is that she first be transformed into a man. A woman is expected to shed any existing female characteristics, mannerisms, and biological instincts to acquire a man’s state of mind. In doing so, the woman will be able to attain the religious mind necessary to reach enlightenment. Conversely, a male transforming into a woman is viewed as an adverse consequence of his

Buddhism and Gender

actions. This restriction on gender roles is further depicted by symbols of the Buddha. For instance, the majority of Buddhist statues tend to be in the form of a male. John Powers notes that the Buddha’s physique is depicted as the supreme male form, and his body is a sheer demonstration of his attainment of perfect virtue. Unfortunately, there is little to no representation of an ideal female form that promotes a path for women to attain perfect virtue. On the other end of the continuum, Julia Huang notes that in Taiwanese society, female gender is significant because women may choose paths that do not adhere to traditional gender roles. In Thailand, a vast number of women view Buddhism as more than just a set of principles to live by in their daily lives, such that they consider it as an alternative to marriage. Many Buddhist women in Taiwan are rebuffing their traditionally aspired role of wife and mother to enter monastic life as Buddhist nuns. Despite many women becoming nuns, they continue to assume a subordinate role to men; women are only given the opportunity to ordinate as high as a nun, whereas males have the option to attain supreme ordination as a monk.

Buddhism and the Interaction Between Genders Monastic rules of Buddhism designate gender roles and rules for interaction between females and males. In traditional Buddhist perspectives, it appears that the dichotomy between male and female is pronounced, such that males tend to be perceived as having more value than women. Furthermore, a woman is seen as an obstacle to a male’s achievement of enlightenment. Specifically, Hitomi Tonomura notes that in medieval Japan, the female body is only acknowledged in parts, and when processed through the male gaze, the male’s impure thoughts cause distraction and veer men from their spiritual path. Consequently, Areewan Klunklin and Jennifer Greenwood note, there is a tendency for female body parts and products to be considered toxic and harmful to men. Due to the view that women are polluted, women are forbidden to touch or even come close to a monk for fear of contaminating him. Furthermore, there are noted social consequences for women engaging in behaviors that foster independence. Sherin Wing

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notes that in traditional texts, it was viewed that if women engaged in economic pursuits without men’s oversight, they would not be available to support men, and men would not succeed. Interactions between men and women are limited not only within the monastic community. Klunklin and Greenwood also note that as part of the Buddhist system of gender roles, the ideal Thai man, outside of men who commit the ultimate redemptive act of monk ordination, is expected to become the epitome of masculinity: authority, courage, strength, and sexual prowess. Traditional Thai women are required to acquire and maintain the attributes of a virtuous woman, or kulasatrii. Many such virtues involve direction on sexual interactions between man and woman. Not only is premarital sex forbidden, but women’s curiosity about sex before marriage is considered highly inappropriate, and once women are married, they must remain monogamous with their husbands. Additionally, women must defer and be submissive to men, with some Buddhist perspectives condoning punishment of women for being disobedient to men. Tonomura notes that in medieval Japan, the vagina was viewed as a source of vulnerability for women, as men had unspoken permission to engage in sexual relations with women. Due to this unspoken permission, men are bestowed the power to engage in unrestrained sexual behaviors to satisfy their desires, even at the cost of women’s physical and emotional health. One exception to women having premarital relations would be the interaction between Thai men and commercial sex workers (CSWs). By the time a male reaches midadolescence, he is expected to begin purchasing sex from CSWs, since premarital sex is not available from females aspiring to become kulasatrii. Visiting CSWs is socially acceptable for men even after marriage. It is notable that CSWs are female, are of low socioeconomic status, and have limited to no education, further elaborating on the conceptualization that women are not valued.

Challenges to the Traditional Buddhist Conceptualization of Gender In contrast to the traditional Buddhist conceptualization of gender roles and interactions between genders, there have been a few deviations from the androcentric nature of this conceptualization. Shanshan Du discusses one such anomaly through

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the Lahu Buddhist perspective, noting that marriage unites a male and a female as one. While the traditional story of the Buddha traces Buddha’s beginnings to a prince, the Lahu perspective equates the Buddha with a dyad of male and female gods. It follows that most statues and ­symbols are represented in a dyadic fashion. The Lahu perspective illustrates gender unity and translates into egalitarian gender roles, with a male and female couple sharing the status of head of ­household, men assuming the role of a midwife, and the housework being equally divided between the two. Kuan Yin is an anomaly in Buddhist text, as she was a princess headed toward the traditional path of marriage. However, she rejected marriage, instead following the path to becoming a bodhisattva, despite her father’s disapproval and the harm that he attempted to induce. Kuan Yin is one of the female statues that have been widely seen and worshipped. The Kuan Yin figure symbolizes the empowerment of women, as well as acknowledging the entirety of female existence in an androcentric society. She represents compassion and has provided a role model for women to deviate from the traditional Buddhist female role and proceed to become enlightened as females. To date, there has been a paucity of dialogue addressing LGBTQI (lesbian, gay, bisexual, transgender, queer, intersex) individuals within the ­Buddhist traditions, particularly within traditional texts. If mentioned, there continue to be inconsistencies among the different perspectives, with one view being of tolerance toward individuals and others describing LGBTQI individuals as sexually deviant. This sexual deviance would exclude them from becoming enlightened. The former perspective highlights the Buddhist principles of tolerance and acceptance, whereas the latter viewpoint is in opposition to these principles. With limited to no representation, or even negative representation, in the literature, it may be difficult for some of these individuals to feel comfortable with Buddhism as a philosophy, religion, and/or ideology.

Implications of Buddhist Conceptualizations of Gender The traditional Buddhist conceptualization of gender as favoring androcentrism has many

implications for individuals within Buddhist communities. First, it appears that this conceptualization equates to leadership roles being restricted to men. By allowing only men to become monks or reach enlightenment, it may further perpetuate these androcentric ideas of gender and may play a significant role in the oppression of women within the structure of Buddhism. Second, by bestowing privilege on males only, it may send the message that women are not valued, particularly if there is no male presence. As Klunklin and Greenwood observe, Thai women have difficulty protecting themselves from sexually transmitted infections due to their limited ability to discuss ways to ­protect themselves (e.g., condoms). Women who initiate a dialogue about protection may also be perceived in a negative fashion or may not be ­provided with financial support. Women are also more likely to be uneducated and impoverished, which does not provide many employment options. Last, traditional gender conceptualizations may, or may not, be parallel with the main components of Buddhism, such as compassion and acceptance. One perspective is that dichotomizing gender roles is consistent with Buddhist ideology, which promotes acceptance of contradictions and dialectical statements. This perspective assumes that males and females are in fact contradictions. There is another perspective that considers that these conceptualizations may not be consistent with the core components of Buddhism due to a lack of compassion. By viewing women as “contaminated” or “poisoned,” it stigmatizes them and may be a barrier for future progression within the monastic community, paralleling daily life. By internalizing misogynistic principles, women may remain in restricted roles (e.g., mother), leading to limited or no opportunities to reach enlightenment. Ultimately, this may reinforce gender stereotypes. However, there are many views on the conceptualization of gender, and it is almost impossible to integrate all of these views into one overarching perspective. There may be similarities and differences between the perspectives, but there continue to be ambiguity and fluidity between the perspectives, which is parallel to the Buddhist ideal of detachment. Stephanie J. Wong and Amekia Sims

Buddhism and Sexual Orientation See also Androcentrism; Cultural Gender Role Norms; Gender Role Behavior; Gender Role Conflict; Gender Role Socialization; Sexuality and Men; Spirituality and Gender

Further Readings Du, S. (2003). Is Buddha a couple? Gender-unitary perspectives from the Lahu of southwest China. Ethnology: An International Journal of Cultural and Social Anthropology, 42(3), 253–271. Huang, C. J. (2008). Gendered charisma in the Buddhist Tzu Chi (Ciji) Movement. Nova Religio: The Journal of Alternative and Emergent Religions, 12(2), 29–47. Klunklin, A., & Greenwood, J. (2004). Buddhism: The status of women and the spread of HIV/AIDS in Thailand. Health Care for Women International, 26(1), 46–61. Powers, J. (2011). Gender and virtue in Indian Buddhism. Crosscurrents, 61, 428–440. Tonomura, H. (1994). Black hair and red trousers: Gendering the flesh in medieval Japan. American Historical Review, 99(1), 129–154. Wing, S. (2011). Gendering Buddhism: The Miaoshan legend reconsidered. Journal of Feminist Studies in Religion, 27(1), 5–31.

Buddhism and Sexual Orientation Despite the civil rights gains that have been achieved since the Stonewall Uprising of 1969, lesbian, gay, bisexual, transgender, and queer (LGBTQ) people continue to experience marginalization and discrimination in the United States and across the world. Queer-related hate crimes are second only to racial hate crimes in the United States. Sexual orientation accounts for more than 20% of all hate crimes reported by the Federal Bureau of Investigation. Parents of LGBTQ youth often communicate messages that their LGBTQ children are inferior or undesirable in comparison with their heterosexual and/or gender conforming peers. In the United States and many other nations around the world, LGBTQ youth experience societal pressures to adhere to majority norms for fear of being ostracized by their peers as well. Boys who do not exhibit “rough and tumble” play

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habits and girls who do not adhere to heteronormative feminine role models often experience rejection by their parents as well as their peers and mentors. The result for youth who are nonconforming in gender and/or sexual identities is all too often an internalization of feeling less than equal. Using resilient adaptive defenses, many LGBTQ youth assume a “false self” to protect themselves from rejection or withdrawal of love, or being the object of hate crimes. However, this false persona, which is intended to protect the core self, can distance a person from feeling a loving acceptance of self and results in a fear of the other and, in turn, fosters feelings of isolation and loneliness. Whether LGBTQ people choose to “pass” or to develop a public persona intended to protect their essential self, they are at high risk for depression and social isolation. Although pockets of U.S. society have become more accepting of fluidity in gender and sexual identity, LGBTQ people continue to be stigmatized, often in isolation, when they take up an identity that deviates from the cultural norm of heterosexuality and traditional gender roles. Only recently has the national press begun reporting the stories of transgender youth who have been maimed and tortured for their differences. LGBTQ youth today are not that different from the LGBTQ youth who grew up pre-Stonewall. Most youth tend to need to differentiate from their family of origin, although they simultaneously have an attachment and need for affirmation and acceptance. Internalized shame about identities such as sexual or gender identity, core aspects of self, not only traumatizes a person but also results in mistrust of others. A pattern of anxious attachment and hesitancy to be close with others may result in a lifelong fear of openly expressing a need for ­intimacy. The implication for stable adult relationships can be profound if the internalized shame and mistrust are not addressed. This entry examines both historical and contemporary Buddhist understandings of LGBTQ issues. Specific attention is paid to how Buddhism differs from Judeo-Christian beliefs on gender and sexual identity. Consideration is also given to how Buddhist teachings and practices can be embraced as a way for LGBTQ people to counter the heterosexist and homophobic attitudes they encounter in society at large.

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Traditional Buddhist Understandings of Gender and Sexual Identity Judeo-Christian beliefs are the foundation of ­Western culture, and these houses of worship are traditionally a place that people turn to in order to heal from psychic wounds. However, interpretations of biblical teachings that have pathologized LGBTQ people continue to reverberate in these institutions. Although many urban Jewish and Christian faith organizations have opened their doors to LGBTQ people, memories of prohibition and condemnation of same-sex relationships and people who are nonconforming in gender and/or sexual identity continue to exist. Traumatic memories related to early shameful rejections are evoked by these institutions and their teachings. LGBTQ people often feel unwelcome and unsafe in these places of worship. However, Buddhism, with its teaching of inclusiveness, potentially offers LGBTQ people mind training and/or spiritual practices free of the Judeo-Christian teachings on homophobia. Buddhism, coming out of the East, focuses on a loving acceptance of all sentient beings and teaches of the universal quality of basic goodness inherent in all beings, regardless of sexual orientation. It offers an alternative path to the traditional JudeoChristian teachings that are embedded in Western culture. Rather than being taught that human beings are essentially damaged or in need of salvation, students of Buddhism focus on the qualities of the Buddha that are believed to exist within all people. The path to accessing basic goodness so that one does no harm to one’s self or others is achieved in Buddhism through the practice of meditation, wherein students initially learn to quiet the mind and then to develop love and compassion for the self. In more advanced practices, that love and compassion experienced for the self are then extended out in society in recognition of the Buddha nature present in all sentient beings. Since the 1970s, when Buddhist teachings were brought to the West, many sanghas (“communities”) have openly welcomed LGBTQ people. Dzogchen Ponlop Rinpoche, the Tibetan lineage holder of the Kagyu and Nyingma lineages, has lectured on the essential qualities of a loving relationship, including respect for one’s partner, and the precept to do no harm to others. These are

guidelines that Buddhist practitioners apply to all human relationships, whether heterosexual or same-sex relationships. The focus of Buddhism is on loving acceptance of all beings. Both Nalandabodhi, founded by Dzogchen Ponlop Rinpoche, and the Shambhala sangha, currently led by Sakyong Mipham Rinpoche, welcome and accept all people and have groups that address the specific needs of LGBTQ Buddhists. Early Buddhist teachings and prohibitions against sexuality that were intended to address the monastic communities have been misinterpreted in the West as applying to any sexual relationship. An additional source of confusion is that early Buddhist teachings prohibited the lay population from performing any sexual behavior other than penisvaginal intercourse with one’s monogamous ­partner. More recently, these teachings have been clarified. Dzongsar Khyentse Rinpoche, a Tibetan Buddhist lineage holder, has articulated the ­contemporary Buddhist teachings on sexual orientation. In a talk given in 2015, he repeatedly emphasized that sexual orientation was irrelevant to Buddhist teachings and focused instead on the importance of leading one’s life with wisdom and truth. His overall message has been one of acceptance and celebration of human sexuality in all of its manifestations as long as nonmonastic practitioners behave with respect for themselves and others.

Buddhism as a Source of Healing and Strength One of the gifts and corrective experiences of ­Buddhist practice for LGBTQ people has been the opportunity that students have to learn how to quiet the mind’s critical chatter, which is often related to internalized homophobia. In mindfulness meditation practice, the student learns how to quiet the central nervous system and to selfregulate residual feelings of trauma. This training can be an opportunity for the LGBTQ person to learn to be compassionate toward the self for earlier experiences of rejection that have become internalized as self-loathing. Sakyong Mipham Rinpoche has written extensively about the concept of basic goodness that exists as an essential quality of all human beings. Buddhist teachings, meditations, and advanced practices are a vehicle for practitioners to explore

Bulimia and Gender

this concept of basic goodness, first by focusing on the self and then on the basic goodness of others, eventually extending these feelings out to all of society. Meditation teaches practitioners how to hold themselves with loving compassion and then extend to others this experience of loving kindness. Once the meditator is able to quiet the discursive chatter, the practitioner learns to accept himself or herself with compassion. As meditators experience maitri, or loving kindness, they learn how to identify with and send out healing energy to alleviate their own suffering and the suffering of others. The beginning student learns the basic breathing exercises and experiences the ensuing moments of peacefulness that basic meditation provides. Anxiety diminishes, and a state of peaceful abiding occurs. The transition from the early stages of meditation into developing maitri, or compassion for the self, begins as practitioners begin to focus on their heart center. The heart center is considered to be the seat of wisdom in Buddhist culture, the source of the intuitive intelligence that each person is born with. The wisdom center is similar to what contemporary psychology describes as the core affective state. Core affective state is that place within each of us where we are undefended and experience an acceptance of our emotional truth. In this way, contemporary psychology and Buddhist practice support and enhance each other. Buddhism offers the LGBTQ person the opportunity to experience profound self-acceptance and to heal the ruptures in self-esteem that have occurred from prior traumatic experiences of rejection. This awakening of essential basic goodness, believed to be present in all conscious beings, has the potential to heal anyone caught in cycles of samsara, or suffering. The reparative experience for LGBTQ people who have internalized that ­something about their essential self is unlovable or ­broken has profound implications for creating healing opportunities. The stigma of not conforming to binary expectations of straight/gay, male/female, and butch/fem becomes irrelevant within Buddhist teachings that focus on the essential basic goodness of all beings. David E. Greenan See also Buddhism and Gender; Spirituality and Gender; Spirituality and Sexual Orientation

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Further Readings Corless, R. (1998). Coming out in the sangha: Queer community in American Buddhism. In C. S. Presbish & K. Tanaka (Eds.), The faces of Buddhism in America (pp. 253–265). Berkeley: University of California Press. Fosha, D. (2000). The transformative power of affect. New York, NY: Basic Books. Greenan, D. E. (2015). Resiliency-focused couple therapy: A multidisciplinary model. Transformance: The AEDP Journal, 5(1). Retrieved from https://www .aedpinstitute.org/?s=Resiliency-focused+couple+therapy Greenan, D. E., & Tunnell, G. (2003). Couple therapy with gay men. New York, NY: Guilford Press. Mipham, S. (2003). Turning the mind into an ally. New York, NY: Riverhead Press. Mipham, S. (2013). The Shambhala principle. New York, NY: Crown. Rinpoche, D. P. (2009). Address to queer dharma. New York, NY: Shambhala Meditation Center. Trungpa, C. (1984). The sacred path of the warrior. Boston, MA: Shambhala.

Bulimia

and

Gender

Bulimia nervosa is an eating disorder characterized by recurrent binge eating followed by compensatory behaviors such as purging; fasting; the use of laxatives, enemas, and diuretics; and overexercising to burn excess calories. Bulimia nervosa can lead to a variety of health risks, including damage to dental enamel and gum tissue, gastrointestinal problems, and death. In fact, eating disorders have the highest mortality rate of any mental health issue; an estimated 4% of those suffering from bulimia nervosa will die from it. This entry offers a definition of bulimia nervosa and discusses gender differences in symptomology, prevalence rates, and known individual and environmental risk factors, as well as how gender affects both prevention and treatment.

Diagnosis of Bulimia Nervosa Objective criteria to diagnose bulimia nervosa can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is published by the American Psychiatric Association.

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In general, to qualify for a diagnosis of bulimia nervosa, individuals must be engaging in binge eating behavior (eating a larger amount of food than most people would eat during a similar situation) at least once a week for 3 months. Most of the time, these binge eating episodes will then be followed by an act meant to rid oneself of the excess calories consumed (e.g., self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise). In addition, most individuals with binge eating disorder report a lack of control over their behavior (i.e., they can’t stop themselves from binge eating), and most are also preoccupied with body shape and weight, tending to base their self-esteem largely around these two aspects. Although to be diagnosed with bulimia nervosa, one must engage in binge eating, as well as efforts to compensate for the binge, once a week for 3 months, bulimia nervosa is also characterized by the severity of the disorder, ranging from mild (1–3 episodes per week) to extreme (14 or more episodes per week).

Gender Differences in Symptomology Although diagnosis of bulimia nervosa depends on recurrent episodes of both binge eating and inappropriate compensatory behaviors, the specific types of bulimic behaviors may differ for men and women. For example, men are more likely than women to binge rather than restrict due to negative body image. Differences exist in compensatory behaviors as well. Females are more likely than males to report using laxatives or vomiting to control weight, whereas males are more likely to engage in activities such as excessive exercise to compensate for overeating.

Prevalence Rates It is difficult to estimate the exact numbers of individuals who are affected by eating disorders. This is due to the fact that although up to 24 million people in the United States are estimated to suffer from an eating disorder, only 10% seek treatment. Based on population studies of those who report bulimic symptoms, however, prevalence rates suggest the following. More than one half of teenage girls and one third of teenage boys utilize unhealthy weight control behaviors, which may include

compensatory mechanisms such as vomiting or taking laxatives. One in four college-age women engage in bingeing and purging as a weight management technique. Research on men with bulimia nervosa is sparse; however, recent studies indicate that the number of men suffering from the disorder may be greater than was previously thought. Recent studies suggest that 10% to 15% of those individuals who suffer from anorexia nervosa or bulimia nervosa are men. Among homosexual men, 14% suffer from bulimia nervosa.

Individual and Environmental Risk Factors Individual Risk Factors

Many factors contribute to the development of an eating disorder, but they can generally be grouped into three areas: (1) genetic predisposition, (2) individual characteristics such as personality and demographics, and (3) environmental risk factors. For example, individuals with mutations in the ESRRA (estrogen-related receptor alpha) gene have a 90% chance of developing an eating disorder, whereas individuals with a mutation in the HDAC4 (histone deacetylase) gene show an 85% chance of developing an eating disorder. That being said, these genetic mutations are very rare, with 1 in 1,000 having the ESRRA mutation, and 2 in 10,000 having the HDAC4 mutation. Genetic differences have also been found in certain neurotransmitters and hormones in the brain of individuals who suffer from bulimia nervosa. For example, having the G allele of the oxytocin (a bonding hormone) receptor gene may be linked to a predisposition for developing bulimia nervosa. There may also be some differences in the receptors for leptin (a hormone that signals satiety), melanocortin (a family of peptide hormones), and neurotrophin system (a protein system that ensures cell survival) genes in patients with bulimia nervosa. Reduced dopamine (a neurotransmitter involved with mood and motor control) activity has also been reported in individuals with bulimia nervosa. Individual Characteristics

There are several personality and lifestyle characteristics that seem to relate to an increased chance of developing bulimia nervosa. These include, but are not limited to, depression, chronic

Bulimia and Gender

loneliness, shame, moodiness, feeling unworthy or empty inside, having difficulty expressing feelings, and having impulse control issues. Women are more likely to be diagnosed with bulimia nervosa than men, but as stated previously, diagnoses of bulimia nervosa are not unheard of and are becoming more common in certain subsets of the population (e.g., gay men). Eating disorders have historically been considered to be more ­prevalent in Caucasian women. However, this is not the case as the prevalence of eating disorders in the United States is similar among Caucasians, Latino Americans, African Americans, and Asian ­Americans. Eating disorders have also been thought of as only affecting the upper class; however, one recent study found that bulimia nervosa was more common in individuals who report a lower socioeconomic status than in the middle or upper class. Finally, stereotypes about eating disorders also portray sufferers as being teens and college-age students. However, bulimia nervosa diagnoses are becoming more prevalent in women in their 30s, 40s, and 50s. Environmental Risk Factors

Research on environmental risk factors for the development of bulimia nervosa abounds, with media portrayal of the “ideal” body image taking the top prize among the factors attributed to the increase in bulimia nervosa diagnoses. Other environmental risk factors are also suspected. For example, children raised in appearance-oriented or weight-oriented homes or those raised in homes where parents model restricted eating or compulsive exercise are more at risk of developing bulimia nervosa. Even familial factors such as whether children were encouraged to eat breakfast have been found to play a role in the development of an eating disorder. Children who were teased about their weight by parents or peers are also at an increased risk for bulimia nervosa. Peer groups are also influential in terms of modeling eating-­ disordered behaviors. For example, peer groups that place an emphasis on weight or appearance may pressure members of that group to engage in drastic weight loss measures, such as bingeing and purging. For this reason, women in sororities may be at an increased risk of developing bulimia nervosa. In addition, athletes who compete in ­ sports where weight is emphasized (e.g., ballet,

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gymnastics, wrestling, track and field) appear to be a group with an increased risk for the development of bulimia nervosa. The Interaction of Genetic and Environmental Risk Factors

Determining the amount of variance accounted for by genetic factors, individual factors, and environmental factors is difficult because there are clearly interactions between the three. For example, children receive genes from their parents that may increase their risk of developing bulimia nervosa, but they are then usually raised by the same parents, who may be modeling habits (e.g., body dissatisfaction, bingeing or food restriction) that may encourage disordered eating behaviors and attitudes. Other possible interactions between individual, environmental, and genetic factors also exist. For example, someone with a genetic propensity to develop an eating disorder may be more inclined to seek out appearance-related feedback from friends and family or seek peer groups where appearance is reinforced. These comments then support the importance of appearance for that individual, which may reinforce the use of compensatory weight loss mechanisms such as purging or compulsive exercising. Genetics may also play a role in the effect certain environmental influences have on an individual. For example, someone with a genetic predisposition for bulimia nervosa may respond more strongly to teasing or negative comments about weight or appearance, causing them to be more likely to engage in unhealthy weight loss behaviors.

Gender Differences in Risk Factors for Bulimia Nervosa As explained earlier, there are many risk factors for developing eating disorders such as bulimia nervosa. However, research suggests that these risk factors may not be the same for men and women. Risk factors suspected to differ for men and women are discussed in the following subsections. Self-Esteem

Research on self-esteem indicates that boys and girls appear to have similarly high levels of selfesteem in childhood but that girls experience a

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decline in self-esteem in adolescence. As many teens struggle with weight and shape concerns, it is perhaps not surprising that girls’ self-esteem is related to unhealthy weight loss strategies, such as bingeing and purging, whereas boys’ self-esteem is not significantly related to strategies to lose weight.

Personality

Scant research exists on personality differences in individuals suffering from bulimia nervosa, but one study found that males with higher levels of chronic bulimia nervosa reported more perfectionism and interpersonal distrust whereas females reported more drive for thinness and approval motivation.

Body Image

Earlier studies of body image revealed that men were less likely to have body image issues than women; for that reason, body image was not predictive of bulimic symptoms in men. In the past decade, however, it has become apparent that researchers were asking the wrong questions. Whereas women tend to overestimate their body size and desire to be thinner, men are more likely than women to underestimate their body size and desire a more muscular body. The drive for muscularity in men and for thinness in women typically begins in childhood. Thus, it is perhaps not surprising that the drive for thinness is associated with the development of bulimic symptomology in women but is less likely to be associated with bulimia symptomology in men. On the other hand, the drive for muscularity is associated with bulimic symptomology in men but not in women. Thus, body image is predictive of bulimia nervosa in both men and women but in different ways. Emotional Expressivity

One of the hallmark symptoms of bulimia nervosa is difficulty expressing emotions. Research indicates that this may vary by gender. For example, emotional expressivity relates to bulimic symptoms in women. In men, bulimic symptoms relate to both emotional expressivity and alexithymia (inability to identify and describe emotions in the self). Although women appear to be more likely to engage in bulimic behaviors when they are in a negative mood state than are men, men and women appear to do this for different reasons. Men engage in bulimic behaviors to reduce anger states, whereas women engage in bulimic behaviors to reduce the likelihood of their becoming angry. Thus, they both appear to use bulimic behaviors in an effort to cope with anger—just in different ways.

Coping

Bulimic behaviors appear to relate to the way men and women cope overall—not just with anger. For example, in men, bulimic symptomology relates to the use of involuntary disengagement (withdrawal, escape, inaction) as a coping mechanism, but this relationship is absent in women. In addition, boys who engage in problem-focused coping (e.g., doing something to fix the problem, seeking help) and those who seek social support when stressed are more likely to report bulimic symptomology. Girls, however, do not display this relationship. Bulimic symptoms in girls seem to relate more to their perceived stress level than to their ways of coping with stress. Attachment Style

Attachment styles (e.g., secure, fearful, dismissing, preoccupied) are known to affect our relationships with parents, peers, and romantic partners. They also appear to affect our relationship with food and our bodies. Specifically, men with secure attachment styles are less likely to report a drive for thinness, bulimic symptomology, or body dissatisfaction. Although women with secure attachment are less likely to report body dissatisfaction, secure attachment is not predictive of bulimic symptoms in women. Instead, women who report having a more fearful attachment (the urge to protect oneself and stay away from relationships while at the same time wanting to be in a relationship) are more likely to report bulimic symptoms. Sexual Orientation

As stated previously, homosexual men are more likely to report bulimic symptoms than are heterosexual men. Specifically, gay men are more likely to report body dissatisfaction, dietary restraint,

Bulimia and Gender

anorexia nervosa, or bulimia nervosa than are heterosexual men. The same is not true for women. Lesbians are less likely than are heterosexual women to report body dissatisfaction, a drive for thinness, dietary restraint, or bulimia nervosa. Relationships With Parents and Peers

While research with both boys and girls indicates that body dissatisfaction, bulimia, and the drive for thinness relate to higher levels of family and peer eating concerns, there are notable ­differences. Specifically, boys who report body dissatisfaction are more likely to report higher levels of a family history of eating concerns, peer influences on eating concerns, and perceptions of teasing, as are girls. Boys who have bulimic symptoms are more likely to report teasing but not family history or peer influence, whereas girls who exhibit bulimic behaviors tend to report teasing, family history, and peer influence. Finally, there may be some differences in parental influences between boys and girls. Girls who report higher levels of bulimic symptomology report that their mothers control their food intake. On the other hand, boys tend to be more influenced by their fathers’ body dissatisfaction and food monitoring.

Gender Differences in Prevention and Treatment of Bulimia Nervosa Research suggests that bulimic symptoms appear at different ages for males and females. Whereas bulimic symptoms tend to increase in females from ages 14 to 16 years, males tend to experience an increase in bulimic symptoms in their early 20s. This may explain why school-based interventions designed for preadolescents are more ­effective in girls than in boys. Thus, prevention efforts should occur in different age-groups for men and women. As many individuals still hold the stereotype that eating disorders are a “female” problem, it is perhaps not surprising that men who suffer from bulimic symptomology are less likely to report and seek treatment than are women. Even if men do report symptoms, they may not be diagnosed with an eating disorder, as eating disorder assessments have proven unreliable in men since symptoms of eating disorders may differ in men and

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women. In addition, many eating disorder professionals have not undergone male-specific treatment training, and most residential facilities do not take men. On the plus side, the little research that has been conducted on treating eating disorders in men has found that men have similar treatment prognoses as women in both gender-specific group therapy and cognitive behavioral therapy. Mary E. Pritchard See also Body Dysmorphic Disorder and Gender; Body Image Issues and Men; Gay Men and Health

Further Readings Abebe, D. S., Lien, L., & von Soest, T. (2012). The development of bulimic symptoms from adolescence to young adulthood in females and males: A population-based longitudinal cohort study. International Journal of Eating Disorders, 45(6), 737–745. doi:10.1002/eat.20950 Berger, U., Schaefer, J., Wick, K., Brix, C., Bormann, B., Sowa, M., . . . Strauss, B. (2014). Effectiveness of reducing the risk of eating-related problems using the German school-based intervention program, “Torera,” for preadolescent boys and girls. Prevention Science, 15(4), 557–569. doi:10.1007/s11121-013-0396-4 Joiner, T. J., Katz, J., & Heatherton, T. F. (2000). Personality features differentiate late adolescent females and males with chronic bulimic symptoms. International Journal of Eating Disorders, 27(2), 191–197. doi:10.1002/(SICI)1098-108X(200003)27: 23.0.CO;2-S Jones, W. R., & Morgan, J. F. (2010). Eating disorders in men: A review of the literature. Journal of Public Mental Health, 9(2), 23–31. doi:10.5042/ jpmh.2010.0326 Kwan, M. Y., Gordon, K. H., Eddy, K. T., Thomas, J. J., Franko, D. L., & Troop-Gordon, W. (2014). Gender differences in coping responses and bulimic symptoms among undergraduate students. Eating Behaviors, 15(4), 632–637. doi:10.1016/j.eatbeh.2014.08.020 Stanford, S. C., & Lemberg, R. (2012). A clinical comparison of men and women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment for Men (EDAM). Eating Disorders: The Journal of Treatment & Prevention, 20(5), 379–394. doi:10.1080/10640266.2012.715516 Wichstrøm, L. (2006). Sexual orientation as a risk factor for bulimic symptoms. International Journal of Eating Disorders, 39(6), 448–453. doi:10.1002/eat.20286

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Bullying, Gender-Based

Bullying, Gender-Based Bullying based on gender involves a pattern of threatening, intimidating, harassing, assaultive, and/or abusive behaviors, or a combination of these, for the purpose of maintaining the traditional gendered status quo: heteropatriarchy, where heterosexual men and boys enjoy privilege and women, girls, and sexual minorities are allotted a secondary status. Gender-based bullying can occur based on one’s real or perceived gender identity, gendered performance, or sexual orientation. For gender-based bullying/harassment to occur, an imbalance of power should exist, whether formal or informal; these behaviors tend to occur over time, and the victim, who is often in a position of subordination, can feel defenseless against the perpetrator. Minimization of bullying/harassing behaviors is common, especially when these behaviors are seen as “corrective measures” or involve gender or heterosexual policing of those individuals who step outside of traditional gender roles or heterosexual expectations. Gender-based bullying/ harassment involves intimidation, control, the misuse of power, and, in essence, the attempt on the part of the perpetrator to deny the victim equality. Furthermore, gender-based bullying/harassment can include name calling, slurs based on stereotypes, graffiti, dissemination of offensive materials or drawings, vandalism, comments about personal appearance, sexual innuendoes, accusations about one’s sexual orientation, sexual leering, unwanted touching, inappropriate gestures, unwanted contact via technology, unwanted gifts and attention, repeated and unwanted requests for dates, pressure for sexual favors, sexual rumors, and sexual assault (actual, attempted, simulated, or threatened). This entry problematizes the term bullying as opposed to the preferred legal term harassment and briefly introduces research on gender-based bullying/ harassment. The entry concludes with a discussion of the frequency and severity of gender-based ­bullying/harassment, the effects on victims and targets, and implications for policy prescriptions.

Gender Defined The concept of gender is constantly evolving and is viewed by many as a socially constructed

phenomenon, as performative, and as a fluid and potentially ever-changing amalgamation of clothing, behaviors, gestures, speech patterns, and the like, subject to the milieu of which one is a member. Once thought to be essentially tied to biological sex, gender is now conceived as more prone to individual choice and level of comfort and not inextricably linked to biology.

Federal Law Catherine MacKinnon, a pioneer in sexual harassment law, was the first to argue that sexual harassment qualifies as a form of sex discrimination (under Title VII of the 1964 Civil Rights Act). Title VII is a federal law that prohibits employers from discriminating against their employees on the basis of sex, race, color, national origin, and religion. It applies to employers with 15 or more employees, including federal, state, and local governments. Passed in 1972, Title IX of the Educational Amendments prohibits sex discrimination in schools. Title IX also protects all students of all genders and sexual orientations from sexual harassment. Students in federally funded institutions, public and private schools, and colleges and universities have a right to an education free from discrimination on the basis of sex, including equitable access to all academic programs, activities, athletics, course offerings, admissions, recruitment, and scholarships and freedom from harassment (including assault) based on sex, gender, gender identity and expression, and sexual orientation. Title IX also protects students from discrimination in academic and nonacademic activities because of pregnancy, childbirth, miscarriage, and abortion and protects faculty, staff, and whistleblowers from sexual harassment, sex discrimination, and retaliation.

Bullying Versus Harassment The word bullying is often used as an umbrella term, particularly in K–12 schools, to explain ­various behaviors, some illegal, and to define perpetrator behaviors that serve to regulate the behaviors of victims in order to punish those who do not conform to some ideal standard based on gendered expectations or other standards required by societal expectations based on hetero-patriarchy.

Bullying, Gender-Based

Bullying is commonly conflated with harassment, particularly in schools. Bullying should be defined as repeated and unwanted behavior used to intentionally ridicule, humiliate, or intimidate another person. However, bullying is not necessarily based on the target’s membership in a protected class or based on one’s identification with a particular group, as is harassment in its many forms. Bullying behaviors are not necessarily illegal. By its very nature, gender-based bullying should be deemed gender-based harassment or gender-based bullying/harassment because federal laws are in place to protect individuals from harassment based on gender. To be more ­specific, Title IX protects all students in federally funded institutions, public and private schools, and colleges and universities from harassment (including assault) based on real and perceived ­ conceptions of another’s sex, gender, gender identity and expression, and sexual orientation. To deem such behaviors as bullying may prevent victims from legal redress. Title VII protects employees from sexual harassment. Sexual harassment in the form of sexual orientation harassment may be considered a form of sex discrimination under Title VII. Bullying and harassment are often viewed as synonymous; their definitions overlap in terms of the behaviors they prohibit, but there are important differences. In instances of bullying, some state laws require proof that the perpetrator intended the harm. In instances of harassment, the intention of the perpetrator is almost always irrelevant, and the victim’s perception of the behavior is largely determinative. Another important difference between bullying and harassment is that the definition of harassment is fairly uniform among all 50 states while bullying laws vary widely. Finally, schools have little to no liability for violations of bullying laws, while they face multiple pathways of potential liability if they fail to comply with antiharassment laws.

Types of Gender-Based Bullying/Harassment Sexual Harassment

Sexual harassment involves any unwanted sexual behavior including sexual assault, verbal and/ or written comments, requests for sexual favors,

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unwelcome sexual advances, spreading of sexual rumors, questioning of one’s sexuality/sexual orientation, gestures, pictures or images, and/or physical coercion. Sexual harassment can be direct or indirect and is typically conceived of as consisting of two types: (1) quid pro quo sexual harassment or (2) hostile environment sexual harassment. Quid pro quo sexual harassment involves a person in a position of power making decisions that affect the employment or educational status of another based on whether or not the target complies with sexual demands. Quid pro quo sexual harassment can involve the perpetrator promising a reward in exchange for a sexual favor or threatening a consequence if the target fails to comply with the request for a sexual favor. Hostile environment sexual harassment is defined as unwanted behaviors that interfere with an employee’s or a student’s work by causing the environment to become hostile, intimidating, threatening, or offensive. Contrapower sexual harassment, a term coined by Katherine Benson in 1984, occurs when the target of sexual harassment has formal power over the perpetrator. The power relation essential to sexual harassment is not formal, organizational power but the differential relation that exists between men and women in society. Contrapower sexual harassment has much to do with informal power based on privilege that enables perpetrator behaviors. Gender Harassment

Gender harassment involves unwanted behaviors that enforce traditional, heterosexual/gender norms. Gender harassment includes sexual ­harassment; homophobic, or lesbian, gay, bisexual, ­transgender, or queer (LGBTQ) harassment; and harassment for gender nonconformity. Gender policing, a form of gender harassment, involves “correcting” those who fall outside of the essentialist binary of the man/woman, male/ female dichotomous mind-set. Individuals who are androgynous or who adopt cultural artifacts— clothing, behaviors, gestures, speech patterns— that are perceived by some to be associated with the “opposite” gender may be subjected to harassment by those who adhere to such an essentialist mind-set. Gender policing can take many forms: teasing and taunting, questioning of one’s sexual orientation, rumor spreading, and assault. For

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example, female athletes are often deemed lesbian because strength and athleticism in women and girls are not valued within hetero-patriarchy. Heterosexual Policing

Heterosexual policing involves the regulation of behavior or dress, or, in essence, the regulation of one’s real or perceived sexual orientation for failure to conform to heterosexual norms of behavior. Students who do not present themselves within the feminine/masculine binary required of heteropatriarchy can experience difficulty in gaining acceptance from peers and adults, especially when those peers and adults adhere to traditional notions of gender. Males are most troubled by this type of harassment, as being called gay is dangerous within our current hetero-patriarchal milieu, where sexism and homophobia are inextricably linked, particularly in schools. Heterosexual policing greatly affects LGBTQ youth. In 2013, the Gay, Lesbian Straight ­Education Network published its National School Climate Survey and found that schools tend to be hostile places for sexual minority students, the majority of whom experience sexual harassment and discrimination at school. Heterosexual policing also affects those students who may not identify as LGBTQ but are perceived as sexual minorities because they do not conform to traditional notions of gender or perceived sexual binaries. Patriarchal Bullying/Harassment

Patriarchal bullying/harassment involves the maintenance of male privilege in the cultural or educational milieu. Patriarchal bullying/harassment can take on many forms, such as sexist ­comments, jokes, and the overall hierarchical privileging of heterosexual masculinity, including the perpetuation of rape culture, the minimization of sexual assault and harassment through victim blaming, rape jokes, sexist comments, denials of inequality based on sex and gender, the objectification of women, and the like.

Gender-Based Bullying/ Harassment: Frequency, Severity, and Effects According to a 2011 report published by the American Association of University Women, based on a nationally representative survey of 1,965

students in Grades 7 through 12, gender-based bullying/harassment and sexual harassment continue to negatively affect the climate of U.S. middle and high schools. Approximately half of the students surveyed experienced some form of sexual harassment; 87% indicated that sexual harassment had a negative effect on them. Verbal harassment was the most common form of harassment experienced by students. Sexual harassment via ­electronic means affected approximately 30% of students. Girls were the most likely victims of sexual harassment (56% of females vs. 40% of males). Girls’ experiences of sexual harassment also were more physical than the sexual harassment experienced by boys. The questioning of a person’s sexual orientation, a form of gender and heterosexual policing and a form of gender-based bullying/harassment and sexual harassment, was reported equally by females and males (18%). Witnessing gender-based bullying/harassment and sexual harassment at school was also common. Thirty-three percent of females and 24% of males reported that they had observed gender-based bullying/harassment and sexual harassment in school. Reporting Levels

Of the victims of gender-based bullying/harassment and sexual harassment in Grades 7 through 12, only 9% reported the harassment to school personnel (12% of females and 5% of males). Moreover, only 27% of victims indicated that they discussed their experiences of harassment with parents or family members, and only 23% discussed their experiences with friends. Females were more likely than males to discuss their experiences of harassment with parents or other family members and friends. Approximately 50% of harassment victims did not report their experiences. Perpetrators of Gender-Based Bullying/Harassment

Many harassers do not consider their behavior as serious (44%). Some engage in sexually harassing behavior because they consider it to be humorous (39%), but only a small percentage desire to date the target (3%) or perceived that the target enjoyed this treatment (6%). Many harassers claim to be unaware that their actions are upsetting to

Bullying, Gender-Based

others, or they claim that their behavior is simply misperceived humor. Most school-based gender-based bullying/ harassment and sexual harassment are peer based. Although males are more likely than females to identify as perpetrators, most perpetrators (92% of females and 80% of males) also indicate that they have been targets of harassment themselves. Only 5% of students who had never experienced gender-based bullying/harassment and sexual harassment identified themselves as harassers. Effects of Gender-Based Bullying/Harassment

Victims of gender-based bullying/harassment exhibit various forms of social isolation stem­ ming from personal attacks, verbal threats and criticism, rumor spreading, and attacks on their reputation. Females are more likely than males to say that they had been negatively affected by gender-based bullying/harassment and sexual harassment. The effects of gender-based bullying/harassment include insomnia (22% of females vs. 14% of males), school avoidance (37% of females vs. 25% of males), and changes in route to or from school (10% of females vs. 6% of males). These negative effects of harassment can result in decreased productivity and increased absenteeism from ­ school. Thus, although both females and males can encounter gender-based bullying/harassment, the phenomenon produces more negative outcomes for females and sexual minorities. Witnessing gender-based bullying/harassment can also have negative effects, such as reducing one’s sense of personal safety, even if one has not personally experienced harassment. Witnessing sexual harassment at school may serve to ­normalize the behavior, potentially contributing to the perpetuation of a culture that tolerates harassment.

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witnessed harassment; proper protocols for the anonymous reporting of harassment; enforcing gender-based bullying/harassment and sexual harassment policies; and holding harassers accountable for their behavior. Gender-based bullying/harassment prevention efforts must address humor, for it is not the intention of the perpetrator that constitutes harassment; rather, it is the perception of the target that constitutes whether or not harassment has occurred. Prevention efforts must also make it clear that for some harassment can indeed be serious and minimization or trivialization of the experiences of victims will only worsen the problem. School districts are required to appoint, train, and make available to the public a Title IX Coordinator to oversee compliance and to deal with complaints and oversee reporting procedures of sexual harassment in its many forms (and other instances of sex discrimination). To put an end to gender-based bullying/­ harassment, the implementation of restorative justice models for dealing with oppression and harassment will, in the short term, minimize the impact of identity-based harassment and, in the long term, reduce its occurrence. The first step in this process is to include antibullying and harassment statements in school and employee handbooks, accompanied by detailed instructions on how to report incidents of harassment, including antiretaliation statements. Institutions should publicize these initiatives so that all are aware of them. Support systems and mentoring programs are crucial for victims of harassment, but particularly for those possessing marginalized identities; institutions should create, monitor, and support such systems. Restorative justice models should be created as an option for targets/victims, but they should be only utilized if the targets/victims desire to address their perpetrators in such a manner.

Dealing With Gender-Based Bullying/Harassment

Policy Prescriptions

Strategies for reducing gender-based bullying/ harassment in schools and in workplaces include the following: a designated person to whom targets can confide; online resources for victims of harassment, including information on their legal rights and appropriate reporting procedures; support groups for those who have experienced or

Labeling harassing behavior as bullying changes nothing about a school’s or an employer’s legal responsibility to deal with harassment as a civil rights violation. However, the failure to use the term harassment may prevent victims from exercising their rights in a timely fashion, if at all, simply because they may not appreciate the harm they

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suffered as a federal civil rights legislation. Institutions benefit from framing offensive behavior as “bullying” for many reasons, including that erroneous labeling can create false data. For example, if criminal sexual assault or sexual harassment is labeled “bullying,” a school can publicly claim to have few or no issues with illegal behavior or discrimination. Labeling harassment as bullying ­ may keep liability costs down. To ensure that victims of harassment have the opportunity to pursue legal recourse, if desired, and to protect against the risk that antibullying laws will inhibit the understanding of victims of their experienced harm as civil rights harassment, state lawmakers and policymakers should crossreference federal and state antiharassment and civil rights laws in antibullying statutes and policies. This action will inform the public that bullying behavior may also violate antiharassment/ discrimination laws. Any antibullying laws should require that schools adopt policies and procedures that provide for a “prompt and equitable” response and resolution to reports of bullying, as this is the standard schools must apply when responding to reports of harassment. Addressing gender-based bullying/harassment in schools and workplace settings is of crucial importance. Educators and employers must be ­prepared to deal effectively with issues of genderbased bullying/harassment. To alleviate genderbased bullying/harassment, the underlying causes must be addressed through the promotion of gender equity; this will involve the training of human resource officers and school officials on the danger of stereotypes based on gender, and on their responsibility to adhere to the requirements of ­federal civil rights laws.

Benson, K. A. (1984). Comment on Crocker’s: An analysis of university definitions of sexual harassment. Signs: Women, Culture, & Society, 9(3), 516–519. Espelage, D. L., Astor, R. A., Cornell, D., Lester, J., Mayer, M. J., Meyer, E. J., . . . Tynes, B. (2013, April). Prevention of bullying in schools, colleges, and universities: Research report and recommendations. Washington, DC: American Educational Research Association. Retrieved from http://gse.buffalo.edu/ gsefiles/documents/alberti/Prevention%20of%20 Bullying%20in%20Schools,%20Colleges%20and%20 Universities.pdf Hill, C., & Kearl, H. (2011). Crossing the line: Sexual harassment at school. Washington, DC: American Association of University Women. Retrieved from http://www.aauw.org/files/2013/02/Crossing-the-LineSexual-Harassment-at-School.pdf Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2013). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian Straight Education Network. MacKinnon, C. A. (1979). Sexual harassment of working women: A case of sex discrimination. New Haven, CT: Yale University Press. Martin, J., Kearl, H., & Murphy, W. J. (2013). Bullying and harassment in schools: Analysis of legislation and policy. In M. A. Paludi (Ed.), Women and management: Global issues and promising solutions: Vol. 2. Signs of solutions (pp. 29–51). Santa Barbara, CA: Praeger. Meyer, E. J. (2009). Gender, bullying, and harassment: Strategies to end sexism and homophobia in schools. New York, NY: Teachers College Press. Paludi, M. A. (1997). Sexual harassment in schools. In W. O’Donohue (Ed.), Sexual harassment: Theory, research, and treatment (pp. 225–249). Boston, MA: Allyn & Bacon.

Jennifer L. Martin See also Gender and Society: Overview; Gender Bias in Education; Sexual Harassment; Title IX

Further Reading American Association of University Women. (2004). Harassment-free hallways: How to stop sexual harassment in schools—A guide for students, parents, and schools. Washington, DC: Author. Retrieved from http://history.aauw.org/files/2013/01/ harassment_free.pdf

Bullying

in

Adolescence

The problem of bullying between children and adolescents was initially investigated in the 1970s by the Norwegian researcher Dan Olweus. Since then, bullying in schools has been identified as a pressing global and national problem. This entry describes the etiology of bullying behavior that occurs between adolescents, the victimization and

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perpetration rates, and outcomes based on gender, sexual orientation, and disability.

that nationwide 20% of students in Grades 9 through 12 experienced bullying.

Defining Bullying

Gender

On Stopbullying.gov, a public information site, the U.S. Department of Education defines bullying as

Gender makes a difference, although outcomes of the 2013 surveys are at odds with older results. Two 2001 studies conducted by Dorothy Espelage and Dan Nansel had found that males both bullied others and were bullied more often than females. Their findings, similar to those of a number of studies conducted on bullying since the 1970s, reported that females experienced bullying through the use of rumors and sexual comments while males reported being bullied by being hit, slapped, or pushed. However, findings from the 2013 School Crime Supplement to the National Crime Victimization Survey reflect a higher percentage of females than males aged 12 to 18 years reporting being bullied at school during the school year (24% vs. 19%). The 2013 YRBS survey also found that more females were bullied (23.7%) than males (15.6%).

unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose.

School bullies have been described as children or adolescents who use physical or relational aggression in a systematic and calculated way with a group of weaker peers. Research and theory on bullying tend to focus on the personal or psychological characteristics of bullies (e.g., severe adjustment problems), situational factors that prompt bullying, or the reciprocity of bullying behaviors (a number of children and adolescents are characterized as “bully/victims”).

Victimization and Offending Rates A 1998 national survey conducted by the National Institute of Child Health and Human Development indicated that one third of children in Grades 6 through 10 are directly involved in bullying, with 10% as bullies, 13% as victims, and 6% as both. It also reported that the frequency of bullying was higher among 6th- to 8th-grade students than among 9th to 10th graders. Two other national annual surveys that track bullying victimization in schools provide comparison rates over the past 20 years. The first is the U.S. Department of Education’s National Center for Education Statistics School Crime Supplement to the National Crime Victimization Survey. The 2013 survey reported the prevalence of bullying victimization among students aged 12 to 18 years at 22%, a drop of 6% since 2005. The Centers for Disease Control and Prevention Youth Risk ­Behavior Surveillance System (YBRS) survey is also ­conducted annually, and the 2013 survey showed

Age and Race According to the YRBS survey, grade level makes a difference: Bullying victimization rates decline as students age. Fourteen percent of 12th graders, compared with a range of 19% to 23% of 8th to 11th graders, reported bullying. The highest amount of bullying victimization was reported by 6th and 7th graders (28% and 26%, respectively). The 2013 YRBS survey showed that a higher percentage of White students (24%) than of Black students (20%), Hispanic students (19%), and Asian students (9%) reported being bullied at school.

Sexual Orientation Less research has been conducted on the effects of bullying on adolescents who identify as gay, lesbian, bisexual, or transgendered (LGBT). However, the Gay, Lesbian & Straight Education Network (GLSEN) conducts a biennial national survey to assess school climate issues for LGBT youth. The 2013 study found that more than a third of these students had been physically bullied (e.g., shoved or pushed) at some point at school during the past

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year and 19% had been physically assaulted (e.g., punched, kicked, or injured with a weapon).

Disability Although the current literature on bullying and students with disabilities is meager, some insight is available into the experiences of this population. Stephen Russell and colleagues studied 9,016 adolescents in two national surveys and found that among youth reporting victimization, 6.5% reported disability-related bullying. Other studies regarding bullying or peer victimization focused on the specific disabilities of autism, attentiondeficit/hyperactivity disorder (ADHD), and intellectual disability and found that a high proportion of male adolescents with ADHD perpetrated cyberbullying. Other studies of adolescents with intellectual disabilities or those who received special education found that these students were significantly more likely to report being bullied than their peers with typical cognitive development.

Why Bullies Bully Each aspect of bullying, victimization and perpetration, has been well studied. Research on bullying covers the etiology of bullying, differential assessment of bullies, and outcomes for bullies. Additionally, research on the outcomes victims of bullying experience has also been well documented. There is a plethora of information in the literature defining the developmental problems that lead to bullying behavior. Studies have shown that bullies have more psychiatric or physical symp­ toms than other young people and may suffer from insecurity, anxiety, depression, loneliness, unhappiness, or low self-esteem while giving the i­ mpression of being aloof and detached emotionally from others. Such bullies are likely to be cold, manipulative, and highly skilled in social situations and could pose a risk to the safety of their peers. Research has also shown that some bullies are impulsive and bully due to their ADHD. Opposing findings have been that the bully may be very competent socially, have a high level of self-esteem, and be popular with peers. Looking to external factors, some studies have suggested that bullying is learned from influential

role models in the social environment of the child. Parental maltreatment, emotional and/or physical, combined with physical discipline and bullying in the home has also been shown to be a predictor of bullying behavior. Additionally, family size has also been indicated as a cause, with children from larger families more likely to bully.

Profile of Victims Although the literature portrays bullies in a poor light, the picture is even worse for their victims. Being bullied is a significant indicator of risk for mental disorders in adolescence, including the development of anxiety and depression. Victims have a lower level of social acceptance than their peers and more serious mental and physical health problems combined with fewer support systems than others. Finally, victimization is related to a greater incidence of depression and suicidal ideation in adolescents and young adults.

Bully/Victims Victims of bullying do not always suffer quietly. There is increasing concern about victims ­expressing their frustration and bullying back in retaliation and thus being considered as bully/ victims. A study by Jessie Klein highlights the role that ­ bullying has played in school shootings. Many school shooters (all male) had been bullied and ostracized by peers, and after years of ­experi­encing homophobic attacks, they organized revenge schemes. School was a dangerous place for them, but attendance was compulsory, and these male adolescents then retaliated against teachers and classmates. James P. McGee and Caren R. DeBernardo studied 16 male adolescents who committed homicide in schools and found 14 to be both bully and victim.

Depression and Suicide Results suggest that the relative odds of suicidal ideation are elevated for youth victims of bullying. Within the context of other important factors, being bullied was associated with odds of suicidal ideation twice that for nonvictimized youth. Michelle Ybarra and colleagues conducted a metaanalysis of peer victimization studies occurring

Bullying in Adolescence

over 20 years (1980–2000). This multiyear analysis found that bullied boys were four times more likely to be suicidal as compared with bullied girls, who were eight times more likely to be suicidal than their nonbullied peers. Within sexual identity, the relation between bullying and suicidal ideation was particularly strong for LGBT youth, even after adjusting for other influential factors. Findings from the 2013 YRBS survey compared gay, lesbian, and bisexual students with their heterosexual peers and found that sexual minority students were four times more likely to have attempted suicide. Other factors including depressive symptomatology and low self-esteem were also predictive of recent suicidal ideation across all sexual identities. A 2012 study conducted by Andrea Roberts and colleagues reported on gender nonconformity in adolescents. For gender nonconforming youth, abuse and bullying victimization both inside and outside the home accounted for approximately half the increased prevalence of depressive symptoms in adolescence. Gender nonconforming heterosexuals and males were at particularly elevated risk for depressive symptoms. With regard to adolescents with a disability, one study found that a high proportion of male adolescents with ADHD were victims of cyberbullying and reported more severe depression and suicidality than those who were not victims. These findings highlight the complex relation between bullying and depression.

Sexual Bullying Some bullying behaviors are categorized as sexual bullying, where students are called derogatory names (e.g., slut, whore, or fag) that demean their gender or sexual orientation, or they experience physical intimidation, such as being touched ­sexually (e.g., groping, forced kisses, etc.). Cyberbullying frequently falls under this label, because ­students are humiliated online with rumors of their “sleeping around” or by having public remarks written about them alleging sexual conduct with other people. Many of these behaviors are in ­actuality sexual harassment, which if defined as such would provide students more redress. ­Distinguishing between bullying and sexual harassment behaviors is important because a child or

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adolescent who identifies a behavior as bullying does not have the same protections as one who calls those same behaviors sexual harassment.

Sexual Harassment and Bullying Two concerns have arisen about conflating sexual harassment and bullying (or sexual bullying) behaviors. One is that state laws may offer fewer protections than federal civil rights laws. Many states have now passed antibullying laws, but these offer a lower bar in protecting students from noxious behaviors than do federal laws addressing sexual harassment. Thus, a failure to identify a case as sexual harassment, rather than bullying, could lead to a failure to provide all possible protections to victims. A second potential drawback when sexual harassment is called bullying or sexual bullying can be the personalization of the behavior to particular students, whether bully or victim, thus pathologizing them as individuals. This perspective alters the problem from being a school environment issue that the school has a responsibility to solve under Title IX to an issue in which individual students are to blame for their bad behaviors, with their parents subsequently shouldering the burden to correct them. Under Title IX, a school system can be held responsible when school personnel knowingly allow a “hostile environment.” Thus, legally, schools are responsible for the actions of their students (and employees) with regard to sexual harassment. However, when bullying is alleged, it is legally more likely that responsibility will revert to the individuals involved (bully or victim), with their parents required to provide a solution.

Outcomes for Adolescents Who Bully The long-term prediction for bullies is not good. Research shows that being a bully is a strong predictor of juvenile delinquency and community violence. The most remarkable conclusions have been drawn from the work of Olweus, who found that former bullies were four times more likely to engage in criminal behavior. At the age of 24, 60% of former bullies had one or more criminal convictions, and 35% had three or more convictions. Susan Fineran

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See also Bullying, Gender-Based; Bullying in Childhood; Identity Formation in Adolescence

Further Readings Centers for Disease Control and Prevention. (2014). Youth Risk Behavior Surveillance System. Morbidity and Mortality Weekly Report, 63(4), 1–272. Espelage, D., & Holt, M. K. (2001). Bullying and victimization during early adolescence: Peer influences and psychosocial correlates. In R. A. Geffner & M. Loring (Eds.), Bullying behavior: Current issues, research, and interventions (pp. 123–142). Binghamton, NY: Haworth Maltreatment and Trauma Press/Haworth Press. Gruber, J. E., & Fineran, S. (2008). Comparing the impact of bullying and sexual harassment victimization on the mental and physical health of adolescents. Sex Roles, 59(1/2), 1–13. Klein, J. (2006). Sexuality and school shootings: What role does teasing play in school massacres? Journal of Homosexuality, 51, 39–62. Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian, Straight Education Network. McGee, J. P., & DeBernardo, C. R. (1999). The classroom avenger. In N. G. Ribner (Ed.), The handbook of juvenile forensic psychology (pp. 230–249). San Francisco, CA: Wiley. Nansel, T. R., Overpeck, M., Pilla. R. S., Ruan, W. J., Simons-Morton, B., & Scheidt, P. (2001). Bullying behaviors among U.S. youth: Prevalence and association with psychological adjustment. Journal of the American Medical Association, 285, 2094–2100. Olweus, D. (1993). Bullying at school. Oxford, England: Basil Blackwell. Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, B. (2012). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: An 11-year longitudinal study. American Academy of Child and Adolescent Psychiatry, 52(2), 143–152. Russell, S. T., Sinclair, K. O., Poteat, V. P., & Koenig, B. W. (2012). Adolescent health and harassment based on discriminatory bias. American Journal of Public Health, 102(3), 493–495. U.S. Department of Education, Office for Civil Rights. (2013). School Crime Supplement to the National Crime Victimization Survey. Washington, DC: Author.

Ybarra, M. L., Mitchell, K. J., Kosciw, J. G., & Korchmaros, J. D. (2015). Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States. Prevention Science, 16(3), 451–462.

Bullying

in

Childhood

Bullying has received a lot of attention in recent years as a serious social problem with harsh ­consequences for many children and adolescents, including depression and suicide. Bullying occurs across ethnicities and across age- and grade groups among children and adolescents across the United States as well as internationally. Bullying occurs in all genders, albeit oftentimes in different ways. Cyberbullying has become another vehicle for bullying among children who frequently use social media and electronic devices to communicate with each other. This entry examines some of the theories used to explain bullying and cyberbullying among boys and girls, as well as children exhibiting nonconformist gender behaviors and those who identify as transgender.

Social Learning Theory Social learning theory explains different social phenomena, such as bullying, by examining social relationships and understanding how people learn. In the case of bullying, social learning theorists believe that children learn certain behaviors and how to react to certain situations, thus their behaviors are called learned behaviors. Girls often learn about female stereotypes through the media, including television shows and movies, magazines, and advertisements. This creates pressure to look and behave in certain ways. Girls may also learn how to react to certain situations from watching their parents’ interactions. Equally, boys also learn about how men “should” behave through the media. Male stereotypes of aggressive behaviors are present on television shows, in movies, and in video games that condone the use of violence or physical behavior to solve problems; some theorists believe that this, in turn, leads to increases in boys’ aggressive behaviors. In general, children who witness their parents’ experiences of

Bullying in Childhood

interpersonal violence (IPV) are at a higher risk of acting as a bully. The same is true for children who are abused, either physically or emotionally, as this is one of the primary ways in which they learn to resolve conflict. Higher levels of parental involvement and support are also associated with children who do not engage in bullying behavior.

Cognitive Theory Cognitive theory explains social phenomena, such as bullying, through an individual’s thought processes. In the case of bullying, cognitive theorists or cognitive psychologists focus on the thoughts of the bully and the bullied, examining their perceptions of themselves and others, and the way they perceive or understand their surroundings. For example, if a child or adolescent has a specific idea or thought about another child or adolescent, this thought could lead to a bullying behavior in response. Furthermore, if a child or adolescent bully perceives another child to be “weak” and does not expect the child to retaliate, they may choose to bully this child based on that perception. Many children who are victimized by bullying already have cognitive perceptions of self-doubt, which are perpetuated by the bullying experience. These children may feel as if they deserve the bullying, which may in turn lead to further self-doubt and depressive symptoms as well as anxiety. In relation to gender, individuals, including children and adolescents, have cognitions, or thoughts, about their gender roles. Cognitive theorists believe that children develop thought patterns about their gender roles as they grow. Thus, children interact with others and react to others differently based on ways that they think are consistent with their gender norms.

Sociocultural Theory Similar to social learning theory, sociocultural theory examines social phenomena by understanding the way culture influences people to behave. Children and adolescents are socialized in different ways based on their cultural upbringing. For example, children of first-generation immigrants may be socialized around more traditional gender roles, which could heavily influence the way that they react in any social interactions with peers,

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including bullying situations. It may influence boys to act or react with more aggression, as men in their culture might be socialized to show strength through aggression. Girls, however, may not feel comfortable asking for help, if they are socialized to be quieter and less obtrusive than boys. Another culture may normalize shaming behavior in certain situations, leading children to behave this way toward their peers. These types of situations may contribute to whether or not they view bullying as acceptable behavior.

Gender and the Bullying Process Although all genders are involved in bullying, the experiences are often different. Boys are more likely to use physical and verbal forms of aggression in order to bully, whereas girls use more relational forms of bullying, such as spreading rumors about one another. Girls are also more likely to experience teasing and indirect forms of bullying, such as sexual harassment and comments that are sexual in nature. However, there are disputes in the literature about whether or not boys and girls participate equally in indirect forms of bullying. The research is clear that boys are more likely to be aggressive and participate in physical forms of bullying. Classic stereotypes of women and girls spreading rumors and being “catty” may perpetuate ideas that girls are more likely to use this type of bullying than boys. There are studies that show, however, that boys also participate in such indirect forms of bullying, in addition to being physical and aggressive. Boys are more likely to be bullied about religion or race than girls. Furthermore, boys who bully are more likely to smoke cigarettes and use drugs than girls who bully. Bullying in adolescent boys often takes the form of sexual harassment of girls. Bullying in girls is often related to social power. Girls often develop at a faster rate than boys and may have a quicker wit or may be more easily able to verbalize their aggression than boys. Similarly, girls may participate in cyberbullying more often than boys because they have stronger verbal skills. For example, an adolescent girl might be angry about something that happened with another girl in school and she might text her or message her on Facebook with a nasty message, demeaning her. The use of Facebook to bully creates a very public presence in social media.

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Cyberbullying also allows both parties to be less inhibited because there is no face-to-face or direct voice contact when using social media. In defining types of bullying, girls are also more likely than boys to identify social aggression as a form of bullying. Adolescent girls are also more likely than adolescent boys to identify cyberbullying as an issue. Studies are mixed in terms of gender and victimization by cyberbullying. Some suggest that girls are at higher risk, since girls report being ­bullied more often over e-mail and through text messages, while others suggest that the risk is equal in both genders. Boys and girls also use the Internet differently. Girls are more likely to use instant messaging and to keep blogs, while boys are more likely to play video games, including games that include interactions with other players. Thus, these forms of social media may play a role in the way girls and boys experience bullying. Bullying is often done within the context of the peer group or in a classroom setting, with the objective to raise power status by using bullying behavior toward another child. Bullies often look for others to watch their behavior in order to gain status. Girls are more likely than boys to reach out for help and to believe that help and support will end the bullying. Boys are more likely than girls, though, to intervene in the bullying situation.

Nonconformist Gender Behaviors and Gender Identification Bullying among children who have gender nonconforming behavior is a subject that has started to receive more attention, although research on this topic is not robust. Some studies suggest that these children are at higher risk for bullying and mental health issues, such as depression, anxiety, and suicide attempts. Research is not clear about differences in gender with regard to biological females and males being at higher risk in this area, but it is clear that both biological females and males exhibiting gender nonconforming behavior are at higher risk of being bullied. It is important to note that a very large, national, long-term study found increases in depression and depressive symptoms in children who exhibited gender nonconforming behaviors. Bullying and abuse from peers around these issues accounted

for half of the increase in depressive symptoms. The results in this study were more pronounced for males than for females. Another large national study found that 81% of adolescents who identified as transgender reported bullying in the form of sexual harassment. Furthermore, studies also demonstrate that youth who identify as sexual ­ minorities are at higher risk for bullying and physical abuse by peers than heterosexual youth. All genders identifying as sexual minorities are at higher risk than heterosexual youth of being threatened with a weapon on school grounds.

Interventions Children and adolescents who are bullied are at an overall higher risk for depression and anxiety and are often found to be more socially withdrawn. These children also have more psychosomatic complaints of headaches and stomachaches than children who are not bullied. Girls are at a higher risk for depression and posttraumatic stress disorder (PTSD) symptoms than boys. Boys are at a higher risk for increased aggressive behavior. All genders have increased risk for suicide and serious mental health concerns. Bullying in the form of sexual harassment can lead to more serious forms of aggression toward young women. Interventions to handle bullying among children of all ages should be gender and culture sensitive. Interventions should include work with parents, as children often learn behavior in the home context, whether related to parental habits or cultural beliefs. Interventions must also be sensitive to children who do not follow gender norms and may be victimized in this context. Children who either exhibit gender nonconforming behavior or identify themselves as sexual minority are at higher risk for bullying and the serious associated consequences of bullying. Children identifying as transgender or exhibiting gender-atypical behavior have received a lot of media attention in recent years. However, this is not yet normalized in many cultures or families, thus it becomes a source of discomfort for many and leads to bullying behavior because the child is different from others. So children who exhibit gender nonconforming behaviors or identify as transgender should be watched and engaged with additional intervention as they may be bullied. Psychoeducation for parents, families,

Butch

teachers, and peers is important to reduce the risk for bullying among these children.

Future Directions In summary, bullying has become a nationally as well as internationally recognized social problem. Bullying specifically related to gender and gender identity issues is also receiving attention in the media. Some work has been done examining the relationship of gender nonconforming behaviors and bullying, suggesting that these children are at higher risk for bullying. Research has also been done to examine gender differences in bullying behaviors and experiences. However, although the majority of research demonstrates that boys are more heavily involved in bullying physically and girls may be more likely to use relational and verbal bullying strategies, there are other studies that show that few differences exist between genders. Thus, additional research must be done to resolve these disparities. Attention must also be paid to strategies of measurement and the types of questions asked, so that there is some uniformity of results across studies. Bullying related to gender nonconforming behaviors and children identifying as transgender is a very important topic, as many children and adolescents have either tried to commit suicide or have successfully committed suicide because they were bullied around these issues. Research is needed to establish evidence-based interventions to educate communities, schools, and families about the consequences of bullying, especially with regard to bullying and gender identity issues. Gendersensitive interventions must take issues surrounding identity into account if they are to be effective. Interventions that assist children struggling with gender identity and development issues are necessary as well. Amanda Sisselman-Borgia See also Behavioral Theories of Gender Development; Body Image; Bullying, Gender-Based; Bullying in Adolescence; Identity Formation in Adolescence

Further Readings Carbone-Lopez, K., Esbensen, F. A., & Brick, B. T. (2010). Correlates and consequences of peer victimization:

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Gender differences in direct and indirect forms of bullying. Youth Violence and Juvenile Justice, 8(4), 332–350. Erdur-Baker, Ö. (2010). Cyberbullying and its correlation to traditional bullying, gender and frequent and risky usage of Internet-mediated communication tools. New Media & Society, 12(1), 109–125. Espelage, D. L., & Swearer, S. M. (Eds.). (2011). Bullying in North American schools. New York, NY: Routledge. Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S. & Sites, E. W. (2006). The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. Journal of Adolescent Health, 38, 621–623. Hinduja, S., & Patchin, J. W. (Eds.). (2011). State cyberbullying laws: A brief review of state cyberbullying laws and policies (Cyberbullying Research Center). Retrieved from http://cyberbullying .org/Bullying-and-Cyberbullying-Laws.pdf Mitchell, K. J., Ybarra, M. L., & Korchmaros, J. D. (2014). Sexual harassment among adolescents of different sexual orientations and gender identities. Child Abuse & Neglect, 38(2), 280–295. Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, S. B. (2013). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: An 11-year longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 143–152. Russell, S. T., & Joyner, K. (2002). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91, 1276–1281.

Butch Butch was a term coined in the early 20th century to describe people with masculine gender presentation (the way one physically presents oneself to the world) and/or masculine gender identity (the way one internally feels about one’s gender). While the term can be utilized for any gender, it is most commonly utilized by the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community to describe lesbian or queer identified women who fall on the masculine end of the spectrum regarding physical appearance, because they wear men’s clothing or maintain a masculine hairstyle (e.g., short, cropped

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hair). As such, butch is typically utilized to describe the gender presentation and/or gender identity of lesbian, bisexual, or queer women. Butch identified women are oftentimes stereotyped as upholding specific values, beliefs, and ways of navigating society that are similar to those of heterosexual men. For example, butch women may take on the gender role typically associated with men, such as serving as the primary breadwinner, initiating sex, playing/watching sports, or exhibiting a dominant or assertive role in a relationship. These assumptions are often misconceptions held by society, since butch individuals do not exclusively behave in ways (negative or positive) typically displayed by heterosexual men. This entry examines butch personality traits, behaviors, beliefs, and styles; the terminology used to describe butch individuals; and the types of discrimination commonly faced by women who fall on the butch continuum.

intentionally flattening breasts with a bandage, spandex, sports bras, or multiple layers of clothing) or packing (e.g., wearing a phallic device in one’s underwear to indicate masculinity or readiness for penile penetration). Other butch identified women do not engage in the aforementioned behaviors and may exhibit a combination of physical traits and personality characteristics associated with both men and women. As such, the term butch is not a formulaic categorization of gender identity or gender presentation but an overarching theme of masculine sensibilities beyond being a tomboy. A woman may be characterized as butch even if she embodies physical attributes, personality characteristics, and gender roles associated with both men and women. For example, she may have long hair but may navigate the world in men’s clothing, display a dominant attitude, exhibit masculine gestures, and comport herself in a strong, assertive interpersonal manner.

Personality Traits, Interpersonal Behaviors and Beliefs, and Personal Style

Other Terminology

The earliest articulations of butch were observed in the early 20th century, when women “passed” (women physically looked like men to others in society) wearing traditional male garments, including suits and ties. Historical reasons for ­ wearing men’s attire and “passing” for male mainly involved gaining access to specific societal and financial privileges typically circumscribed to men (e.g., owning property, writing checks, opening a bank account). Arguably, the use of a masculine style of dress by butch women in the latter part of the 20th century and the beginning of the 21st century has been for reasons other than accessibility. ­Embodiment of the butch identity is a ­departure from the rigid explicit and implicit expectations for women in U.S. culture. The butch label is a complex identity that ­cannot be distilled down or simplified to style of dress (wearing men’s clothing), behaving in ways similar to men (aggressive, competitive), or the common misunderstanding that butches are simply women who want to be men. Butch identified individuals exhibit wide-ranging physical traits, beliefs, attire, expectations, and ways of existing in the world. Some butch identified women engage in behaviors to affirm their internal and external sense of ­masculinity, including breast binding (e.g.,

Varied terminology connoting the butch identity has emerged since the 21st century. Terms such as boi, AG/aggressive, and masculine of center have developed as popular terms among LGBTQ women of color (African, Latin, and Asian Americans) in the United States to describe lesbians, bisexual women, transgender individuals, and queer women who fall on the masculine end of the gender spectrum. While these terms are mainly used among women of color in the LGBTQ community, these classifications serve as an umbrella term synonymous with butch. They also imply particular types of behavior, choice in clothing, expectations, and attitudes. The term boi typically describes individuals who dress in an extremely stylish/hip yet masculine manner. Boi has the connotation of being a “player” (e.g., a person who has sex with several people without relationship commitment) or exhibiting sexual prowess. Boi is considered a positive descriptor for masculine identified persons. Similarly, stud is also an affirmative term for LGBTQ identified persons who are considered masculine and tend to receive significant attention from women (heterosexual or LGBTQ) and who are considered to be skillful in the bedroom. However, they are not characterized as remarkably fashionable individuals, which is a descriptor distinctive to

Bystanders

boi. On the other hand, bull dyke and diesel dyke are disparaging terms that refer to LGBTQ persons who are perceived as aggressive and hypermasculine. The term is used to describe women who partake in stereotypical masculine behaviors (e.g., playing or watching sports), wear functional men’s clothing rather than stylish attire (e.g., flannel shirts and baseball caps), and engage in stereotypical masculine occupation pursuits (e.g., construction or any other type of manual labor).

Discrimination and Differential Treatment Butch identified women are typically perceived as more “visible” or easily identifiable than many other LGBTQ persons. In other words, the larger society frequently assumes that butch women are LGBTQ identified due to their masculine way of dressing, even though butch is not a term used to describe sexual orientation. Given this phenomenon, butch women oftentimes are vulnerable to multiple layers of discrimination (for being gay and butch), harassment, violence, and rejection. Butch women can be easily targeted or accused of wanting to be a man, which can provoke discriminatory remarks by individuals who uphold bigoted or insular attitudes about gender from both the heterosexual and the LGBTQ community. Similar to effeminate gay men, butch women cannot easily disguise their gender presentation, leaving them susceptible to prejudicial treatment and preconceived notions about their values, beliefs, and sexual orientation. Melissa J. Corpus See also Gender Fluidity; Gender Identity; Gender Identity and Adolescence; Gender Identity and Childhood; Gender Identity Disorder, History of; Gender Marginality in Adolescence; Gender Microinequities; Gender Nonconforming Behaviors; Gender Nonconforming People

Further Readings Levitt, H. M., & Heistand, K. R. (2004). A quest for authenticity: Contemporary butch gender. Sex Roles, 50(9/10), 605–621. Levitt, H. M., & Heistand, K. R. (2006). Gender within lesbian sexuality: Butch and femme perspectives. Journal From Constructivist Psychology, 1(18), 39–51.

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Bystanders The concept of a bystander is frequently linked to issues of gender, in the context of bystanders who take responsible action against harassment and discrimination. Bystanders are people who observe or learn about good—or bad—behavior by others, while not knowingly engaged in planning or executing the behavior. They have no formal role in the situation and may or may not take action. If they take helpful action, they may be called “active” or “positive” bystanders, or “up-standers.” This entry considers the cultural, religious, and gender perspectives through which one can understand bystander behavior, the value of bystander training, and directions for future research.

Cultural, Religious, and Gender Lenses Historically, many cultures have expected bystander males to protect females, but depending on the situation, these cultures have also at times expected bystander males to exploit or demean females. For example, a male leader may take action to assist a female who is being harassed, especially if she is a family member or he sees her as part of his “in-group.” The same person may engage in ­ ­micro-inequities or even aggressive behavior in different circumstances or after drinking. Some male bystanders will more typically help men; some women will more typically help women. Gender effects appear to be important but case dependent. Many studies have examined the effect of gender on bystander behavior. Girls and women, by self-report, seem modestly more likely to intervene as responsible bystanders than are boys and men, but interventions vary case by case and issue by issue. The presence of women in formerly all-male groups has been found to be associated with diminished violence; this may be in part due to an indirect bystander effect. Many religions and many organizations have understood the potential importance of bystanders in helping affirm exemplary behavior and discourage unacceptable acts and speech. Peer pressure is widely understood to be powerful for good as well as for unacceptable behavior. The religious parable

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of the Good Samaritan exemplifies the role of a bystander who stops to help a person who had been mugged. The victim was not only not in the Samaritan in-group but may actually have been from a religion the Samaritan would normally have despised. Everyday examples of bystanders taking helpful action on the spot to help strangers are very common: giving a seat to a pregnant woman, helping a man or woman change a tire or dig out a car, breaking up a fight in a dorm, passersby reporting an accident. Bystanders also frequently report unacceptable behavior to the authorities (e.g., by calling a police tip hotline). There are many studies of bystander behavior with respect to specific issues. Most anecdotal and quantitative research refers to bystanders reacting to behavior they perceive as unacceptable, such as micro-inequities, microaggressions, and sexual assault. There are fewer studies of bystanders affirming and fostering behavior seen as good. Despite the fact that helpful bystander behavior is common in real life, there are common situations where both females and males will not notice or not take action when very good things happen or very bad things occur. Because of this, bystanders sometimes have a bad name; the term bystander effect now exists in many languages and refers to a person who does nothing when expected to act. In sum, no generalization about bystander behavior is a universal truth. Many bystanders are strongly influenced by context and to some extent by gender.

Focused Bystander Training With the growing awareness of sexual harassment, bullying, and alcohol and drug abuse, “bystander training” continues to gain support. The government now sometimes encourages or requires certain kinds of bystander training, with respect to specific issues such as safety, sexual assault, and discrimination. The U.S. government and other authors have compiled lengthy bibliographies about the potential effectiveness of bystanders in dealing with sexual violence. Many reports discuss bystander training programs in a context of strong support for such training. For methodological reasons, it is difficult to assess the effectiveness of bystander training in

changing actual behavior. For one thing, the training may suddenly begin in the context of strong organizational leadership, new policies and procedures, and new resources—it could be that any behavioral changes in an organization would properly be linked to many factors. However, a number of studies suggest positive results of training, especially in terms of self-reports by trainees about attitudes.

Future Research Bystanders can be enormously helpful in fostering exemplary behavior and dealing with unacceptable behavior. Future researchers may learn to measure bystander effectiveness, bystanders’ ability to take notice of exemplary or unacceptable behavior, and their being able to judge certain situations as requiring action. Research can examine initiatives, programs, and organizations that assist bystanders in understanding their resources, helping affirm good behavior, and taking appropriate action with unacceptable behavior. With regard to support systems and policies to elicit bystander action, researchers can examine how authorities’ leadership affects whether or not bystanders come forward. For each of these future directions, variables such as gender, race, and ethnicity may be examined to better understand how culture influences bystanders’ experiences across different contexts. Mary P. Rowe and Anna Giraldo-Kerr See also Cultural Gender Role Norms; Gender Microinequities; Gender Stereotypes; Hostile Sexism; Institutional Sexism; Male Privilege; Microaggressions; Sexism; Sexual Harassment; Street Harassment; Subtle Sexism; Women’s Issues: Overview; Workplace Sexual Harassment

Further Readings Katz, J., & Moore, J. (2013). Bystander education training for campus sexual assault prevention: An initial meta-analysis. Violence and Victims, 28(6), 1054–1067. U.S. Department of Justice. (2014). NOT ALONE: Bystander-focused prevention of sexual violence (Report of the White House Task Force to Protect Students From Sexual Assault). Washington, DC: Author. Retrieved from https://www.justice.gov/ovw/ page/file/905957/download

C people with disabilities. First-year students are at a higher risk for campus rape during the first few months of college life, and as a result, this period of campus life is referred to as the “red zone.” Research has also found that the incidence of campus rape of students in Western countries other than the United States is similar to the reported U.S. percentages. A few cultures may be less prone to violent sexual acts, but U.S. culture and most other cultures are referred to as rape-prone ­cultures. Rape is especially common in societies that are characterized by male dominance and by a high degree of violence in general; both are illustrative of an ideology of male aggressiveness.

Campus Rape The term campus rape is used to describe sexual rape of a student attending an institution of higher learning, whether the assault took place on or off the college or university campus. Rape is legally defined as nonconsensual oral, anal, or vaginal penetration obtained by force, by threat of bodily harm, or when the survivor is incapable of giving consent. Consent involves a knowing, informed, voluntary, and mutual decision to engage in sexual activity. Silence, in and of itself, cannot be ­interpreted as consent. Consent can be given by words or actions, as long as those words or actions create mutually understandable permission regarding the conditions of sexual activity. Individuals cannot legally give consent if they are incapacitated due to alcohol or legal or illegal drugs or if they are under a certain age (e.g., 17 years of age in New York State). This entry examines rates of campus rape, perpetrator profiles, reporting procedures, short- and long-term impacts, and legal implications.

Perpetrator Demographics Studies have found that serial rapists account for approximately 90% of all campus rapes. An average of six rapes each has been reported for serial campus rapists. In addition, 1 in 12 college men admit to committing acts that meet the legal definition of rape, while interpreting their behavior as nonrape. Furthermore, 35% of men have reported that they would rape if they could be assured of not being caught. Research has identified several individual factors that contribute to the heightened levels of campus rape. These factors include alcohol consumption and attitudes toward women that are not egalitarian. Cultural factors related to campus rape include peer group support for all types of sexual aggression, including rape. Acceptance of rape myths, prejudicial beliefs about rape and

Incidence Rates The incidence of campus rape has been reaching epidemic proportions. Current statistics indicate that one in four women and one in seven men are survivors of campus rape. In approximately 80% to 90% of campus rapes, the survivors knew the assailant. The incidence of campus rape is higher for people of color, LGBTQ individuals, and 275

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situations surrounding rape, are correlated with self-reported past sexual aggression and with self-willingness to commit rape in the future ­ among men. College men who hold nonegalitarian attitudes toward women and gender roles report that rape is justified in some circumstances and are more likely to blame the victims for their victimization. In some rape-prone campus envi­ ronments, rape is identified as an expression of masculinity and an act by which women can be controlled.

Reporting Campus Rape Less than 5% of sexual assaults are reported to campus and/or law enforcement officials because of self-blame, fear of being blamed for the assault, shame, embarrassment, or fear of retaliation by campus officials and one’s peer group. Individuals who do press charges or report to their campus official may be met with questions, accusations, and other degrading and humiliating experiences. With these barriers preventing the survivors of campus rape from coming forward, it is understandable that rape continues to be one of the most underreported crimes.

campus rape. The legislation states that campuses must adjudicate campus rapes by using the “preponderance of the evidence” standard (i.e., ­ the respondent will be held responsible if it is determined that there is at least a 50.1% chance that the rape occurred). Campuses have also taken additional preventative programs to educate ­students, faculty, staff, and administrators about the incidence and psychological dimensions of campus rape, including their responsibilities to report incidents to the appropriate campus official (i.e., Title IX Coordinator or Deputy Title IX Coordinator). These programs include bystander intervention programs that encourage students to identify and diffuse situations that may lead to rape, social media campaigns to raise awareness about campus rape, and participation in “Take Back the Night” marches, which seek to draw attention to how all individuals are at risk for rape, including campus rape. Michele A. Paludi See also Acquaintance Rape; Date Rape; Rape Culture; Sexual Assault, Adolescent Survivors of

Further Readings

Impact of Campus Rape on Individuals and the Campus Survivors of campus rape exhibit high distress ­levels within the first week following the assault. This distress peaks in severity 3 weeks following the violence, continues at a high level for 1 month, and then starts to improve 3 months after the rape incident. One fourth of college women who are raped continue to experience negative effects ­several years postvictimization. Survivors also are likely to experience depression, substance abuse, cutting, generalized anxiety disorder, and ­posttraumatic stress disorder. The cost of sexual misconduct to campuses includes absenteeism, fear, decreased morale, decreased productivity, and lack of trust.

Legal Responsibilities of Campuses Title IX of the 1972 Education Amendments requires that all college and university campuses prevent, investigate, and adjudicate cases of

Fisher, B., Cullen, F., & Turner, M. (2000). The sexual victimization of college women. Washington, DC: U.S. Department of Justice, National Institute of Justice and Bureau of Justice Statistics. Koss, M. (1993). Rape: Scope, impact, interventions and public policy. American Psychologist, 48, 1062–1069. Lundberg-Love, P., & Marmion, S. (2006). Intimate violence against women: When spouses, partners, or lovers attack. Westport, CT: Praeger. O’Donohue, W., Yeater, E., & Fanetti, M. (2003). Rape prevention with college males: The roles of rape myth acceptance, victim empathy, and outcome expectancies. Journal of Interpersonal Violence, 18, 513–531. Paludi, M. (Ed.). (2008). Understanding and preventing campus violence. Westport, CT: Praeger. Rozee, P. (1993). Forbidden or forgiven: Rape in crosscultural perspective. Psychology of Women Quarterly, 17, 499–514. Waits, B., & Lundberg-Love, P. (2008). The impact of campus violence on college students. In M. Paludi (Ed.), Understanding and preventing campus violence (pp. 51–70). Westport, CT: Praeger.

Career Choice and Gender

Career Choice

and

Gender

In the United States, gender disparity in the workforce has slowly diminished as women’s ­ participation in the labor market has increased. ­ While women accounted for only one third of the workforce in the 1960s, by the 2010s, women accounted for at least one half of the workforce. Despite this rapid growth, gender-segregated employment patterns persist. Gaining a better understanding of how gender influences career choices is an important step toward creating and sustaining a gender-balanced and economically equal labor market. While the issue of biological differences in abilities and preferences for the selection of occupation is relevant, it is not the focus of this entry. Rather, this entry examines gender as a social construction, provides an overview of current theories on career decision making, and explores the factors that may contribute to ongoing gender disparities in career choice.

Gender Differences in Career Choices and Statuses

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education, the humanities, health care, social work, and the human sciences, whereas men dominated both undergraduate and graduate programs in STEM. Furthermore, women who graduated with a STEM degree were less likely than their male counterparts to work in the STEM fields. With regard to professional status, the general pattern suggests that men outnumber women in higher prestige and higher paying positions across different professions. In business management, women hold only 25% of middle- and executivelevels jobs. In addition, less than one fifth of women make it to leading executive positions. In academia, although the number of doctorate degrees received by both genders is about the same, women constitute only one third of all ­full-time professors. Moreover, only 26% of the tenured professor positions were filled by females in 2005. In sum, gender disparity is profound both vertically and horizontally across different career fields and levels. Aptitude Versus Attitudes

Psychologists have questioned whether gender differences in career choices are due to abilities or attitudes. The gender similarities hypothesis proOccupational segregation between women and men posed by Janet Hyde posits that women and men has remained substantial, especially in professional have more similarities than differences in their aptifields that require intensive educational training tude. Evidence shows that girls and boys have comsuch as the physical sciences, technology, engineerparable math and science grades throughout middle ing, and mathematics (STEM). According to the and high schools, although boys slightly outperAmerican National Survey in 2009, women held form girls on tests of science and math on the only 24% of STEM jobs, with the lowest represenNational Assessment of Education Progress. In tation in mathematics-related careers. Women are contrast, greater gender differences have been found employed predominantly in areas with lower salary in attitudes toward math and science: Girls tend to and lower professional status, such as elementary report a higher level of math anxiety, lower confiand secondary education, clerical work, child dence, and more negative self-perception. In short, care, and health care. While the underrepresentadata generally support the theory that attitude, tion of women in STEM has received much a­ ttention rather than aptitude, is a crucial predictor of educain research, the underrepresentation of men in tional and occupational choices. Thus, there have female-dominated professions is often o ­ verlooked. For example, male participation in female-­ been increasing efforts to understand and investigate how attitudinal and motivational factors infludominated areas such as early-childhood education, ence the career choices of women and men. nursing, the health professions, the humanities, and social work was lower than 30% in 2013. Gender imbalance is also seen in educational Overview of Theoretical attainment, choice of college majors, and career Perspectives on Career Choices status. Data collected by the Department of EducaPsychologists have formulated various theoretical tion indicate that in 2010 women made up more approaches to explain how career choices are than 70% of the undergraduate majors in

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made. These theories generally fall under two dimensions: (1) the differential perspective and (2) the developmental perspective. The differential perspective examines how a person’s attributes match with those found in a job environment. The developmental perspective argues that individuals’ career choices are not stagnant and should be viewed in the context of their personal development across different life stages. The Differential Theory

One of the most widely researched career t­heories is John Holland’s model of vocational personalities—known as RIASEC, each letter standing for a particular vocational type: realistic (practical, hands-on), investigative (thinking, scientifically oriented), artistic (creative, self-expressive), social (helping, relationship oriented), enterprising ­(persuading, leading), and conventional (verbally or numerically ordered). The nature of jobs and career environments is also classifiable by these six types. Holland’s theory maintains that individuals seek out occupations and job environments that are congruent with their vocational personalities, which will allow them to express their interests, abilities, and values. The main critique is that the model views career choice as a one-time ­“here-and-now” decision that does not account for contextual influences. The Developmental Theory

In contrast, developmental theorists acknowledge the role of life events in shaping individuals’ occupational interests and choices. Donald Super’s life span approach proposes that career development is a lifelong, continuous process. Individuals develop, refine, and express their self-concept as they progress through five life stages. There are developmental tasks associated with each stage: (1) growth, the development of needs, aspirations, abilities, and attitudes associated with the selfconcept from birth to early adolescence; (2) exploration, the transition from school to work, when choices are narrowed down but not yet finalized; (3) establishment, the trial and stabilization of the self-concept through work experiences from young adulthood to middle age; (4) maintenance, the continual process of modifying the self-concept

until retirement; and (5) decline, the adjustment of the new self-concept following the termination of one’s occupational role. The life span approach states that both internal (e.g., physical and mental abilities) and external (e.g., sociopolitical environment, access to resources) conditions influence the development of self-concept. The main criticism of the life span approach is that it implies a linear career path, which does not reflect the dynamic nature of career development for women and men since the 1990s. For instance, midcareer professionals may return to school for an advanced degree and then launch a new career. The approach also does not explain why and how women and men develop different attitudes and motivations with regard to their careers starting from early childhood. The social cognitive career theory (SCCT), developed by Robert Lent, Steven Brown, and Gail Hackett, on the other hand, provides a more explicit discussion of the reciprocal influence of individual attitudes and external factors on career interests and choices. Rooted in Albert Bandura’s social cognitive theory, SCCT posits that individuals’ career choices depend not only on their ­interests and abilities but also on their self-efficacy (i.e., belief in their capacity to execute a behavior), ­outcome expectations (i.e., perceived outcomes of pursuing a particular job), and interactions with contextual variables such as gender, ethnicity, and social class. Empirical evidence has generally supported the assertions of SCCT; for example, ­ studies have indicated that self-efficacy in a career (e.g., engineering) is linked to individuals’ later outcome expectations, interests, and intent of pursuing the career. Similarly, studies regarding contextual variables have shown that the perception of social opportunities or barriers, such as the visibility of one’s gender group in a particular career field, is associated with individuals’ self-efficacy, interest, and attitude toward getting a job in that field. None of these theories fully account for the gender disparities in career choices; however, SCCT has provided a framework for considering how the interactions among interests, attitudes, and contexts may shape one’s career goals and choices. It has opened up an important process of inquiry on the factors that contribute to gender differences in individuals’ career attitudes, values, and motivations.

Career Choice and Gender

Factors Contributing to Gender Differences in Career Choices Gender Roles and Gender Stereotypes

Psychologists suggest that social contexts play an important role in the development of self-concept and attitudes. Like any other learning and socialization processes, children learn and internalize socially expected and acceptable traits and behaviors for their genders from an early age. Gender-appropriate behaviors (e.g., girls being nurturing toward their dolls or playmates) are reinforced, and genderinappropriate behaviors are discouraged (e.g., girls playing soccer with a group of boys). Girls and boys therefore have different experiences, which subject them to different social roles and statuses in ­adulthood. To illustrate, boys are socialized to be independent, competitive, and aggressive—­ ­ characteristics that are valued by a patriarchal society. On the other hand, girls are socialized to be nurturing, gentle, and yielding—characteristics that will make them less likely to compete or participate equally with men. There are ethnic and cultural variations in the degree to which gender distinctions are emphasized. For example, Mexican ­American families tend to emphasize strict gender stereotyped behaviors, whereas African American families are less likely to adhere to traditional ­gender roles. When gender distinctions are rigidly applied, gender stereotyping ensues. Sandra Bem, a feminist psychologist, proposes that the more gender stereotyping an individual learns during socialization, the more likely she or he will use gender as a lens to classify and evaluate her or his own behavior and that of others. Possible outcomes of gender socialization of relevance to educational and career choices are the development of a gendered self-concept (including a career self-concept) as well as the gender stereotyping of academic subjects and careers. For example, studies have shown that gender stereotypes about math as a male domain are pervasive in North American culture and can be found as early as in second grade. Adolescent girls encounter sexist comments about their math abilities from both peers and teachers. Similarly, male students and trainees report experiencing negative attitudes and mistrust from teachers and administrators of both sexes when they work in female-dominated professions such as nursing and early-childhood education.

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As a result, individuals are more likely to select careers that are congruent with their prescribed gender roles. Women may be dissuaded from pursuing careers in STEM because they are incompatible with feminine traits and behaviors; men may be reluctant to seek female-dominated occupations because they are viewed as being inconsistent with stereotypic male gender roles and behaviors, which are defined by control, dominance, and power. Environmental Constraints

Sociologists and psychologists argue that career choices are embedded in a complex process that is constrained by environmental factors such as social class and cultural values and that people are not always free to make their decisions based on their interests and preferences. Sociologists also point out that a career often symbolizes the fulfillment of a societal role. The concept of a career carries varied meanings to women and men in ­different social, cultural, and economic milieus. Studies have shown that children from workingclass families are less likely to aspire to a professional career because of their limited exposure to role models and education resources than compared with children from professional families. Immigration and acculturation contexts also affect individuals’ career choices; for instance, a lot of working-class immigrants in the United States do not view employment as an execution of their self-concept but rather as a decision based on ­ financial and survival necessity. Many middle-class ­immigrants, especially men, face the brutality of downward social mobility, as they are unable to secure the same career status after migration due to language, cultural, and institutional barriers. Gender differences in career choices and advancement may be more pronounced in traditional, patriarchal societies, where men hold a higher place in the social hierarchy. Women’s primary roles are viewed as being homemakers and caretakers, or followers of their husbands and families; and thus, they are less encouraged to pursue educational and career opportunities. Conversely, men are encouraged to find careers that fulfill their breadwinner and leadership roles. Research shows that men—especially those from lower socioeconomic ­backgrounds—consider job and financial stability as a prime factor in their occupational choices.

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Subsequently, they are deterred from seeking femaledominated occupations, which are seen as lower in status and ­financial rewards. Nonetheless, the economic recession in the United States during the late 2000s has limited men’s job prospects and forced them to consider nontraditional career choices, such as nursing and early-childhood education. Organization Culture

Organization culture, such as the norms, traditions, and practices within an organization, is typically created by men and favors men’s values and lifestyle. The corporate culture, which requires long working hours, overtime work, or intense traveling schedules, often generates work-life ­conflicts for women, who are primarily responsible for child rearing, domestic work, and caring for the elderly. Studies show that when other major decisions such as marriage and child rearing need to be taken into consideration, occupational choices in professional fields for women become restricted. Women also tend to be perceived as less committed to their careers than men because of their family priorities. Psychologists find that organization culture has a substantial impact on individuals’ job satisfaction, commitment, and work performance. Since women need to modify their behaviors (e.g., communication style) to fit in a male-dominated work environment, they often experience lower job ­satisfaction, higher stress, and lower commitment. Additionally, women who advance in nontraditional fields tend to face hostility due to the perception of their violation of traditional gender roles; they are perceived negatively as cold and bossy. All in all, male-centered organization policies and work culture could jeopardize women’s performance and create barriers to their career advancement and promotion, while at the same time reinforcing men’s leading positions and power within the organization. The incongruence between gender roles and professional identities may contribute to higher stress and lower job satisfaction for women and may deter them from pursuing male-dominated occupations.

Future Directions Researchers have investigated various paths to improve the pattern of gender-segregated

occupations. Consistent with the SCCT model ­discussed earlier, research supports the idea that contextual factors such as positive role models can shape women and men’s attitudes, outcome expectations, and intent to pursue a career. One study found that having identifiable female role models in STEM fields promotes college women’s implicit identification with science and reduces their implicit gendered stereotypes about STEM. Another study found that girls reported an increase in their self-esteem, school self-efficacy, and interest in pursuing nontraditional career choices after participating in an intervention program that emphasizes identification with a STEM field and mentoring from a role model. Thus, the recruitment and retention of women scientists and professors in academia and the visibility of women executives in corporations can have far-reaching impacts on how female students think about and associate themselves with careers in traditionally male-dominated fields. Furthermore, familyfriendly organization policies (e.g., parental leave, flexible work hours, work from home) may encourage men to assume an egalitarian partnership at home, reduce work-life conflicts for women, and allow women to participate equally with men in the workforce. On the other hand, evidence suggests that men who choose female-dominated careers easily adapt and have the opportunity to pursue self-fulfillment. The entrance of men into female-dominated ­occupations may also lead to increased occupational status and higher pay for both male and female workers. Psychologists suggest that career counselors or college counselors could utilize ­gender responsive therapy to help male clients better understand how their gender role attitudes and other masculinity-related issues influence their career choices and enable them to further explore a wide range of traditional and nontraditional behaviors and career options. For future research, psychologists propose the use of an intersectional approach—examining how gender interacts with other variables such as race, ethnicity, immigrant identity, socioeconomic class, and sexual orientation—to develop a more nuanced understanding of how women and men of diverse backgrounds consider and choose their careers. Economists also suggest studying the family and workplace as intertwined contexts. As gender stereotypes gradually erode and men become more

Career Choice and Sexual Orientation

involved in parenting and domestic responsibilities, there is hope that attitudes toward work and career choices will continue to shift over time. Munyi Shea and Khanh Nguyen See also Career Choice and Sexual Orientation; Women in Academia, Experiences of; Women in Corporate Positions, Experiences of; Women in Government, Experiences of

Further Readings Ceci, S. J., & Williams, W. M. (2007). Why aren’t more women in science? Top researchers debate the evidence. Washington, DC: American Psychological Association. Division of Science Resources Statistics, National Science Foundation. (2012). Women, minorities, and persons with disabilities in science and engineering (Special Report NSF 11-309). Arlington, VA: Author. Retrieved from https://www.nsf.gov/statistics/women/ Dodson, T. A., & Borders, L. A. (2006). Men in traditional and nontraditional careers: Gender role attitudes, gender role conflict, and job satisfaction. Career Development Quarterly, 54, 283–296. Hyde, J. S. (2005). The gender similarities hypothesis. American Psychologist, 60, 581–592. Lent, R. W., Brown, S. D., & Hackett, G. (2000). Contextual supports and barriers to career choice: A social cognitive analysis. Journal of Counseling Psychology, 47, 36–49. Presidential Task Force on Educational Disparities, American Psychological Association. (2012). Ethnic and racial disparities in education: Psychology’s contributions to understanding and reducing disparities. Washington, DC: American Psychological Association. Retrieved from http://www.apa.org/ed/ resources/racial-disparities.aspx Radford, J. (Ed.). (1998). Gender and choice in education and occupation. New York, NY: Routledge. Wingfield, A. H. (2013). No more invisible man: Race and gender in men’s work. Philadelphia, PA: Temple University Press.

Career Choice Orientation

and

Sexual

The world of work plays a significant role in the lives of many people. In the United States, it is estimated that 59.3% of the population (ages

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16 years and older) are employed, with the average full-time employee working approximately 46.7 hours a week. The capacity to work is of dire importance for most persons residing in the United States as employment provides the income needed to cover the basic costs of living, as well as the much-needed health care benefits for the workers and their family members. This entry surveys some of the educational and workplace obstacles that face lesbian, gay, bisexual, ­transgender, and queer (LGBTQ) communities in the workplace, the link between workplace ­climate and career development, and emerging protective factors.

Educational and Workplace Obstacles For the LGBTQ community, the world of work must be considered within a sociopolitical framework, especially given the number of legal and social battles the LGBTQ community has faced in recent years. Many LGBTQ people contend with bias and discrimination in schools, which in turn affects their ability to attend college and pursue a meaningful career. In the social science literature, many practitioners and researchers understand the career development of diverse communities by using social cognitive career theory (SCCT). SCCT is a commonly used theoretical framework that allows for a holistic understanding of the development of career-related interests, the selection of career-related choices, and engagement in careerrelated endeavors by LGBTQ workers. SCCT is especially useful for LGBTQ workers because it helps illuminate the links between one’s personal background, the environmental factors related to cultural identity and experience, and the career development process. Thus, SCCT helps practitioners understand the social issues influencing LGBTQ workers’ career choice and development, such as homophobia in schools and the workplace. The real-life impact of homophobia in the workplace affects many LGBTQ workers’ ability to get hired, promoted, and build a meaningful career. In fact, as of 2015, only 29 states in the United States covered nondiscrimination in employment related to sexual orientation and gender identity. This translates to many LGBTQ workers having little to no protection when they face bias and discrimination from their bosses or

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coworkers. In fact, a national study revealed that 15% to 43% of gay and transgender workers experienced discrimination on the job; 8% to 17% reported being overlooked for a job or getting fired as a result of their sexual orientation or gender identity; 10% to 28% received a negative performance evaluation or were not promoted because they were gay or transgender; and 7% to 41% were verbally or physically abused or had their workplace vandalized. As these data illustrate, bias and discrimination related to sexual orientation and gender identity affect the career experiences and development of LGBTQ workers, who must often negotiate their ability to be hired, ­promoted, and retained as a result of the challenging work climates in which they work.

The Connection Between Workplace Climate and Building a Career For many LGBTQ workers, the ability to focus on building a career is hindered by the constant attention they must give to negotiating homophobia in the workplace. Specifically, many workers have to devote time and energy to deal with challenging interpersonal dynamics to ensure that they are not fired if their supervisors or coworkers hold negative beliefs about LGBTQ people. As described by a team of psychology researchers, “Energy that might have been directed toward work-related endeavors must be redirected to self- and job-preserving strategies” (Brenner, Lyons, & Fassinger, 2010, p. 322). Thus, negotiating homophobic workplace climates stifles the career trajectory of many LGBTQ workers. In the realm of career choice, LGBTQ people may have fewer options to find and secure employment in areas where a homophobic and ­ heterosexist workplace culture is known to be prevalent, such as law enforcement and athletics. Researchers have found that some LGBTQ workers choose careers they perceive to be “gay friendly” or “trans friendly for increased opportunities for success, such as fashion and hairstyling for transgender women and nursing for gay men. Thus, perceived workplace culture can affect entire fields of work (e.g., law enforcement) that are deemed too biased against LGBTQ people, thereby limiting career choices of many LGBTQ workers and job seekers.

Finally, it is important to consider that LGBTQ workers are culturally diverse. In addition to LGBTQ status, other areas of bias and discrimination may negatively affect LGBTQ workers, such as sexism against women, racism against people of color, ableism against people with disabilities, and so on. Thus, it is important that practitioners and researchers consider the multiple challenges experienced by the diverse range of LGBTQ workers since individuals live at the intersection of identities.

Protective Factors for LGBTQ Workers Although many LGBTQ workers face challenging workplace cultures, there are positive factors that help buffer the impact of bias and discrimination in the workplace; namely, emotional support from one’s family and friend networks can play an important role. LGBTQ women’s career aspirations have been shown to be higher among those in committed romantic relationships than among women who are single. Furthermore, family career support is especially important for women who hold more negative beliefs about their sexual orientation, meaning that those women with higher rates of internalized homophobia benefit the most from having supportive family and friends. The support from one’s family and friends is helpful in that it cancels out the negative sentiment from people in the workplace, in addition to giving LGBTQ workers the motivation to succeed—one’s career becomes tied to the needs and wishes of the entire family. This entry reviews the many ways LGBTQ workers face challenges, ranging from the lack of state and federal employment protections based on sexual orientation and gender identity to negotiating challenging, sometimes homophobic work environments. However, many LGBTQ workers rely on emotional support from their family and friends to buffer the bias and discrimination they face at work. Thus, although many LGBTQ workers struggle against systemic challenges in the world of work, the presence of a supportive network that provides socioemotional support in the face of homophobic work climates is immensely helpful in career choice for this community of ­talented workers. Alison Cerezo and Konjit Vonetta Page

Caretakers, Experiences of See also Career Choice and Gender; Sexual Identity; Workplace and Gender: Overview

Further Readings Brenner, B. R., Lyons, H. Z., & Fassinger, R. E. (2010). Can heterosexism harm organizations? Predicting the perceived organizational citizenship behaviors of gay and lesbian employees. Career Development Quarterly, 58, 321–335. Bureau of Labor Statistics. (2015). Labor force statistics from the current population survey. Washington, DC: U.S. Department of Labor. Retrieved July 21, 2015, from http://data.bls.gov/timeseries/LNS12300000 Burns, C., & Krehely, J. (2011). Gay and transgender people face high rates of workplace discrimination and harassment: Data demonstrate need for federal law. Washington, DC: Center for American Progress. Retrieved July 21, 2015, from https://cdn. americanprogress.org/wp-content/uploads/ issues/2011/06/pdf/workplace_discrimination.pdf Cerezo, A., Morales, A., Quintero, D., & Rothman, S. (2014). Trans-migrations: A qualitative exploration of life at the intersection of transgender identity and immigration. Psychology of Sexual Orientation and Gender Diversity, 1, 170–180. Chung, Y. B. (2003). Career counseling with lesbian, gay, bisexual, and transgendered persons: The next decade. Career Development Quarterly, 52, 78–86. Chung, Y. B., Chang, T. K., & Rose, C. S. (2015). Managing and coping with sexual identity at work. The Psychologist, 28, 212–215. Retrieved July 21, 2015, from http://thepsychologist.bps.org.uk/ volume-28/march-2015/ managing-and-coping-sexual-identity-work Chung, Y. B., & Harmon, L. W. (1994). The career interests and aspirations of gay men. Journal of Vocational Behavior, 45, 223–239. Elliot, J. E. (1993). Career development with lesbian and gay clients. Career Development Quarterly, 41, 210–226. Fassinger, R. E. (1995). From invisibility to integration: Lesbian identity in the workplace. Career Development Quarterly, 44, 148–167. Fassinger, R. E. (1996). Notes from the margins: Integrating lesbian experience into the vocational psychology of women. Journal of Vocational Behavior, 48, 160–175. Fisher, L. D., Gushue, G. V., & Cerrone, M. T. (2011). The influences of career support and sexual identity on sexual minority women’s career aspirations. Career Development Quarterly, 59, 441–454.

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Human Rights Campaign Foundation. (2015). Corporate Equality Index 2015: Rating American workplaces on lesbian, gay, bisexual and transgender equality. Washington, DC: Author. Retrieved July 24, 2015, from http://hrc-assets.s3-website-us-east-1.amazonaws. com//files/documents/CEI-2015-rev.pdf Lent, R. W., Brown, S. D., & Hackett, G. (1994). Toward a unifying social cognitive theory of career and academic interest, choice, and performance. Journal of Vocational Behavior, 45, 79–122. National Center for Transgender Equality, & the National Gay and Lesbian Task Force. (2011). Injustice at every turn. Washington, DC: Author. Saad, L. (2014). The “40-hour” workweek is actually longer—by seven hours. Retrieved July 21, 2015, from http://www.gallup.com/poll/175286/hour-workweekactually-longer-seven-hours.aspx

Caretakers, Experiences

of

Caretakers, also referred to as caregivers, are an incredibly diverse group, and their concerns are similarly varied. The majority of caregivers in the United States are not provided payment for their caregiving services, and even those who are employed as direct caregivers are often underpaid and undervalued for their time and efforts. Caregivers, both paid and unpaid, are predominantly female identified and experience a multitude of daily-life stressors as a result of their primary caregiving role. As a result of their assigned sex at birth and assigned gender roles, females are expected to be innately nurturing and to be better caregivers than their male counterparts. Often, women are expected to sacrifice careers and other potential personal, academic, and/or professional goals in order to care for family members, including dependent children and aging parents. Issues surrounding diverse sexual orientations and gender identities complicate the experiences of both familial and nonfamilial paid caregivers. Often, caregivers do not get to choose their family members and/or assigned clients; therefore, they must adapt to the evolving needs of their loved ones and/or clients. Although comprehensive sexuality education is more readily available in the 21st century in many countries, including the United States, many people have not yet received any

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education regarding sexual orientation and/or gender identity diversity. As those being cared for progress through their own sexual and gender evolutions, their caregivers must also adapt and be prepared for changing personal needs and societal reactions. On the other hand, as caregivers discover and affirm their nonheterosexual sexual orientations and noncisgender gender identities, the care recipients must also go through their own process in reaction to such changes. Both processes can cause stress on the caregiver/care recipient relationship. Especially with regard to paid ­caregivers, other culturally and socially based differences can also affect the caregiver/care recipient relationship. Race, ethnicity, socioeconomic status, and religion are all factors that can cause clashes between paid caregivers and their clients and/or their client’s families. This entry examines familial and paid caretakers, as well as some of the burdens faced by caretakers.

Familial Caretakers In the face of increasing diversity, in the United States, caregivers now potentially include biological parents, foster parents, adoptive parents, grandparents, aunts/uncles, older siblings, and other extended family members. To survive, families must often rely on multiple income earners, and therefore, traditional gender roles of women as sole caregivers and men as sole income earners are being ­challenged. Both men and women must share caregiving duties as well as financial earning responsibilities. Modern families are composed of not only single-parent households but also family structures headed by same-sex couples. Additionally, lesbian, gay, bisexual, and transgender ­individuals are “coming out” younger, and their caretakers also have to learn how to adapt as a result.

Paid Caretakers Paid caregivers are often employed either directly or indirectly by families when there is a child or adult who requires personal and/or medical care other than what can be provided by family members. These caretakers are either independently employed or provide caregiving services via a ­contracting agency or facility. Paid caregivers can work in private homes, community care centers,

group homes, assisted living facilities, nursing homes, and other long-term care communities. Paid caregivers often specialize in providing care for particular populations, such as children with developmental disabilities, older adults with dementia, adolescents with terminal illnesses, and so forth. Unfortunately, most professional caregivers do not receive either initial or ongoing professional development with regard to sexuality, sexual orientation, and/or gender identity. Therefore, when issues related to any one of these topics arise within their client population, they are often ill equipped to provide appropriate guidance or instruction to either the client or the client’s family. Additionally, depending on their background, religion, and/or value system, these types of issues can place much stress on the caregiver and the caregiver/care recipient relationship.

Caregiver Burden Caregiver burden is multifactorial and can lead to caregiver stress and eventual burnout if caregivers continuously deny their own personal needs. Caregivers of those with chronic and/or terminal illnesses often have to be reminded to care for ­ themselves in addition to caring for their loved ones. Often, caregivers neglect their own needs, including sexual and romantic wants, needs, and desires, when providing continuous care to dependent children or chronically/terminally ill adult family members. Caregiver stress can also be exaggerated when there exists additional stressors surrounding the sexual orientation or gender identity of either the caregiver or the care recipient. For example, same-sex parents or guardians may be concerned about potential overt or covert discrimination from their child’s teachers or their parent’s visiting nurse. On the other hand, an adult child of a trans identified older adult may be stressed by the parent’s worsening dementia and corresponding gender identity confusion. Stephanie C. Chando and Eli R. Green See also Career Choice and Gender; Child Adoption and Gender; Children With LGBTQ Parents; Children With Transgender Parents; Coming Out Processes for LGBTQ Youth; Coming Out Processes for Transgender People; Domestic Care Industry and Women; Family Relationships in Adolescence;

Child Adoption and Gender Fatherhood; Gender Role Socialization; Long-Term Care; Motherhood; Parental Messages About Gender; Parental Stressors

Further Readings Family Caregiver Alliance. (2012). Fact sheet: Selected caregiver statistics. San Francisco, CA: Author. Fredriksen-Goldsen, K., Kim, H., Muraco, A., & Mincer, S. (2009). Chronically ill midlife and older lesbians, gay men, and bisexuals and their informal caregivers: The impact of the social context. Sexuality Research & Social Policy: A Journal of the NSRC, 6(4), 52–64. doi:10.1525/srsp.2009.6.4.52 Hooyman, N. R. (2014). Social and health disparities in aging: Gender inequities in long-term care. Generations, 38(4), 25–32. Wilber, S., Ryan, C., Marksamer, J., & Child Welfare League of America. (2006). CWLA best practice guidelines: Serving LGBT youth in out-of-home care. Washington, DC: Child Welfare League of America.

Child Adoption

and

Gender

Despite the notion of the “traditional family” as a White nuclear family, adoption has a long history in human civilization. Over the past several decades, adoptive families have become more ­visible and recognized in the United States, challenging notions of what constitutes a family and what types of family arrangements are in the best interest of a child. Rather than assume that nontraditional families are destined for maladaptive outcomes, researchers and mental health professionals are increasingly investigating how differences among family members affect child and family functioning, with the goal of producing strong, high-functioning families. While adopted children make up roughly 2% of the total youth population in the United States, they constitute 11% of adolescents referred for therapy. Research has reported that adopted persons identify their adoption status as a significant reason for their participation in mental health services, due in part to the unique challenges that arise in their families. The adoption triad of every adoptive family, which consists of the birth mother, the adoptive parents, and the adopted person, can

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embody differences in biology, race, class, and gender, depending on the type of adoption. This entry addresses the impact of gender differences in adoptive families and how these differences affect the psychological adjustment of adopted persons as well as their adoptive and gender identification.

Adoptive Family Rates and Compositions It is estimated that more than 1 million children in the United States live with an adoptive parent or parents. According to government data, families living in the United States adopted 135,813 children in 2008, a 6% increase from the total ­ adoptions reported in 2000. The majority of children are adopted through stepparent or private domestic infant adoptions (about 46%), followed by adoptions through the child welfare system (41%) and international adoptions (13%). While the gender distribution of children adopted domestically is equal, only about one third of children adopted internationally are males, in part due to the large number of girls made available for adoption from China. Adoptive families are formed through the adoption of children by heterosexual couples, gay couples, lesbian couples, and single parents.

Biases Inherent in Adoption Laws and Practices Long-standing beliefs and prejudices about effective parenting and successful families have ­ influenced the laws and regulations surrounding adoption. Policy changes throughout the past several decades have reflected shifts in belief systems and have begun to change the face of adoption, permitting more transracial in-country and international adoptions, as well as adoption by gay and lesbian couples. Laws legalizing marriage among same-sex couples in many states across the United States have, at least theoretically, made adoption more feasible for gay and lesbian couples. In practice, however, judicial reaction to lesbian and gay couples wanting to adopt has wavered from supportive to hostile, and the efforts of adoption agencies to recruit these couples as adoptive parents have been deficient. Single people choosing to adopt also report greater challenges with the adoption process than heterosexual couples. Despite

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nearly one third of adoptions from foster care being completed by unmarried persons in 2011 (a large majority by single women), biases against single parents persist in the world of adoption. Much of the focus against adoption by single ­parents and lesbian and gay parents has been on the gender identification of adopted persons and the belief that without both a male and a female parent, the gender identification of adopted children will be negatively influenced.

parents determined that the play behavior of boys and girls in same-gender parent families was less gender stereotyped than the play behavior of boys and girls in heterosexual parent families and that these differences were most notable in lesbian mother families. Adopted sons of lesbian mothers evidenced less masculine play behaviors than adopted sons of gay fathers or adopted sons of heterosexual parents.

Gender Identification in Adoptive Families

Advantages for Adoptive Children of Lesbian and Gay Couples

Within the widely held view that family experiences affect children’s outcomes later in life is the debate about whether children reared by lesbian and gay adoptive parents and single adoptive ­parents will be at risk for negative consequences concerning their gender identification. Various psychological theories posit differences in the extent to which parenting affects children’s gender identification. Biological theories stress the importance of intrapsychic processes and prenatal ­hormones, while social-cognitive theories emphasize the impact of dynamic interactions between social experiences and cognitive processes on ­gender role behavior and activities. Most of the research addressing how parental sexual orientation affects child development has found that children of lesbian and gay parents develop similarly as children of heterosexual parents, yet not many studies have focused on adoptive families. Those studies that have focused on adoptive families have yielded some inconsistent results; some have shown no significant differences in the gendered attitudes and behaviors of adopted children of gay and lesbian versus heterosexual parents, while others have reported less gender stereotyped behaviors in adopted children reared in gay and lesbian homes. One set of researchers examining gender role behaviors and activities among adopted preschoolers found no significant differences in the gender development of these children as a function of family type. Regardless of the sexual orientation of their parents, most boys in the study exhibited behavior typical of other adopted same-age boys, and most girls exhibited behaviors typical of other adopted same-age girls. Another study of preschool-age children with lesbian, gay, and heterosexual

Studies such as these have highlighted some advantages for children adopted by gay and lesbian couples. Gender roles modeled by heterosexual couples tend to be more restrictive and conforming to traditional gender roles, influencing children’s views of what it means to be male and female, including their potential for achievement. Lesbian and gay parents may embody more liberal ­attitudes concerning gender nonconformity, such that they are more likely to create environments that reinforce less gender stereotyped play. They may be more likely to facilitate their young children’s cross-gendered play and activities by encouraging such play rather than by punishing it. Division of labor in gay- and lesbian-headed households reflects greater shared responsibilities and flexibility in the roles of income earner and child care provider than in most heterosexualheaded households. Furthermore, they offer a more egalitarian relationship model compared with some heterosexual couples whose actions and beliefs are more likely to be rooted in social and gender constructs of superiority. Some studies have found that daughters adopted by lesbian mothers evidenced a better understanding of establishing appropriate boundaries and verbalizing their needs in the context of interpersonal relationships. Differences in parent reports of the gendered play behaviors of their adopted children, however, may not necessarily reflect actual behavioral differences among their children as much as differences in parents’ level of comfort with ­gender-atypical behaviors. It is possible that heterosexual parents are less comfortable with the gender-atypical behaviors of their adopted ­children, causing them to minimize reports of their frequency.

Child Adoption and Gender

Gender Identification in Single-Parent Adoptive Families Even fewer studies have been conducted examining the gender identification of children and ­adolescents from single-parent adoptive families. Researchers who have studied single-parent adoptive families have determined that the gender ­identity of children in these families is unambiguous and age appropriate.

Gender Preference of Pre-Adoptive Parents While gender biases have been inherent in the laws and policies allowing and prohibiting different types of families to pursue adoption in this ­country, gender biases also are evident in the preferences some pre-adoptive parents reveal in the adoption process. Studies have shown a preference for adopting females across family type, including heterosexual couples, gay and lesbian couples, and single parents. The history of adoption is one that has led to negative misconceptions about birth families: birth mothers and their families have been associated with poverty, instability, promiscuity, and violence. Some prospective adoptive parents worry that their prospective adoptive children could take on the negative ­characteristics of their birth families. In light of this concern, they indicate a preference for females because they are more likely to view girls as victims of their environments and believe that boys will take on the troublesome and delinquent characteristics of their birth families. Others have suggested that adoptive mothers with a history of infertility have an intense desire to nurture a child and many of these women believe that young girls are more capable of being nurtured than young boys. The gender preference in adoption is particularly evident when prospective adoptive parents seek to adopt a child of color, either domestically or internationally. White adoptive parents evidence a preference for females of color. While there is a greater demand for female adoptions from some countries, specifically China, scholars and professionals believe that other factors contribute to the preferences shared by pre-adoptive parents, most of whom are White. It appears that long-held

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negative stereotypes about boys of color as troubled, angry, and threatening influence transracial adoptive parents to choose girls in the adoption process. While some research has indicated that adopted children of color raised in White families present with more behavioral problems than White adopted children raised in White families, other research has shown that transracially adopted youth are just as well-adjusted and no more likely to use drugs or alcohol than same-race adopted youth. Furthermore, no significant differences between male adopted children of color and female adopted children of color were identified in these studies.

Role of Gender in the Development of Adoptive Identity While the gender stereotypes evident in the ­decision-making processes of pre-adoptive parents do not necessarily hold true for adopted individuals, some research has pointed to differences between male and female adopted persons regarding the integration of their adoptive identity into their overall sense of self. A great deal of research on general identity development has focused on chosen aspects of identity including education, vocation, values, and relationships. Children and adolescents strive to integrate these aspects of their identity with those that were not chosen, including race, class, sexual orientation, and gender. For adopted persons, there is the additional task of integrating another assigned identity into their sense of self—namely, their adoption status. How individuals construct meaning about their adoption is made even more complicated by the varying degrees of information made available to them about their birth families and histories prior to their adoption. Some research has pointed to the greater complexity with which girls integrate the relational aspects of their identity compared with boys. Whereas boys seem to focus greater attention on aspects of their identity having to do with school or work, girls tend to integrate aspects of identity across more areas of life. Thus, some researchers suggest that girls are better equipped to integrate their adoptive identity into who they are than boys, who may avoid or struggle to integrate this unique relational identity.

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Future Research Nontraditional families have become more prevalent in the United States over the past several decades and have simultaneously become the focus of more research in an attempt to unpack the effect of difference on family members. Difference in adoptive families can be represented through ­gender roles, structural arrangement, biological ties, and/or race. The manner in which adoptive families navigate these differences contributes to various ­ psychological outcomes for adopted persons. To date, more research has addressed the messages about race and culture transmitted in adoptive families than those about gender and gender identification. Despite the disproportionate numbers of adopted persons who seek psychological treatment, adoption remains a relatively unaddressed topic in mental health settings, in both academic and ­practice realms. A better understanding of gender stereotypes and gender roles in adoptive families, including those of birth and adoptive parents, is warranted to help adopted children navigate the differences that make up their families. Rebecca M. Redington See also Child Play; Childhood and Gender: Overview; Children’s Social-Emotional Development; Gay Men and Gender Roles; Gender Identity; Gender Role Behavior; Identity Formation in Adolescence; Identity Formation in Childhood; Lesbians and Gender Roles; Parental Messages About Gender; Parenting Styles, Gender Differences in

Further Readings Brodzinsky, D., & Pertman, A. (Eds.). (2011). Adoption by lesbians and gay men: A new dimension of family diversity. New York, NY: Oxford University Press. Farr, R. H., Forssell, S. L., & Patterson, C. J. (2010). Parenting and child development in adoptive families: Does parental sexual orientation matter? Applied Developmental Science, 14, 164–178. Farr, R. H., & Patterson, C. J. (2013). Coparenting among lesbian, gay, and heterosexual couples: Associations with adopted children’s outcomes. Child Development, 84, 1126–1140. Goldberg, A. E., Kashy, D. A., & Smith, J. Z. (2012). Gender-typed play behavior in early childhood: Adopted children with lesbian, gay, and heterosexual parents. Sex Roles, 67, 503–513.

Grotevant, H. D., Dunbar, N., Kohler, J. K., & Lash Esau, A. M. (2007). How contexts within and beyond the family shape developmental pathways. In R. A. Javier, A. L. Baden, F. A. Biafora, & A. Camacho-Gingerich (Eds.), Handbook of adoption (pp. 77–89). Thousand Oaks, CA: Sage. Pakizegi, B. (2007). Single-parent adoptions and clinical implications. In R. A. Javier, A. L. Baden, F. A. Biafora, & A. Camacho-Gingerich (Eds.), Handbook of adoption (pp. 190–216). Thousand Oaks, CA: Sage. Patton-Imani, S. (2002). Redefining the ethics of adoption, race, gender, and class. Law & Society Review, 36, 813–862.

Child Neglect Child maltreatment is the abuse or neglect of a child who is under the age of 18. Child neglect, a specific form of child maltreatment, refers to the consistent failure of a caregiver to meet a child’s basic needs. Examples of a child’s basic needs that may be omitted include, but are not limited to, health care, education, nutrition, emotional support, and a safe living environment. This entry examines the prevalence and different types of child neglect, as well as the causes and symptoms of child neglect. The entry concludes with the effects of neglect on children and intervention efforts.

Prevalence of Child Neglect Based on Health and Human Services (HHS) data from 2013, child neglect is the most common form of child maltreatment. More than 79% of child maltreatment cases involved neglect, which is equal to 539,576 victims of child neglect. However, child neglect is frequently unreported, as it is oftentimes not as obvious as other types of child maltreatment, such as physical abuse. Defining child neglect can be difficult due to the inconsistencies in policies and practice; there is no universal definition for child neglect. The d ­ efinitions of child neglect vary across different states and agencies. Many professionals debate the questions that arise on the definition of child neglect. Does a caregiver’s inaction need to be deliberate to constitute child neglect? If the inaction is an outcome of

Child Neglect

poverty, is the situation neglect? What are the minimum requirements for providing basic needs to a child? These questions are examples of the issues that professionals face when deciding on a definition of child neglect. These questions also affect the number of child neglect cases that are reported. Furthermore, defining child neglect depends on the age and development of the child. For instance, leaving a 3-year-old child unattended for an hour at home would be considered neglect. However, if the child were 15 years old, this would not be considered neglect. In addition, cultural values can contribute to differences in the definition of child neglect. For example, in the United States, it is common for children to sleep in their own bedrooms. Yet in other countries, this would be considered emotional neglect. Similarly, many cultures do not support Western medicine. As a result, some cultural groups seek traditional medicine or do not seek medical care at all for their injured or sick children. In many Westernized countries, not seeking appropriate medical attention for an injured or sick child would be considered medical neglect. Cultural differences can make it hard to intervene in instances of neglect, as some caregivers think that they are acting in the best interest of the child.

Types of Child Neglect The most noted types of child neglect include physical, emotional, educational, and medical neglect. Physical neglect is the result of caregivers failing to provide the basic physical necessities to their children. Physical neglect has been identified as the most common type of child neglect. Examples of physical neglect include abandonment; failure to provide food, shelter, or a clean environment; as well as failure to protect a child from physical danger. Emotional neglect is the result of a caregiver failing to provide a child emotional support. Examples of emotional neglect include giving insufficient affection, constantly belittling a child, and lack of response to a child’s maladaptive behavior, such as the use of drugs or alcohol. The impacts of emotional neglect on a child can be more detrimental than the effects of physical neglect.

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Educational neglect occurs when a caregiver fails to provide a child with an environment necessary for adequate development. Examples of ­educational neglect include failure to send a child to school, failure to provide home schooling if the child is not enrolled in a school, or failure to obtain or follow recommended services for a child’s special needs or learning disabilities. Finally, medical neglect occurs when a caregiver fails to seek necessary health care for a child. Examples of medical neglect include refusal to provide the needed health care as recommended by a health care professional, failure to seek mental health care for a child, and failure to seek medical care in a timely manner or from the appropriate professionals. Like all types of child neglect, failure to seek medical care, even in nonemergency situations, can negatively affect a child’s growth and development.

Risk Factors for Child Neglect Children of all socioeconomic classes, races, religions, and genders experience neglect. However, there are factors that can help identify the children who are more at risk for neglect. Children living in poverty are more likely to experience neglect than children who are not living in poverty. Certain family factors can also increase a child’s risk of experiencing neglect. When caregivers experience financial stresses, substance abuse, or social isolation, especially when paired with poverty, their child is at an increased risk of neglect. Other family factors, such as single-parent homes and unemployment, can be risk factors for child neglect. However, it must be noted that most caregivers who experience hardships or live in poverty provide a healthy and ideal environment for their children to develop and grow. When investigating child neglect, it is important to consider the factors that may be affecting the caregiver’s ability to provide for their child. Factors such as physical and mental health issues, low intellect, and substance abuse may negatively affect a caregiver’s ability to care for a child. Young caregivers who may not have adequate knowledge of what children are capable of doing for themselves at different ages may neglect their children. For instance, a young caregiver may not realize that a 3-year-old cannot adequately cook dinner or

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even get a snack without assistance. In addition, many caregivers who neglect their children were neglected themselves when they were children. Moreover, caregivers who do not have family or friends to provide social support or physical help with caring for children may be more at risk of neglecting their children. Societal and environmental factors can also influence a caregiver’s ability to provide a child with an optimal environment for growth and development. Society and environmental factors negatively affecting development can include lack of neighborhood resources and an unsafe neighborhood, such as one with a high prevalence of drugs and crime.

Effects of Child Neglect Child neglect can have long-lasting effects on victims, and it can affect development in multiple areas, such as physical, intellectual, emotional, social, and behavioral. Physical consequences of child neglect include skin infections, severe diaper rash, illnesses, impaired brain development, and malnourishment. In addition, children who do not receive proper medical care can experience poor physical health and impaired brain development. When a child’s brain is not able to fully develop, mental and emotional development may be affected, as well as the development of healthy social skills. Additionally, malnutrition can affect the social, behavioral, and cognitive development of children. For example, malnutrition can trigger anxiety, social problems, attention problems, and motor delays. Experts claim that child neglect can also cause cognitive and intellectual delays. Neglected children oftentimes fall behind academically and become frustrated with schoolwork. Neglected children are more likely to experience insecure attachment with their caregivers, which may cause a child to be unable to trust others and to have low self-esteem. Children exposed to neglect are also at risk of indulging in delinquent behavior and of neglecting their own children as a result of thinking that their child rearing is normal. Oftentimes, when children are exposed to one unhealthy physical condition, it can lead to additional health problems. For example, children who suffer from constant dehydration can experience

more serious health problems, such as kidney failure or seizures. In addition, if children are constantly exposed to pollutants, they can develop severe asthma. A condition oftentimes associated with child neglect is failure to thrive. Failure to thrive consists of the interrupted growth and development of a child compared with peers of the same age and gender. Failure to thrive can be evident through a child’s unresponsiveness, lack of vocalization, and lack of physical growth. Determining whether or not a child is experiencing neglect can be difficult. Oftentimes, the most evident indication is in the child’s appearance. Signs of child neglect include a child with poor hygiene, little energy, and unattended dental or medical problems. Additional signs include a child who frequently reports caring for younger siblings or a child with clothing that is dirty, too small, or too large. Doctors, nurses, neighbors, and day care providers are oftentimes the first people to suspect child neglect. Once a child enters school, school employees often notice the common indicators of child neglect, such as poor hygiene or insufficient medical care. Signs from a child’s caregivers can also indicate possible child neglect. Indifferent and apathetic attitudes toward a child may indicate that a caregiver is neglectful. Additionally, drug and alcohol abuse, irrational behavior, and viewing a child as worthless are signs of child neglect.

Child Neglect Intervention All 50 states in the United States mandate that designated professionals (e.g., teachers, doctors) report child abuse and neglect. However, as previously explained, these states have different definitions of child neglect; therefore, depending on the state, professionals have different considerations to make before reporting neglect. In addition, 18 states have laws stating that any person who has reasonable belief that child abuse or neglect is occurring is mandated to make a report. In all other states, anyone is permitted to make a report; however, reporting is not mandatory for individuals in nonprofessional roles. Child Protective Services is the organization within states that ­ conducts child abuse and neglect assessments ­ and interventions, with the assistance of other

Child Play

community organizations and professionals such as police officers and health care providers. Child neglect prevention efforts are exerted by different organizations. Community centers, parent education groups, and substance abuse treatment programs are examples of organizations that help prevent child neglect by identifying parents who are at risk of neglecting their children. These organizations oftentimes provide parents with education on child neglect and information on what they can do to avoid neglect. Support groups and home visitations for identified at-risk mothers have also been shown to be effective in reducing child neglect. These protective factors are important; however, experts suggest that intervention efforts need to target risk factors as well. Intervention programs may include concrete resources, social support, stress management training, ­instructions on basic child care, and training in communication skills, responsibility, and home management. Sarah Taylor and Yan Xia See also Emotional Abuse; Perpetrators of Violence; Posttraumatic Stress Disorder and Gender Differences in Children; Psychological Abuse; Sexual Assault, Child Survivors of

Further Readings DePanfilis, D. (2006). Child neglect: A guide for prevention, assessment, and intervention. Washington, DC: U.S. Department of Health and Human Services, Adminsitration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Office on Child Abuse and Neglect. Friedman, E., & Billick, S. (2015). Unintentional child neglect: Literature review and observational study. Psychiatric Quarterly, 86(2), 253–259. Hildyard, K. L., & Wolfe, D. A. (2002). Child neglect: Developmental issues and outcomes. Child Abuse & Neglect, 26(6), 679–695. Straus, M. A., & Kantor, G. K. (2005). Definition and measurement of neglectful behavior: Some principles and guidelines. Child Abuse & Neglect, 29(1), 19–29. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2015). Child maltreatment 2013. Retrieved from http://www.acf.hhs.gov/programs/cb/

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research-data-technology/statistics-research/childmaltreatment Young, J. C., & Widom, C. S. (2014). Long-term effects of child abuse and neglect on emotion processing in adulthood. Child Abuse & Neglect, 38(8), 1369–1381.

Child Play Child play is a child’s natural method for expressing, interacting, and learning. It is the primary language of children and showcases their symbolic understanding of the world in which they live and engage. Child play organizes children’s experiences and encourages their understanding of the world through their exploration of objects, language, social roles, and feelings. Play is intrinsically motivated, spontaneous, and noninstrumental, and happens at all times across all situations. Play serves as the primary communication mode for children, given their language and cognitive development structures. Whereas adults communicate primarily through verbalization, play allows children to express their experience at a concrete level through objects and figures. Child play is person dominated in that the child directs and creates the play experience. Given these defining features of child play, it can be understood as the essential and universal activity of children. This entry reviews the functions, types, and patterns of child play and then discusses the impact of diversity issues and adverse events.

Functions of Child Play Child play serves numerous functions across behavioral, emotional, cognitive, and social realms. On a behavioral level, child play contributes to children learning basic skills such as hand-eye coordination and balance. Play also allows a child to relax and expend physical energy. For children’s emotional functioning, play stimulates internal sensations related to both positive and negative feelings. Children increase their ability to recognize, label, understand, and express feelings through play. Similarly, play behaviors allow children to have nonthreatening experiences with individuation and separation. For example, playing peek-a-boo or hide-and-seek prepares a child

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to navigate the emotional regulation and tolerance required when separated from caregivers. Another affective-focused function of child play is the gaining of mastery over conflicts through wish ­ fulfillment and symbolism. Through play, a child can reexperience traumatic events and feelings in a safe environment until the child reaches resolution. On a cognitive level, child play encourages children’s exploration of their world and their understanding of their minds, bodies, and environments. They engage directly with the concrete dimensions of their experience, thereby enhancing cognitive development. The social functions of play include learning how to share, take turns, and be cooperative. The social realm also includes identity ­formation, in which play teaches children about cultural factors and expectations, gender roles, and adult roles.

Types of Child Play There are six different types of child play typically observed: (1) solitary, (2) onlooker, (3) parallel, (4) associative, (5) cooperative, and (6) unoccupied. Solitary play occurs when a child plays alone and independent of others. Two-year-old and 3-yearold children tend to engage in this type of play more frequently than older children. Compared with other types of play, a hallmark of solitary play is the child’s engrossment in the independent play activity. Onlooker play involves a child beginning to interact with others while still maintaining an independent play style. In onlooker play, the child exhibits active interest in another child’s play and may talk to the other child or ask questions. The child does not enter into the play behavior of the other child, thereby maintaining a level of separation between the two play experiences. The level of interaction between the child and others increases with parallel play. In parallel play, the child plays separately while actively imitating the play of another child or using the same toys that another child is using. Preschoolers engage in parallel play frequently, whereas older children do not. As children become older, they are more likely to engage in associative and cooperative play. Associative play involves social interactions with a focus on the group members rather than on the task. This play is not structured and not governed

by many rules and expectations. Cooperative play includes the social interaction exhibited in associative play, but it differs from associative play based on the emergence of a strong group identity and on the level of structure and shared expectations present in the play. This type of play is the primary play of middle childhood. The final type of play, unoccupied play, occurs when children behave in ways not typically understood as play. An example of unoccupied play is standing in one spot and looking around. Such play is rare and is noticeably ­differentiated from the other five types of play.

Play Patterns Across Developmental Stages Child play varies across developmental stages, with play patterns evolving as cognitive, emotional, social, and language development unfolds. For children 2 to 5 years of age, play is shaped by magical beliefs, egocentricism, and centration. Egocentric thinking means that children cannot yet engage in perspective taking, so their ability to engage in empathy or to share playthings can be compromised. Younger children tend to focus on only one characteristic without attending to a ­variety of other features, a concept known as centration. These developmental processes contribute to children being focused primarily on the here and now. Child play at this age is mentally and physically active, with children using themselves as the primary vehicle for expression. For example, a child may pretend to ride a horse around the room and will actively be galloping as part of the play. By the age of 5 years, children will focus their pretending on objects and can engage in elaborate fantasy play. This developmental stage is marked by high levels of solitary play and pretending. Children 6 to 8 years of age are able to recognize the relationship between thoughts and feelings, engage in logical thinking connected to concrete examples, and demonstrate cognitive ­ reversibility, or the ability to mentally undo an action. Children in this developmental stage are able to consider others’ perspectives as empathy begins to develop and egocentricism diminishes. The preferred and more frequent type of play is cooperative play. The most notable play pattern at this stage is the development of play rituals such as rock-paper-scissors. Play rituals and games with

Child Play

rules are enactments of a child’s concrete thinking, thereby providing structures to the child’s world in congruence with the child’s cognitive development. For children 9 to 12 years of age, the balance between play and verbal interactions shifts, with increased reliance on verbalization and decreased use of symbolic play. Child play at this developmental stage tends to focus on the acquisition and demonstration of skills. Whereas a younger child may play with a doll and create an elaborate fantasy of interactions, conversations, and experiences with that doll, an older child may play with a doll and be focused on developing braiding techniques on the hair. The symbolic play with the doll is nonexistent, but the same play object could be used by an older child with a different functionality to the play. A lot of child play at this age manifests in selfexpression through puppetry, masks, or art. It is common for the communication and expression of older children to vacillate between play and verbalization, which results in play patterns being simultaneously sporadic and recurrent.

Multicultural Issues in Child Play In addition to being the natural language of expression, child play reflects the multicultural identities present in the child’s own family system and society as a whole. Play can function to facilitate healthy identity development and confident expression in early childhood while also meeting the challenges of the changing times. Thus, child play and other early-childhood experiences serve as tools for learning about culture, adult roles, and social skills while creating the foundation for the development and expression of multiple identities. Play is universal across cultures, yet the way in which it is displayed varies across cultures. For example, some cultures teach children games that focus on competition and winning, whereas other cultures emphasize games that promote collaboration. Poverty, race, ethnicity, religion, disability, and family structure can affect child play in terms of how roles are expressed, access to playtime and toy objects, how cultural messages are communicated, and the level of imaginative play. Recent data suggest that in 2014, 21% of all American children lived in poverty. Children growing up in poverty have reduced access to tangible

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and intangible resources that can promote spontaneous and imaginative play. Children from lower socioeconomic groups demonstrate less imaginative and cooperative play compared with their peers in middle-class groups and are less likely to have access to recess in educational settings and playtime in their communities. More than half a million American households are led by a same-sex couple, and more than 100,000 of these households report having ­biological, step-, or adoptive children. The 2015 landmark U.S. Supreme Court decision in Obergefell v. Hodges, affirming gay rights and same-sex marriage across all 50 states, will translate into legislation focused on restricting further oppression and marginalization of children and families who may embody and embrace identities outside the dominant heterosexual norm. Given these statistics and the rapidly changing family dynamics in the United States in the 21st century, complex and dynamic identities emerge that may naturally affect the lives of children and their development. Researchers have found that children with samesex parents exhibit less gender stereotyped play behaviors than their peers with heterosexual ­parents. Thus, child play evidences both societal factors as well as familial factors, and children from different cultural systems manifest differences within their play patterns. The first cultural difference that children tend to identify is gender, with most 18-month- to 2-yearolds communicating an awareness of gender differences. Awareness of gender is followed by ­ awareness of racial and ethnic differences and then, subsequently, by awareness of disability. Children from different racial and ethnic groups tend to develop a racial consciousness by the age of 3 years and consistently manifest a preference for play objects and playmates who vary based on racial characteristics. Consciousness of disability and ability emerges for most children by the ages of 4 and 5 years and can influence the level of play interaction a child has with a peer identified or perceived as having a disability. How a child plays, and with what toys, varies by culture, and because of that, play serves to acculturate children and to prepare them for the roles they will assume as adults. Child play reflects children’s cultural values and their bio-ecological system, and it is affected by their level of awareness of cultural dimensions.

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Trauma Affecting Child Play Children who may have been exposed to adverse experiences early in their development can ­generate challenges in attachment, cognitive functioning, emotional regulation, self-worth, and self-identity. The impact of trauma on children can influence how and when play is manifested. Children who have experienced trauma tend to engage in play behaviors at older ages compared with their developmentally matched peers. Children exposed to trauma tend to experience a decrease in spontaneous play, and they may be more likely to engage in literal play, such as sweeping up the room or organizing items on a shelf. Play behaviors correlated to trauma exposure also include developmental immaturity, opposition, aggression, dissociation, withdrawal, passivity, sexually charged interactions, and hypervigilance. Although trauma ­exposure has the potential to alter a child’s developmental framework, play both is developmentally appropriate and may function to rebuild a sense of trust, safety, power, and control without imminent risk in children. Nicole R. Hill and Amber S. Haley See also Cultural Gender Role Norms; Parental Expectations; Pretend Play; Sociodramatic Play/ Role-Play

Further Readings Barbu, S., Cabanes, G., & Le Maner-Idrissi, G. (2011). Boys and girls on the playground: Sex differences in social development are not stable across early childhood. PLoS One, 6(1), e16407. doi:10.1371/journal.pone.0016407 Davies, D. (2010). Child development: A practitioner’s guide. New York, NY: Guilford Press. Goldberg, A. E., Kashy, D. A., & Smith, J. Z. (2012). Gender-typed play behavior in early childhood: Adopted children with lesbian, gay, and heterosexual parents. Sex Roles, 67, 503–515. Grieshaber, S., & Cannella, G. S. (Eds.). (2001). Embracing identities in early childhood education: Diversity and possibilities. New York, NY: Teachers College Press. Lieberman, A. F., & Knorr, K. (2007). The impact of trauma: A developmental framework for infancy and early childhood. Psychiatric Annals, 37, 416–422. Milteer, R. M., Ginsburg, K. R., Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health &

Mulligan, D. A. (2012). The importance of play in promoting healthy child development and maintaining strong parent-child bond: Focus on children in poverty. Pediatrics, 129, e204–e213. doi:10.1542/ peds.2011-2953 Obergefell v. Hodges, 276 U.S. ___ (2015). Svetlova, M., Nichols, S. R., & Brownell, C. A. (2010). Toddlers’ prosocial behavior: From instrumental to empathic to altruistic helping. Child Development, 81, 1814–1827.

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Gender: Overview

Gender is arguably the most salient and important social category for children. It is one of the first descriptors they learn about themselves. By the time they are in preschool, they have attitudes and stereotypes about how boys and girls should look, think, and behave. This entry offers an overview of gender in childhood. It covers what children know and how children think about gender, what gender differences exist between boys and girls, how children learn about gender and gender stereo­ types, and how gender affects the emotional, social, and academic development of children.

Children’s Gender Development Children pay attention to gender more than any other human characteristic. They actively seek out information about boys and girls. Most researchers assert that as children learn about gender as a category, they seek out information about gender groups and self-socialize themselves to fit in with their own gender group. In infancy, babies are primarily learning that males and females are two distinct categories. For example, by the age of 6 months, babies can differentiate between men’s and women’s voices. By 9 months, babies can differentiate the faces of men and women. They also can differentiate the faces of adults, especially when they can see a person’s hair, more easily than they can differentiate the faces of other children. Through the period of toddlerhood and into the preschool years, children are learning information about gender categories. By their second birthday, children can label their own and others’ gender.

Childhood and Gender: Overview

Almost all children by this age spontaneously use gender labels in their play. They can also sort objects into gender-typed categories; for example, children associate hammers with boys and sewing kits with girls. Some children are more focused on gender than other children. In studies examining children’s spontaneous language use, it has been shown that children at this age who frequently used gender labels while playing were more likely to play with gender stereotypic toys (e.g., dolls for girls and trucks for boys). By their third birthday, children can consistently identify their own gender. This is referred to as gender identity. Children also tend to prefer their own gender to the other gender and assign more positive traits to their own gender relative to the other gender. However, although children can identify their own and others’ gender, their understanding of what determines gender is not fully developed. At this age, children believe that gender is determined by external attributes, not biological characteristics associated with biological sex. Specifically, they lack gender constancy. So for a child without gender constancy, a boy who is wearing a dress with painted fingernails is actually a girl. Between 3 and 6 years of age, children develop gender constancy and learn that gender is constant and cannot change simply by changing external attributes like clothes. Beginning around age 3 years (or a bit earlier), usually before they have gender constancy, children develop strong and rigid gender stereotypes. Gender stereotypes refer to a shared set of beliefs about the common characteristics of males and females. A key component of stereotypes is the assumption that boys are most similar to other boys and girls are most similar to other girls and that the two groups are nonoverlapping and distinct from each other. In terms of development, children first believe that men and women differ in possessions (e.g., scarves belong to women and ties belong to men), roles (e.g., men are doctors and women are nurses), and toys and activities (e.g., boys play with trucks and girls play with dolls). By age 4, children hold gender stereotypes about behaviors and personality traits (e.g., boys are tough and strong and girls are gentle and like to cry). They even extrapolate to more abstract concepts, such as men being associated with hardness and women with softness. Over the next few years,

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children extend their stereotypes to incorporate who should engage in certain occupations, school tasks, sports, and interests. Importantly, children assume that these gender differences are “essential” differences. In other words, they assume that the differences between boys and girls are innate, biological, and unchangeable. When gender stereotypes are most rigid, children strongly enforce gender roles. For example, they will only play with things that are consistent with their gender. In laboratory studies, children are given a novel toy, and some are told it is a toy that boys like to play with, while some are told it is a toy that girls like to play with. When it is labeled a boy’s toy, boys want to play with it more than girls; when it is labeled a girl’s toy, girls want to play with it more than boys. These stereotypes remain rigid until children reach about 8 or 9 years of age. At that age, children develop more advanced cognitive abilities, which allow them to be more flexible in their thinking about others. Research has shown that the more sophisticated categorization skills that develop around age 8, which allow children to place objects and people into multiple categories simultaneously, can lead to greater flexibility in gender stereotypes. They realize, for example, that an individual can be both a woman and an astronaut and that being an astronaut does not turn a woman into a man. The result is that the endorsement of gender stereotypes declines across elementary school and children become more flexible about gender roles. While children’s stereotypes are becoming more flexible, they are also learning about the implications of these stereotypes. Specifically, by about 6 years of age, children know that men are associated with higher social status than women. For example, when children were shown an image of a job being performed by a man, they assumed it paid more money, was more difficult to do, and was more important than when the exact same job was shown being performed by a woman. This is true even when the jobs are fictional or novel (e.g., someone who pokes holes into buttons). In other words, children generalize their knowledge about the status of men and women to new occupations. Across middle childhood and into adolescence, children are increasingly likely to state that men have greater power and respect than women.

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By early adolescence, children have quite sophisticated knowledge of gender discrimination, or the concept that children can be treated differently based on their gender. For example, elementary and middle school girls most frequently perceived coaches and boys to discriminate against them in sports, recalling the many times they were presumed to have inferior athletic abilities; boys most frequently perceived teachers to be discriminatory, by assuming that girls were better behaved than boys in the classroom. Children do not often ­perceive themselves to be the target of gender discrimination. Instead, they pay attention to contextual cues (e.g., whether the teacher has a history of favoring one gender over the other) before assuming that discrimination is the reason for their unfair treatment. Not only are children learning about gender roles, they are also developing attitudes about their own gender by developing a multidimensional gender identity. Children’s gender identity can differ in terms of how content they are with gender, how typical they perceive themselves to be of their gender, and how much pressure they feel to conform to gender norms. Gender identity is distinct but likely informed by sexual orientation and gender expression. When children are perceived to have a nontraditional gender identity, they are often teased or rejected by their peers, and this can lead to negative psychological outcomes.

Gender Differences Children value gender as a social category from very early in life and form rigid stereotypes before they even begin elementary school. A logical question then is how important is gender in predicting what boys and girls are actually like. In other words, if gender stereotypes are accurate, it would be beneficial for children to learn them. To examine whether gender stereotypes are accurate, researchers have long looked for actual gender differences in behaviors, traits, and activities. ­ Importantly, the best way to determine whether there are actual gender differences in childhood is to look at meta-analyses. A meta-analysis combines the results from many individual studies and analyzes their combined effects. This allows people to be more confident that the conclusions are not simply based on one study (which may be

idiosyncratic) but are much more generalizable across children. Janet Shibley Hyde is a researcher who has ­ conducted numerous meta-analyses on gender differences. In one of Hyde’s largest studies, she conducted a meta-analysis on 46 different meta-analyses. This means that she examined more than 124 different effect sizes drawn from more than 1 million children. What she found was that boys and girls are more similar than different. Indeed, 78% of these studies found either nonexistent or very few gender differences. This led her to create a gender similarities hypothesis, which argues that males and females are alike on most, but not all, psychological variables. Despite the stereotypes, girls were not shown to be more fearful, shy, or scared of new things than boys; boys were not angrier than girls, and girls were not more emotional than boys; boys did not perform better at math than girls, and girls were not more talkative than boys. What are the actual differences between boys and girls? There is a difference in language skills and usage. Girls develop language skills earlier and know more words than boys. Girls are also more likely than boys to offer praise, to agree with the person they are talking to, and to elaborate on the other person’s comments; boys, in contrast, are more likely than girls to assert their opinion and offer criticism. There are some differences in temperament stemming from infancy, such that boys are less able to suppress inappropriate responses and are slightly more active than girls. The difference in aggression is more pronounced, as boys exhibit higher rates of unprovoked physical aggression than girls (but there is no difference in provoked aggression). Some of the biggest differences involve the play styles of children. Boys frequently play organized rough-and-tumble games in large groups, while girls often play less physical activities in much smaller groups. There are also differences in the rates of depression after puberty, with girls much more likely than boys to be depressed. After puberty, girls are also more likely to be unhappy with their bodies than boys. Even when there are mean level differences on some of these variables, it is important to examine the effect size, or the actual size of the difference. Most differences are quite small. This means that knowing someone’s gender does not help much in predicting his or her actual traits. For example,

Childhood and Gender: Overview

imagine the average boy’s activity level, considering that 50% of boys are more active than him and 50% are less active. Although boys are considered more active than girls, 42% of girls are still more active than that average boy. Furthermore, many gender differences do not reflect innate differences but, instead, reflect differences in specific experiences and socialization. For example, one presumed gender difference is that boys show better spatial abilities than girls. When researchers gave girls the chance to practice their spatial skills (by imagining that a line drawing was of different shapes), they discovered that, with practice, the gender difference in spatial abilities completely disappeared. Other domains showed a gender difference historically, but they no longer show differences. In 1990, a meta-analysis indicated that girls were better at simple computation in elementary and ­ middle school and boys were better at complex problem solving in high school. In 2008, however, in an analysis of statewide math standardized tests given from 2005 to 2007, the results indicated that there were no gender differences at all in mathematics performance. The difference that did exist had disappeared over time. Boys do, however, have more confidence and less anxiety in math than girls.

The Development of Gender Stereotypes: Theoretical Explanations Even though there are not many actual gender differences in childhood, children believe in gender stereotypes and act in accordance with gender roles when as young as 3 years old. Many researchers have tried to explain why gender stereotypes are so strong and important so early in life. These theories are not mutually exclusive, but all contribute to explain the development of gender stereotypes and gender roles. One of the first theories to explain how children develop gender stereotypes was social learning theory. Social learning theory asserts that gender roles are learned through reinforcement, punishment, and modeling. Children are reinforced for behaving according to their specific gender roles by being rewarded with praise and positive attention, and they are punished for breaking gender roles. For example, boys are praised when they behave like a stereotypical boy and act very tough and strong, and they are

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criticized when they behave like a stereotypical girl and cry. Most people have heard boys being scolded and told, “Boys don’t cry. Man up.” Social learning theory argues that children learn many of their gender roles by modeling the behavior of same-sex adults and older children, and in doing so, they develop ideas about what behaviors are appropriate for each gender. This is evident when you see girls mimicking their mother by putting on makeup and walking around in her high heels. There is empirical support for social learning theory. A meta-analysis of research from the ­ United States and Canada found that parents treat sons and daughters differently by encouraging ­gender stereotypical activities. Fathers, more than mothers, are particularly likely to encourage ­gender stereotypical play, especially in sons. Specifically, fathers often punish or criticize their sons for playing with girls’ toys. This occurs even in laboratory studies where the boy is told to play with a girl toy. Sometimes this criticism is very subtle and is conveyed through a grimace or smirking face. Research shows that children pay attention to these nonverbal cues and adapt their behavior accordingly. In other words, social learning theory argues that children will only play and behave in ways that elicit smiles from their parents, which is typically gender stereotypical behavior, and avoid behavior that elicits frowns, thus avoiding behavior that runs counter to gender stereotypes. Another theory that explains how children develop gender stereotypes and gender roles is gender schema theory. This theory has been supported more strongly than social learning theory and explains how children can develop gender stereotypes even when parents treat their sons and daughters similarly. Gender schema theory argues that children are active learners who develop their own beliefs and cognitions about gender and then socialize themselves. In this case, children actively organize others’ behavior, activities, and attributes into elaborate and detailed gender categories known as gender schemas. These gender schemas then guide and filter what children notice and remember later. People of all ages are more likely to remember schema-consistent behaviors and attributes than schema-inconsistent behaviors and attributes. For example, children (and adults) are more likely to remember seeing a man as a firefighter and forget seeing a woman firefighter. They

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also misremember schema-inconsistent information. In studies within the laboratory, children were shown pictures of someone standing at the stove. They were more likely to remember the ­person to be “cooking” if the person was depicted as a woman and more likely to remember the person to be “repairing the stove” if the person was depicted as a man. Not only do children remember schema-consistent information better than schema-inconsistent information, they seek out ­ information that is consistent with their gender schema. When given toys labeled for their gender, children remember details about the toys better than if they were given toys labeled for the other gender. Thus, by only remembering schema-­ consistent information, gender schemas strengthen more and more over time and gender stereotypes become and remain strong. More recently, in 2007, another theory was proposed by researchers Rebecca Bigler and Lynn Liben, called developmental intergroup theory, to explain how and why children develop gender stereotypes so strongly. Developmental intergroup theory asserts that children think about gender so much because we heavily emphasize gender in our culture. For example, when someone learns of a new pregnancy, the first question asked is “Is it a boy or a girl?” Developmental intergroup theory postulates that adults’ heavy focus on gender—by color coding babies’ nurseries, clothes, and toys; by constantly labeling children (e.g., “What a smart girl!” or “What a big boy!”); by segregating their play dates into all-girl parties or all-boy ­parties—leads children to pay attention to gender as a key source of information about themselves and others. Children then begin to immediately categorize all encountered individuals into boys or girls (because society says it is such an important category); they seek out any possible gender differences; assume that boys and girls must differ in innate, wide-ranging ways; and subsequently form rigid gender stereotypes that are difficult to change.

Impact of Gender on Childhood Because gender stereotypes are so prevalent in our culture, children are frequently treated differently based on their gender by parents, teachers, and peers. This differential treatment has long-lasting implications for children. In addition, children are

affected by their own conceptions of gender, specifically the ways they presume that boys and girls differ. Children’s emotional, social, and academic development is especially affected by gender stereotypes. This entry offers just a few brief examples of the ways in which gender affects development. Gender and Emotional Development

Many parents interact with their sons and daughters very differently. For example, parents are more likely to discuss emotions with their daughters than with their sons. They discuss more emotional experiences and use more emotionbased words with daughters than with sons. There are also differences in the types of emotions that get discussed; they discuss sadness with daughters more than with sons, but they discuss anger with sons more than with daughters. Indeed, although sons get punished more than daughters, parents are more tolerant of their sons’ expressions of anger and physical aggression. Children are aware of these gendered emotion norms. Boys, when asked, expected negative reactions from their parents for expressing sadness. Importantly, research has shown links between emotion talk from parents and children’s later emotional understanding. Not surprisingly then, girls often have greater emotional understanding than boys. Gender and Social Development

One of the biggest gendered behaviors in childhood is reflected in children’s playgroups. ­ By age 3, children predominantly play in gender-­ segregated playgroups (i.e., all boys or all girls). Indeed, half of all young children’s interactions are in gender-segregated groupings. Traditional explanations for this high level of gender segregation in early childhood are that boys prefer the types of play that boys do, which is rough-and-tumble, highly active play, and girls do not. Other researchers have argued that behavioral similarity does not seem to explain it all. Otherwise, all kids, regardless of gender, who like rough-and-tumble play would play together, but this is not the case. Newer studies point out that children’s beliefs about their similarities to boys and girls drives much of their behavior. In other words, if girls

Childhood and Gender: Overview

believe that they are more similar to girls than to boys, they will be more segregated in their play. Researchers agree on the result of all this segregated play: Each group socializes itself to become more alike over time. Because they only spend time with their own gender, girls become more similar to other girls and boys become more similar to other boys. In addition to keeping on separate sides of the playground, there are also important social sanctions for children who break gender norms and do not conform to stereotypes. Children who are perceived as gender atypical (i.e., do not conform to gender stereotypes) are more likely to be bullied and rejected than their more gender conforming peers; and using measures of popularity instead of bullying, studies show that children who are considered highly gender typical are more popular than their less typical peers. Although this teasing and rejection can occur in preschool, they peak in middle school. Boys, more than girls, are especially likely to be teased and rejected for being atypical, and often homophobic or transphobic epithets are used to tease them. Those children who are teased and rejected are, in turn, more likely to be depressed and anxious. Although there is very little cross-gender interaction prior to puberty, the onset of puberty brings about changes. For heterosexual adolescents (approximately 85% of youth), puberty brings with it an interest in interacting with the other gender. Some researchers argue that as boys try to express sexual interest in girls, they try to minimize the pain of potential rejection and hide their interest behind sexually provocative, seemingly hostile behavior. The result is that by the time boys and girls reach the end of high school, 90% of girls have experienced some form of sexual harassment, most commonly in the form of unwanted touching or comments, being the target of jokes, being sent unwanted sexual messages online, or having their body parts rated. Targets of sexual harassment can experience emotional distress, embarrassment, depression, suicidal thoughts, substance abuse, and externalizing behaviors, as well as greater levels of school disengagement and school absenteeism. For other youth, puberty brings a period of questioning of their sexual and gender identity. Adolescents with a gay, lesbian, or bisexual sexual orientation or a transgender gender identity

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typically become aware of their sexual minority status in early adolescence and discuss it with a close friend by approximately age 16. The school setting can be a very hostile place. Gay, lesbian, and bisexual adolescents are more likely to be the target of sexual harassment than their heterosexual peers (frequently being called derogatory names), and transgender adolescents are the most likely to be sexually harassed relative to all teens. Indeed, among transgender adolescents, 90% have been called a derogatory name, 50% have been physically harassed, and 25% have been physically assaulted during the past year. Gender and Academic Development

Parents, teachers, peers, and children themselves contribute to the differences in children’s academic self-concepts, motivation, and performance. Gender is especially relevant in STEM (science, ­ technology, engineering, and mathematics) domains, as girls are highly underrepresented in these fields. According to the National Science Foundation, in 2008, women accounted for only 15% of the physics doctoral degrees, 20% of the computer science degrees, and 18% of the engineering degrees awarded in the United States. Most researchers trying to explain girls’ underrepresentation in STEM fields point to the different ways in which boys and girls are treated regarding math and science and the lack of role models for girls in STEM occupations. For example, parents talk about numbers and counting twice as often with sons as with daughters, and they talk to sons in much more detail about science than to daughters. In addition, parents have lower expectations for daughters’ math performance than for sons’, and this is independent of their child’s actual math performance. In fact, parents often underestimate girls’ math abilities and overestimate boys’ abilities, relative to actual performance. Furthermore, parents attribute daughters’ math success to their exerting great effort, while attributing sons’ success to natural abilities. These differences in parents’ beliefs about their daughters’ versus sons’ abilities may explain, in part, why boys are more confident about their math abilities and less anxious while doing math than girls. Parents are not the only source of gender bias. By the end of high school, 50% of girls have

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heard negative comments about their abilities in math, science, and computers, and most of this comes from teachers and peers. Importantly, these perceptions of gender bias are related to more negative academic self-concepts, such that girls who receive negative comments from teachers believe that they have lower math and science abilities than girls who do not receive such comments, independent of their actual grades in math and science. Children’s academic performance is also negatively affected by stereotype threat. Hundreds of studies have demonstrated that when people belong to a negatively stereotyped group and are about to perform a task associated with that negative stereotype (e.g., girls about to take a math test), and they are prompted to think about their group (e.g., by circling their gender on the front page of a math test), they will underperform on the task. Being prompted to think about their negatively stereotyped group membership raises very subtle concerns about fulfilling the negative stereotype, and this subconscious concern introduces just enough doubt and anxiety to reduce working memory, and they will perform worse on that test than if their group membership were not prompted. Girls experience stereotype threat in the context of math, and elementary school–age boys experience stereotype threat in the context of general academics (because elementary school girls are stereotyped as “good students”).

Directions for Future Research Taken together, research on gender in childhood indicates that children notice gender categories early and learn as much as possible about their own gender (forgetting, avoiding, or misremembering information about the other gender). Despite few actual gender differences in childhood, children’s own stereotypes, their peer socialization, and the biased treatment they receive by others shape their overall development, leading to bigger differences over time. Christia Spears Brown See also Children’s Cognitive Development; Children’s Moral Development; Children’s Social-Emotional Development; Gender Identity and Childhood; Transgender Children

Further Readings Bigler, R. S., & Liben, L. S. (2007). Developmental intergroup theory: Explaining and reducing children’s social stereotyping and prejudice. Current Directions in Psychological Science, 16(3), 162–166. Eliot, L. (2012). Pink brain, blue brain: How small differences grow into troublesome gaps—and what we can do about it. Oxford, England: Oneworld. Leaper, C., & Brown, C. S. (2008). Perceived experiences with sexism among adolescent girls. Child Development, 79(3), 685–704. Lippa, R. A. (2005). Gender, nature, and nurture (2nd ed.). Mahwah, NJ: Lawrence Erlbaum. Martin, C. L., Ruble, D. N., & Szkrybalo, J. (2002). Cognitive theories of early gender development. Psychological Bulletin, 128(6), 903–933.

Children With LGBTQ Parents The impact of a parent’s sexual orientation on a child’s development has been a prominent question in the minds of society and psychological researchers since the removal of homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders in 1973. Since then, the numerous studies conducted to answer this question have overwhelmingly demonstrated no ­ significant differences between the psychological adjustment, social functioning, or sexual identity of children of lesbian, gay, bisexual, transgender, queer (LGBTQ) parents and children of heterosexual parents. The results of these studies have been instrumental in changing laws that limited or prevented LGBTQ individuals from becoming parents through adoption and have assisted LGBTQ individuals in retaining custodial rights over ­biological children from prior heterosexual relationships. This entry examines the psychological adjustment, social functioning, and sexual identity of children of LGBTQ parents and discusses the limitations of the existing literature on this topic.

Psychological Adjustment Concerns regarding the psychological adjustment of children of LGBTQ parents tend to derive from a number of assumptions. Primarily, it is assumed that children of LGBTQ parents are at greater risk

Children With LGBTQ Parents

of peer victimization, have higher levels of emotional distress by virtue of having LGBTQ parents, and/or are at greater risk of psychopathology due to the lack of a male or female parent. However, studies have consistently demonstrated no significant differences in psychological adjustment between children of LGBTQ parents and children of heterosexual parents, regardless of whether the study was based on self-report, parental ratings, teacher ratings, or independent assessments. In addition, some studies have shown children of LGBTQ parents to have fewer behavioral problems than population-based norms would predict. Instead, researchers have identified that processlevel factors are much better predictors of psychological adjustment than family structure. ­ These factors include level of parenting distress, dysfunctional partner interactions, and quality of parent-child relationships. One large national study found no differences between children of lesbian parents and children of heterosexual ­parents in terms of self-esteem, depression symptoms, anxiety, academic achievement, or family relationship. However, satisfactory parent-child relationships were significantly linked to psychological adjustment and less delinquent behavior. Of note, the psychological adjustment of children of LGBTQ parents has been linked to ­ levels of perceived stigma, with children who perceived higher levels of stigma reporting lower wellbeing. Similarly, experiencing homophobia has been linked to more emotional and behavioral problems. However, in general, the children reported experiencing low levels of stigma and did not experience more behavioral or emotional problems than would be expected in the general population.

Social Functioning Following concerns raised by the courts that children of LGBTQ parents were at greater risk of experiencing peer rejection due to their parents’ sexual orientation, and the subsequent use of that rationale to deny LGBTQ parents’ requests for custody and adoption, researchers investigated the impact of having LGBTQ parents on children’s social functioning. Overall, the results indicated no differences in the quality of peer relationships between children of LGBTQ parents and children

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of heterosexual parents. In addition, with the exception of one study, no differences have been found in rates of teasing or victimization between the two groups. However, the content of the teasing has been found to differ. Children of LGBTQ parents were significantly more likely to be teased for family-related reasons and about their own sexuality. Of note, studies have indicated that levels of teasing and peer rejection vary across developmental periods, with elementary and middle school students reporting higher rates of both. However, this may be due to the tendency of children with LGBTQ parents to cope with bullying by increasingly choosing to hide their parents’ sexual orientation as they grow older. In addition, researchers have hypothesized that children of LGBTQ parents with a higher socioeconomic status may have an additional advantage with regard to developing positive peer relationships, because their parents are able to choose schools and neighborhoods less susceptible to sexual orientation–related harassment. However, this advantage tends to be more apparent for White families than for people of color, who are harassed for reasons other than sexual orientation.

Sexual Identity Sexual identity is generally considered to consist of three components: (1) gender identity, (2) gendered role behavior, and (3) sexual orientation. Gender identity refers to whether one identifies as male or female. Gendered role behavior refers to how closely one’s behaviors, activities, and conduct align with cultural expectations of masculinity and femininity. Sexual orientation refers to the extent to which an individual is attracted to members of their own sex, members of the opposite sex, or both sexes. All three components of sexual identity have been examined with regard to children of LGBTQ parents because of initial assumptions by society that children raised by LGBTQ parents would be more likely to exhibit signs of gender identity disorder (wherein an individual identifies with a gender other than what their biology dictates), gender nonconforming behavior, and samesex sexual attraction. With regard to gender identity development, these assumptions were primarily driven by

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theories that socially normative gender identity development required the presence of a same-sex role model for the child. Thus, since a biologically male child raised by a lesbian couple or a biologically female child raised by a gay couple would not have ongoing access to this essential resource, the child would be more likely to exhibit nonconformist gender identity development. However, studies have consistently shown no significant differences between children of LGBTQ parents and children of heterosexual parents in the rates of gender identity disorder or gender confusion. This is likely due to the availability of gender cues, such as the comparison of genitals, clothes, and word labels, in other aspects of the lives of children of LGBTQ parents (e.g., school, peers, siblings). The findings regarding gendered role behavior of children of LGBTQ parents are somewhat more complex. This is largely due to changing cultural norms regarding the desirability of adherence to traditional gendered behaviors since the late 1900s. Studies have shown that strict adherence to gendered roles can impair the development of males and females and that individuals who exhibit a more balanced mix of masculine and feminine traits tend to be better adjusted psychologically than those who are highly masculine or feminine. As such, one of the essential components of gender development, differential reinforcement of desired gendered behaviors, has declined among both heterosexual and LGBTQ parents. Even so, studies have generally shown that children of LGBTQ parents demonstrate gendered role behaviors at rates comparable with those seen in children of heterosexual parents, with a few exceptions that suggest greater flexibility in gendered activities and interests among children of LGBTQ parents. One study found that children of lesbian parents found gender transgressions by boys (e.g., wearing nail polish, a dress) to be less concerning than children of heterosexual parents. Another study found that daughters of lesbian parents were more likely to “rough-house,” play with male-oriented toys (e.g., trucks), and aspire to traditionally masculine occupations (e.g., lawyer, doctor) than daughters of heterosexual parents. However, these studies indicate that even children of LGBTQ parents who exhibit some atypical gender role behavior generally do so within culturally accepted limits.

With regard to the last component of sexual identity, sexual orientation, the research has consistently demonstrated that children of LGBTQ parents do not identify as nonheterosexual at higher rates than children of heterosexual parents. However, there are some differences in terms of openness to nonheterosexual experiences. Young adults raised by lesbian parents were significantly more likely to report having thought about experiencing same-sex attraction or having a same-sex relationship in the future than young adults raised by heterosexual parents. In addition, they were more likely to have had a same-sex relationship than young adults raised by heterosexual parents. However, these results may have less to do with the sexual orientation of the child’s parents and more to do with how acceptable the parents consider sexual experimentation by their child.

Limitations Despite the numerous studies conducted on the psychological adjustment, social functioning, and sexual identity of children of LGBTQ parents, methodological issues present in the vast majority of the studies require that additional research be conducted. Of foremost concern is the limited number of studies including sexual minority parents other than lesbian parents, such as transgender parents, gay parents, and bisexual parents. Without studies including all of these family structures, only limited conclusions can be drawn regarding the outcomes of children of LGBTQ parents. On a related note, the majority of studies on this topic relied on small samples of convenience. While this is understandable, due to the difficulty of recruiting LGBTQ parents, it limits the conclusions that can be drawn from the results to families of similar socioeconomic status, race, and geographic location. It also limits the study’s ability to detect associations between the variables being studied (i.e., the statistical power of the study). Although some recent national studies have attempted to address these issues, the samples remain remarkably homogeneous. Additionally, due to the heterogeneity of LGBTQ families, it is difficult to determine the appropriate comparison group. Should LGBTQ families be compared with heterosexual families, divorced families, blended families, or some combination of

Children With Transgender Parents

them all? Should the method of conception (i.e., adoption, sperm donor, surrogate) be a consideration in determining the comparison group? All of these questions have yet to be answered satisfactorily and have the potential to significantly affect the results of studies. Last, the research on children of LGBTQ parents has been somewhat limited in the breadth of the outcomes investigated. Unlike research into the outcomes of children of ­heterosexual families, few studies have examined intergenerational poverty, delinquent or criminal behavior, suicide, or education attainment in children of LGBTQ parents. It is necessary for these outcomes to be investigated in order to fully understand the impact of having LGBTQ parents on a child’s life trajectory. Jessica McCurdy See also Children With Transgender Parents; Lesbian, Gay, and Bisexual Children; Motherhood; Parenting Styles, Gender Differences in; Sperm Donor

Further Readings Anderssen, N., Amlie, C., & Ytterøy, E. A. (2002). Outcomes for children with lesbian or gay parents: A review of studies from 1978 to 2000. Scandinavian Journal of Psychology, 43(4), 335–351. Biblarz, T. J., & Savci, E. (2010). Lesbian, gay, bisexual, and transgender families. Journal of Marriage and Family, 72(3), 480–497. Garner, A. (2005). Families like mine: Children of gay parents tell it like it is. New York, NY: HarperCollins. Gartrell, N., & Bos, H. (2010). U.S. National Longitudinal Lesbian Family Study: Psychological adjustment of 17-year-old adolescents. Pediatrics, 126(1), 28–36. Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Worcester, MA: American Psychological Association. Kosciw, J. G., & Diaz, E. M. (2008). Involved, invisible, ignored: The experiences of lesbian, gay, bisexual, and transgender parents and their children in our nation’s K-12 schools. New York, NY: GLSEN. Tasker, F. (2005). Lesbian mothers, gay fathers, and their children: A review. Journal of Developmental & Behavioral Pediatrics, 26(3), 224–240. Wainright, J. L., Russell, S. T., & Patterson, C. J. (2004). Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. Child Development, 75(6), 1886–1898.

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Children With Transgender Parents Very few studies have attempted to observe or measure the impact on children of a parent’s ­gender transition. Yet many people seeking genderaffirming treatments—transitioning to live fully as a member of the opposite sex—are parents. Reports from gender clinics in the United States and national surveys estimate that 38% to 65% of transgender people are parents. A 1978 study followed 16 children of transsexual parents on a long-term basis and concluded that they did not differ appreciably from children raised in traditional homes. But there are no guidelines as to when, or how, to tell a child about a parent’s impending transition. Since 2000, sweeping changes in technology, medicine, and culture have made gender transitions far less taboo than in previous decades. But despite the increasing ­ ­transparency of transgender people, and antidiscrimination laws and policy to protect them, there has been little understanding as to how a child responds to having a parent undergo a gender transition. This entry examines family adaption and the ­factors that promote adjustment in families with a transgender parent.

Family Adaptation Many transgender individuals transition late in life and often in their fourth, fifth, or even sixth decade. Often, they report that they would have transitioned earlier—perhaps decades earlier—but they were cautioned against doing so by mental health professionals who felt that it could be detrimental to their child or children. Until recently, professed experts, many of whom had little or no experience with gender conditions, dispensed the conventional wisdom that young children are not able to process the complexities of gender and would suffer social damage if their parent changed sex. Transgender parents were often advised to wait until their children were “old enough to understand,” lest they be irreparably harmed by a parent’s change. Conventional wisdom is not the same as ­knowledge gained through rigorous research. In an

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attempt to learn more about the adjustment of children to this unusual life event, researchers surveyed professionals who specialized in working with transitioning individuals and their families. They sought to determine if the age of the child (i.e., social and cognitive maturation) affected the ability to deal with this anomalous life experience. After studying data from 4,700 such families, they concluded that children under 7 years of age were best able to adapt to a parental transition, while adolescents had the poorest adaptation. Young adult children, between the ages of 20 and 29, showed slightly better adjustment to a parent’s gender transition than adolescents. The results directly contradicted the admonishment to parents to wait until the children were older.

Factors That Promote Adjustment The researchers were also able to identify several factors that seem to help children adjust, as well as conditions that make adjustment less likely. Foremost, abrupt separation from either parent is a serious threat to both short- and long-term adjustment. This was a key finding, as judges who lacked knowledge of transgender issues often limited visitation or custody rights for transgender parents. Other factors that put a child at risk include a spouse who is extremely opposed to the transition, a personality disorder in either parent, or extreme parental conflict regarding the transition. Children who successfully cope with a parent’s transition are more likely to enjoy close emotional ties with both parents, to have parents who cooperate regarding issues of child rearing, and to have extended family that shows support for the transitioning parent. Since each child has a unique temperament and personality, the researchers wanted to study the children themselves. In a subsequent project, they collected information on 55 children whose parents had changed gender. The researchers were interested in learning whether certain innate characteristics of the child affected the ability to adapt to this unusual life circumstance. They were particularly interested in how social stigma affects a child whose parent is undergoing gender transition. The likelihood of a child experiencing this situation is extremely low. None of these children

knew other people involved with this issue to whom they could turn for support and guidance. Unlike other concerns that arise in families, gender transition can be visually apparent and, therefore, public. The transitioning parent may be conspicuous at a soccer meet or school event, raising the possibility of social stigmatization. The researchers found that children who were teased, or who otherwise suffered socially as a result of the parent’s atypical gender presentation, showed a decline in academic performance, a key indicator of adjustment. These children stated that they were “embarrassed” by their parent’s transition. In this group of children, 73% did not experience a decline in academic performance, 23% experienced a mild to moderate decline, and 4% suffered a severe decline. More than half of the children did not discuss the gender transition with their peers or even reveal it to friends. Approximately 10% of the transitioning parents and children had no contact at all with each other. The children ranged in age from 1 to 25 years at the time their parent transitioned. Neither the gender of the children nor the temperament— introverted or extroverted—appeared to relate to their adjustment. The overall mental health of this group was comparable with that found in the general population. There were comparable rates of psychopathology, although there was a higher incidence of eating disorders among children whose parent had transitioned. Consistent with the previous study, researchers found a strong, positive relationship between the child’s age at transition and adaptation: The younger the child, the better was the overall adjustment. Also, children who were exposed to high levels of parental conflict did not fare as well as children who witnessed little animosity between parents. Interestingly, the same holds true for children of divorce. One interesting finding that emerged was that the name a child used to refer to the transitioning parent correlated to the child’s overall adjustment. One third of the children continued to use the pretransition name (i.e., “mom” for a parent who had transitioned from female to male), and they as well as the group who had no contact with the transitioning parent were the most embarrassed by the transition, suffered the most stigma, and showed the least emotional stability. The children who did

Children’s Cognitive Development

not feel embarrassment either used the parent’s first name or a gender congruent title (i.e., “mom” or “dad”). Two children, spontaneously reacting to their father’s transition to living as a woman, demonstrate the spectrum of reactions within this group: Child 1: “Dad, you’re the best mom in the whole world!” Child 2: “Dad, how could you do this and ruin my life?”

Professionals who work with these children and their families should be proactive in supporting the children as they navigate this unique life situation. Help should not end when a parent completes his or her transition. As children mature, they require different types of support and education. The difference between gender and sexual orientation, gender binaries that are resolute in language and the law, and the diversity of identities are a few of the topics that adults and children can, and should, explore in age-appropriate ways. Not all children have the opportunity to work with therapists. Empathic adults, such as teachers, who encounter these children in any setting, can serve as allies or support persons, thus promoting competence and coping skills in those youngsters who may be struggling with conflict at home or suffering socially. As long-held cultural norms and beliefs evolve, there is a burgeoning understanding that gender is neither fixed nor immutable. Hopefully, this collective rise in consciousness will create a climate of acceptance and eliminate the stigmatization of children or families who have a transitioning member. Randi Ettner See also Coming Out Processes for Transgender People; Gender Nonconformity and Transgender Issues: Overview; Gender Affirming Medical Treatments; Hormone Therapy for Transgender People; Measuring Gender Identity; Pathologizing Gender Identity; Transgender People

Further Readings Felner, R. D., Ginter, M. A., Boike, M. F., & Cowen, E. L. (1981). Parental death or divorce and the school

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adjustment of young children. American Journal of Community Psychology, 9, 181–191. Felsten, G., & Wilcox, K. (1992). Influences of stress and situation-specific mastery beliefs and satisfaction with social support on well-being and academic performance. Psychological Reports, 70, 291–303. Green, R. (1978). Sexual identity of 37 children raised by homosexual or transsexual parents. American Journal of Psychiatry, 135, 692–697. Green, R. (2006). Parental alienation syndrome and the transsexual parent. International Journal of Transgenderism, 9(1), 9–13. doi:10,1300/J485v 09n01_02 Sales, J. (1995). Children of a transsexual father: A successful intervention. European Child and Adolescent Psychiatry, 4, 136–139. Wallerstein, J. S. (1991). The long-term effects of divorce on children: A review. Journal of American Academy of Child and Adolescent Psychiatry, 30, 349–360. White, T., & Ettner, R. (2004). Children of parents who make a gender transition: Disclosure, risks, and protective factors. Journal of Gay & Lesbian Psychotherapy, 8, 129–145. White, T., & Ettner, R. (2006). Adaptation and adjustment in children of transsexual parents. European Child & Adolescent Psychiatry, 16(4), 215–221.

Children’s Cognitive Development Cognitive development refers to the emergence of a broad range of intellectual skills over the course of childhood that forms the basis of thinking and reasoning. Some examples of these abilities include, but are not limited to, the development of sensation, perception, language, memory, logic, spatial reasoning, numerical estimation, motor coordination, and concept formation. Inquiry into cognitive development spans back to antiquity and was revived during the Enlightenment. However, the modern approach to cognitive development originates in the late 19th to early 20th centuries with the work of the French psychologist Alfred Binet (1895) and the Americans G. Stanley Hall (1916) and James Watson (1913), among others. The 20th century saw considerable advancement in theoretical understandings of cognitive development through the adoption of careful empirical methods and research designs, and the 21st century has seen significant progress toward discovering the

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neurophysiological changes underlying the development of cognitive abilities. This entry introduces the concept of development and key theoretical approaches to the study of cognitive development and, furthermore, discusses cognitive development in relation to sex and gender.

Defining Development It is useful first to consider what development means. Most people interpret development as meaning change, but not all change can be thought of as development. Willis Overton’s three principles of development provide a useful starting point. First, development makes individuals better adapted to the environment. So while a baby can only cry or scream to express desire, on the development of language, a child can specifically ask for what they want to satisfy a desire or need. Second, development progresses from simple and global to more complex and specific. So whereas a young child might be able to count to 10 only, an adolescent might be able to use the quadratic equation to solve a problem in algebra. Finally, development is enduring. Once a child learns the transitive inference underlying the ability to measure, they are unlikely to lose it over the course of life (barring injury, cognitive decline, or dementia). These three characteristics are essential for a change to be considered development. Other types of changes may occur—a child might start enjoying broccoli, take up soccer, or express an interest in ballet—all of these are changes of some sort, yet each lacks an essential aspect of development. Yet researchers in cognitive development are not always interested in change. Stability is a core aspect of the ontogeny of any organism. To the extent that certain cognitive processes develop over time, there is an intra-individual stability in some processes that persist over time. For instance, an important question for those interested in the development of mathematical reasoning is whether the ability to estimate number in early childhood is related to mathematical skills later in life. Another is whether exposure to enriched learning environments in early childhood has positive cognitive consequences later in life. Research on stability in the emergence of cognitive skills and the proximal and distal causes of cognitive growth or stagnation is crucial for the study of cognitive development.

There are several common themes woven through the field of cognitive development. The first is whether development occurs continuously or as a series of stages. Some theories view cognitive development as a gradual process of the acquisition of cognitive skills that emerge incrementally. Others view the emergence of cognitive skills as a discrete progression through a series of stage-like processes in which there are periods of continuity, followed by sudden periods of discontinuity when a skill is suddenly mastered. A second theme is whether there is one trajectory of development or multiple pathways toward a developmental goal. There are certain aspects of cognition that seem to emerge in almost all children around the same time, such as taking a first step. Yet other skills show remarkable variability in mastery, such as later math skills. Some children find calculus to be trivially simple, while others can never master this skill. Understanding what endogenous or exogenous factors cause divergences in developmental trajectories is a common theme among those interested in the origins of individual differences. A third theme concerns the role of nature (genes) or nurture (experience) in shaping cognitive development. This theme has long sparked arguments between environmentalists, who believe that experience and input significantly affect development, and nativists, who believe that genes largely guide development and explain individual differences. Today, our understanding of epigenetics (or how genes and environments interact in bidirectional ways) has largely challenged the dichotomy between nature and nurture.

Theoretical Approaches to the Study of Cognitive Development While there are myriad and diverse theories of cognitive development, and more specific theories unique to particular domains (i.e., memory, space, or time, to name a few), there are three main theoretical approaches to cognitive development that generate testable hypotheses: (1) constructivism, (2) socioculturalism, and (3) core knowledge. Each has played an important role in our understanding of how children learn to think. The first theoretical approach was developed by the influential Swiss psychologist Jean Piaget

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(1955), who argued for a constructivist account of cognitive development. According to this approach, children are active participants in the construction of their own ability to develop logic that ultimately produces knowledge. Piaget argued that children’s interactions with the physical environment help move them through a set of stages in which knowledge (schemes) becomes better organized through a process of assimilation (incorporating new information into old schemes) and accommodation (adjusting old schemes to incorporate the new information), a process known as “adaptation.” A second approach appears in the writings of the Russian psychologist Lev Vygotsky (1980), who proposed a sociocultural account, in which knowledge is acquired through social interactions with more experienced members of their culture. Through a process of “scaffolding,” adults socially introduce children into culturally meaningful tasks and abilities. A common concept in this literature concerns what Vygotsky refers to as the “zone of proximal development”—a period when children have all the physical and mental facilities to accomplish a task but can only do so with the assistance of someone who has already mastered that task. A third approach appeared toward the end of the 20th century, when a series of psychologists proposed that many cognitive abilities might be rooted in our genetic inheritance, that there might be domains of core knowledge that we innately understand from our shared evolutionary history. Some examples of such domains might be number, space, time, geometry, and even some social domains such as the knowledge of one’s own social group versus others. Each of these approaches provides very different perspectives on the nature of the mechanisms that guide and drive development. Note that there are many other theories of development that emerged over time that have had a significant effect on research on cognitive development— most notably the “store” model of cognition, which uses the computer as a metaphor for understanding thought. But constructivism, socioculturalism, and core knowledge have had a particularly large impact not just within the field of psychology but also in related fields such as educational theory and cognitive science. In the interest of theoretical diversity, it is worth pointing out that it is likely the

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case that all three approaches may explain different domains of cognitive growth. So while constructivism might better explain how children come to understand the physical properties of the world, sociocultural theory might better explain cognition related to the social processes that are unique to individual cultures, while the core knowledge approach may explain some of the basic cognitive abilities that we may share with other species based on our common evolutionary past, such as the ability to quantify amounts or estimate time, which are crucial tasks whether one is human or any other cognizant species.

Sex, Gender, and Cognitive Development The role of sex and gender has long been a central topic in studies of cognitive development. Often, sex and gender are not differentiated in developmental studies, but sex typically refers to the biological categories of male and female, and gender refers to myriad judgments and assumptions about gender categories, roles, or stereotypes. The historical interest in sex and gender is rational given how fundamental these categories are to our human nature. The first thing anyone knows about a newborn is his or her sex, and a child enters a gendered world in which boys and girls are associated with different colors, play with different toys, wear different types of clothing, exhibit different social practices, and are expected to behave in a manner befitting the gender they were born into. So it is not surprising that sex and gender have become a common and pervasive research topic among those who study cognitive development. However, sex and gender are somewhat controversial and contentious topics in the study of cognitive development. In part, any discussion of gender touches on historical prejudices and biases that are deeply ingrained in our society and cultural institutions. Powerful explicit and implicit biases may have played a role in guiding research findings in the ways studies were (and to some extent still are) designed and interpreted. One powerful way in which such biases can be selffulfilling is in the form of stereotype threat. This theory posits that if one is a member of a group that supposedly does worse on tests, simply being reminded that one is a member of that group will negatively affect one’s test performance. So if

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women are informed that they are supposed to do worse on math tests than men, when tested, the stereotype threat they experience will negatively affect their performance. Before discussing sex or gender differences, it is necessary to point out that there are overwhelming, overlapping gender similarities between boys and girls during cognitive development. Men and women think far more in common than divergently. For example, in language development, girls tend to show slightly higher verbal growth rates in early childhood relative to boys. Yet once they become adults, most adult speakers reach a certain level of communicative competency, so that whatever gender differences may persist likely have little impact on everyday life (i.e., someone with a 50,000-word vocabulary can converse with another having 60,000 words, since many of the additional 10,000 words are likely to be rarely used (i.e., words like izle or xyster are not in common use in everyday conversation). In other words, for most cognitive skills, most adults reach a “threshold” of competence that allows them to function more or less well in everyday life despite any gender differences that might exist. Yet if population-level differences exist, one might expect to find the most significant differences in the “tails” (i.e., the extremes) of the distribution of cognitive ability within a specific domain, such as verbal abilities or quantitative skills. If there is even a small difference in ability between boys and girls, it will be most apparent at the extreme ends of the distributions rather than near the average, where most of the population overlap. In the tails (i.e., the bottom or top 1%), one might find more individuals of one sex or the other depending on which sex exhibits the advantage. Consider science and math. Some have argued that males have a slight advantage in quantitative domains. Apart from evidence acquired in the lab, there is the overwhelming evidence that over the course of the 20th century far more men graduated college in STEM (science, technology, engineering, and math) fields than women. One could argue that this demonstrates an underlying sex difference in cognitive ability (i.e., quantitative reasoning, abductive reasoning)—that men have an advantage over women. And there may be some truth in this argument, as boys show far more variability in math skills. If so, statistically there would likely be

more men in the upper (as well as lower) tails of the distribution of ability. Yet there are so many alternative possibilities other than sex differences in innate capacity that are related to gender roles, historical bias, and institutionalized policies that have disadvantaged women. In fact, due to a wide variety of factors, the sex difference in STEM careers has been narrowing drastically in the first decade of the 21st century as a result of many programs for women encouraging interest in and access to these fields. For instance, the National Science Foundation reports that more than 40% of science and engineering doctorates are now conferred on women, up from 8% in 1966. Other measures show equally large reductions in sex differences. That such drastic change occurred over so short a period of time suggests that whatever natural innate sex differences may or may not exist can be readily overcome by shifting social and educational policy and practice with respect to gender expectations. However, there are some known sex differences in cognitive development that are fairly well established and do have cognitive consequences. The largest concerns sex differences in spatial cognition. One of the largest and most reliable sex ­differences in children concerns mental rotation: the ability to imagine an object and rotate it in one’s mind. Although there are different versions of the task, a basic measure of mental spatial rotation is to present participants with an object (i.e., an R or a reverse R) at some rotated angle away from how it is normally viewed. The participant must indicate whether the R is normal, or inverted. The further the rotation is from normal, the longer it takes participants to respond (a classic finding published by Roger N. Shepard and Jacqueline Metzler in 1971). Across a variety of studies, it has been found that boys have an approximately 1 standard deviation advantage in such tasks. This effect is so pronounced that it has been observed in very young children and even infants—suggesting a biological origin for this difference. However, experiential factors may also be involved, as evidenced by differences between males and females in playing video games and by socioeconomic status. Although spatial ability may be the most reliable sex difference in cognitive development,

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researchers have addressed other divergences in the realm of mathematical development. Sex differences in mathematics represent a complicated story of contradicting findings that depend on the methodological approach. For instance, in 1965, Piaget found no significant sex difference, but he was not looking for them. Piaget believed that logico-mathematical skills were a universal species that everyone masters, while those interested in differential psychology using psychometric approaches commonly used on tests of general intelligence are more likely to find larger ­differences. Yet for every study demonstrating a sex difference, there is another that does not, and resolving divergent findings quickly becomes difficult. In general, most studies find that the gap between women and men is weakest for early-acquired abilities and strongest for later-acquired abilities. As stated earlier, there is some evidence that girls learn language more rapidly than boys in terms of vocabulary growth. In addition, boys exhibit dyslexia and other writing disorders at slightly higher rates than girls. But overall, whatever sex differences exist in language acquisition are relatively difficult to document developmentally. Overall, despite some studies demonstrating sex differences in cognitive development, there is considerable overlap between the sexes in most ­ cognitive domains, and one must be cautious in interpreting results showing large differences, particularly those from studies with small numbers of subjects. It is far more likely that to the extent that differences in performance in cognitive domains between girls and boys exist, it is more likely that any divergence originates from gender expectations and roles that are historically and culturally rooted.

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a new understanding of sex and gender that will help clarify some of the debates over whether, and how, boys and girls come to understand the world using processes that are unique to their biological sex or are shaped by societal expectations that can shift over time and space. One useful direction for future work will be cognitive development in transgender children, which has already started. Even a decade ago, the notion of conducting a study with transgender children would have been a remote possibility. But our society and culture have witnessed remarkable shifts in recent years in views of sexual and gender identity. Studying transgender and cisgender children may be a useful way to better understand how children develop not just cognitions about gender but all domains of cognitive growth. In conclusion, the study of cognitive development in children has had a defining role within the field of child or developmental psychology through the 20th and into the 21st centuries. Future research on sex and gender will help developmental psychologists better refine their hypotheses on how the mind grows, so that by the end of this century we will have a more subtle and complete understanding of children’s cognitive development and how sex and gender shape the emergence of thought. Sean Duffy See also Adolescence and Gender: Overview; Biological Sex and Social Development; Biological Theories of Gender Development; Gender Socialization in Adolescence; Gender Socialization in Childhood; Parental Messages About Gender

Further Readings

Future Directions There is much future work to be accomplished in the study of children’s cognitive development and the role that sex and gender play in shaping the emergence of these important mental processes that allow us to reason. Researchers are only beginning to understand the myriad and complicated processes that start at conception and ­ultimately result in forming the minds of adults who are able to think and reflect on how they came to know the world. Psychology is beginning

Berninger, V. W., Nielsen, K. H., Abbott, R. D., Wijsman, E., & Raskind, W. (2008). Gender differences in severity of writing and reading disabilities. Journal of School Psychology, 46, 151–172. Bornstein, M., & Lamb, M. (2011). Cognitive development: An advanced textbook. New York, NY: Taylor & Francis. Gleason, J. B., & Ely, R. (2002). Gender differences in language development. In A. McGillicuddy-De Lisi & R. De Lisi (Eds.), Biology, society, and behavior: The development of sex differences in cognition (pp. 127–154). Westpoint, CT: Ablex.

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Kimura, D. (1999). Sex and cognition. Cambridge: MIT Press. McGillicuddy-De Lisi, A., & De Lisi, R. (Eds.). (2002). Biology, society, and behavior: The development of sex differences in cognition. Westport, CT: Ablex. Olson, K. R., Key, A. C., & Eaton, N. R. (2015). Gender cognition in transgender children. Psychological Science, 26, 467–474. Spelke, E. S. (2005). Sex differences in intrinsic aptitude for mathematics and science? A critical review. American Psychologist, 60, 950–958.

Children’s Moral Development Moral development is the process by which children come to understand concepts such as good and bad, right and wrong, and they reason and behave according to this understanding. The sequence and quality of moral development is a point of contention in the literature. This entry reviews the prominent theories of the development of moral reasoning and then addresses newer research that brings to light weaknesses in earlier theories of moral reasoning, including research directed at infants’ moral development. This entry then highlights how others (e.g., peers, family members) can influence moral development in ­different ways. Finally, the emotional and motivational factors that intersect with gender and ­children’s moral development are discussed. Throughout this entry, findings on the role of gender in children’s moral development are ­ examined.

Theories of Moral Reasoning Piaget’s Theory on the Moral Judgment of the Child

The first psychologist to theorize about children’s moral development was Jean Piaget in 1932. He focused on moral reasoning because he believed that changes in moral judgments originate from changes in cognitive development. In his research, he examined children’s (ages 4–13 years) moral judgments by questioning them about the rules of their games and the reasons behind those rules. Piaget found that children’s rules could be understood in terms of general principles, and he was the

first to ascribe phases to describe the development of these children as they came to embrace different principles. To comprehend these phases more fully, Piaget developed moral dilemmas and asked ­children to respond to them by choosing a course of action and then justifying their choice. For example, a child would have to decide which is worse, a boy breaking one cup while trying to get to a forbidden jar of jam or a boy breaking 15 cups by accident. Piaget found that children responded differently depending on the phase of their current reasoning. Piaget distinguished two phases: (1) heteronomous (subjective) and (2) autonomous (objective) morality. Preschool children are considered heteronomous because they do not distinguish between moral rules and social conventions (i.e., they are nonmoral). For these children to abide by a rule, it needs to be enforced by an authority figure (e.g., their parent or an older child). Actions resulting in material damage are judged as serious violations because the consequences determine the moral evaluations. In the aforementioned scenario, children in the subjective responsibility phase would rate the accidental breaking of 15 cups as worse than the breaking of one cup, because of the greater degree of quantifiable damage. The progression from the first phase to the next was hypothesized to happen around the age of 7 years, the “age of reason.” Piaget posited that around that age, children evolve from primarily egocentric beings who are concerned mostly with the external consequences of behavior toward consideration of objective principles. Children reasoning using autonomous principles would rate the child who broke the one cup as worse, disregarding the difference in material damage and giving more weight to the boy’s intent to transgress. According to Piaget, a child progresses from one phase to the next by engaging in numerous relationships that are contingent on reciprocity and mutual understanding; this is opposed to most early relationships children have, which are based on authority (e.g., those with parents). Once a child understands that roles can be reversed, a concern for intent, equity, and equality emerges, and these factors are given weight when resolving moral dilemmas. In terms of gender differences, Piaget questioned boys about playing games of marbles and girls about their hopscotch games. He found that young

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girls were not as judicially inclined as boys. That is, they showed a preference for simple games, with fewer players, whereas boys seemed to enjoy developing rules and complex systems to play according to, simply for the sake of having rules. Kohlberg’s Developmental Hierarchy of Moral Judgment

Departing from Piaget’s model, Lawrence Kohlberg advanced a developmental hierarchy of moral judgment. Much like Piaget, Kohlberg had his participants respond to different moral dilemmas. For example, he presented children with the situation of a man named Heinz, whose wife was deathly ill. A pharmacist had the drug to cure the wife’s illness but was selling it at a cost much higher than the man could afford. The children were asked if they thought it was acceptable for Heinz to break into the pharmacy and steal the drug. Kohlberg’s theory was more structured than Piaget’s theory, whose phases were clusters of reasoning typologies that can be observed together but might develop in a variety of ways. Kohlberg established three levels, each containing two stages, which he claimed humans universally developed along the same sequence. At the first level (preconventional), children differentiate right from wrong and good from bad according to their culture’s rules. They do so, however, only because they are concerned with the physical or hedonic consequences of their behavior (e.g., a child might get rewarded for doing something that is considered “good”). The “punishment and obedience” stage is the first within this preconventional level. At this stage, children have no regard for the value or meaning of the consequences of their actions and defer completely to those with power, who have established the rules. For children at the second stage of “instrumental relativism,” the distinction between right and wrong hinges on what satisfies their personal needs. Concepts such as reciprocity, fairness, and sharing are understood in a pragmatic way, where they will help others if it benefits them. When they reach the second level (conventional), children acquire a respect for others’ expectations (e.g., family, group, culture) and seek to conform to them. Within the conventional level, for children in the “interpersonal concordance” or “good boy/ nice girl” stage, good behavior is considered

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conforming to one’s stereotypically “natural role” in society. This stage sees the emergence of ­children’s judging intent. Stage 4 or the “society-­maintaining orientation” brings about the importance of social order and of maintaining its structure by doing one’s duty and respecting authority figures. At the postconventional level, people show an understanding of moral principles beyond the authority figures of the group that developed the standards. The two stages at this level are the “social contract orientation” and the “universal ethical principle orientation.” In Stage 5, what is right has been established by and for the entire society, and there is an understanding of the procedures needed to gain consensus on what is right. The final stage involves abstract and ethical principles such as justice, reciprocity, and respect for human rights and dignity as individuals. Children’s moral reasoning development tends to follow the specific sequence above. Children in one stage show difficulty understanding the reasoning of stages above their current dominant stage, compared with earlier stages. Yet they show preferences for higher-stage reasoning, as compared with stages of reasoning lower than their current stage. They also assimilate better the reasoning of one stage higher than their current stage, compared with the reasoning two stages higher. According to Kohlberg’s model, children around the age of 4 years begin to reason according to Stage 1 and progress to Stage 2 before the age of 10. They should achieve Stage 3 in adolescence, when Stage 4 emerges. Stage 5 develops in adulthood, and Stage 6 is said to only be achieved by scholars who are highly educated in moral philosophy. Cross-culturally and across methodologies, there is strong support for the shift from Stages 2 to 3 (which coincides with Piaget’s phase shift as well), and the claim to universality can be made. There is more debate about the earlier stages, which are clearly present but lack clear boundaries and do not account for all of young children’s moral reasoning. There was also a controversy over Kohlberg’s finding that females tended to have lower moral reasoning scores than males. Gilligan’s Critique of Kohlberg’s Model

A main point of contention for Kohlberg’s approach was the fact that it was developed from

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studying an all-male sample. The main critique came from a psychodynamic researcher named Carol Gilligan, who held that women and men differed in their moral reasoning. Specifically, she argued that the finding that women were typically less morally advanced than men was an artifact of Kohlberg’s model. She claimed that Kohlberg ignored the “care orientation,” which she hypothesized was more dominant in females, who were only judged as less moral because this care orientation was relegated to a lower stage of development. The claim was that Kohlberg made an assumption that the “justice orientation” reflected a more mature moral judgment. According to Gilligan, it was sexist and invalid to deem values such as individuality, rationality, and impersonality as universal moral ideals and to assume that they were an indication of higher maturity than concern for others and relationships. As an alternative, Gilligan created a theory accounting for the differences between girls’ and boys’ moral development. She hypothesized that children of the opposite sex experience a divergent first close human relationship (i.e., the motherchild relationship), which creates irreversible differences in moral reasoning. This is because a little girl experiences bonding with a mother who is of the same sex. Thus, girls learn to discover themselves by comparison and by finding similarities with their mothers. Because of this, girls develop with a deeper concern for connectedness and maintaining human relationships. On the other hand, boys, because they are the opposite sex from their mothers, discover themselves by contrast and should be more motivated to view themselves as individuals. This difference in how children evaluate their relations with others emerges as early as 3 years of age. To explain the development of this care dimension of morality, Gilligan proposed three stages. In the first, girls care for themselves to ensure survival. This stage is then considered selfish. Then a girl progresses on to the maternal stage, when she assumes responsibility for others and places high value in caring for others. The final level arises when a girl understands the interdependence of others’ and her needs yet is able to distinguish between them when necessary and fitting. There is much research comparing girls with boys in their moral development, and a metaanalysis looking at 15 years of research found

small but reliable differences in their use of the justice and care orientations. This supports the idea that females do indeed use care-related concepts when justifying moral reasoning, more than males, but not to the extent claimed by Gilligan. Other reviews of the literature show that girls and boys go through the Kohlbergian stages in the same order. However, much research finds that adolescent girls reach Stage 3 earlier than boys, particularly girls who have more friendships and perspective-taking experiences.

Emerging Research on Infants’ and Preverbal Children’s Morals A new way of conceptualizing moral development has been advanced because of findings that children show evidence of understanding moral principles at an age younger than Piaget or Kohlberg allowed. Research on their models evaluated school-age children and adolescents and assumed that any child before the age of 4 years approximately is amoral. However, research finding that toddlers are able to read and respond to intent initiated a whole new field of study, using methods other than those used to study moral reasoning. While the stage theorists approached the child as a moral philosopher, new theorists of moral cognition insist that our moral actions are more a result of evolutionary adaptation. This evolutionary approach posits that we thrive when living in a society surrounded by others, which has led to the development of characteristics that facilitate our ability to live in society, including an innate understanding of right and wrong. From this perspective, we make automatic morality judgments based on social intuition before we can even verbalize our instincts. Indeed, it is argued, moral reasoning justifications (e.g., those found in the research by Kohlberg and Piaget) are simply rationalizations of gut feelings and are unnecessary for one to behave morally. This rationalization is hypothesized to be a by-product of the moral dilemma methodology where children are asked to provide reasoning after giving a judgment. Recent research supporting this evolutionary approach has shown that even preverbal infants might have what researchers call a “moral core.” Showing the existence of this moral core weakens the evidence that moral development is a

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mechanism entirely learned through interactions with others, as Piaget and Kohlberg stipulated. There are three elements thought to support the existence of this moral core: (1) moral goodness (linked to empathy, discussed below), (2) moral understanding and evaluation (being able to distinguish those who will be helpful, empathetic, or cooperative from those who will not), and (3) retribution (e.g., punishment). Moral goodness is displayed by infants from birth by their early emotional reactions to others’ distress (e.g., emotion contagion, empathy). Furthermore, once they are able to, infants will comfort others, help others in achieving goals, and share resources. Research on moral evaluation indicates that preverbal infants (by age 1 year) understand cooperation and goal helping/hindering and show preference for cooperative people over noncooperative ones. Infants (by 3 months of age) initially pay less attention to people who hinder others’ goals, and once they are able to reach their goals (by 6 months), they show positive evaluation of the helping by reaching toward their helpers. Research on infants and retribution shows that by the age of 2 years, infants expect fairness (i.e., equity) in the distribution of resources. But even toddlers under 2 years of age will selectively punish hinderers and show a preference at as early as 5 months for punishers, an illustration of their capability for moral retribution.

Others’ Influence on Children’s Moral Development Inherent in stage theories is the belief that one’s development is the cause for changes in reasoning that drive movement from one stage to the next in a consistent sequence. However, some behaviorist research has shown that modeling others’ behaviors and also, to a lesser extent, positively reinforcing behavior (i.e., rewarding) can override the intrinsic progression from stage to stage (e.g., in this manner, children can be shaped to skip a stage or revert to a previous one). Research also shows that children learn moral reasoning in naturalistic settings, from imitating their parents, at a very young age. In this way, infants as early as 1 year of age learn to respond to their parents’ emotional expressions, which teach them good from bad and how to behave. Family behavior can also affect

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children’s moral development, as parents who demonstrate sympathy, warmth, and support produce sympathy, emotional regulation, and more sophisticated moral reasoning in their children. Socialization experiences can affect moral development as well. Because gender patterns of moral judgment and behavior arise, at least in part, from dissimilar socialization experiences, they can change, given the proper circumstances. For example, given a situation where a girl is exposed to an all-male environment, she may quickly adapt to a more male-oriented type of moral reasoning. Similarly, according to Piaget and Kohlberg, perspective taking is the source of moral development, which is catalyzed by socialization experiences such as interactions with peers. Children and adolescents who have more interactions with peers and higher numbers of attempts to understand the perspectives of their friends are the fastest to develop morally. Additionally, institutionalized, structured experiences (e.g., school) that force one to consider things from others’ perspectives increase the ability for perspective taking and, in turn, boost moral reasoning. Research shows that educational achievement, high socioeconomic status, urban living, communitarian experiences (e.g., volunteering), and exposure to culturally diverse populations can affect moral reasoning positively. Additionally, some research has shown a relationship between developmentally lagging moral reasoning and antisocial behavior, delinquency, ­ and recidivism. Furthermore, prison environments can lead to deterioration of moral reasoning.

Motivational and Emotional Components Influencing Moral Development An important criticism of moral reasoning theories of development is that responses to moral dilemmas are simply an illustration of reasoning, not how people actually behave. For example, despite the fact that someone might respond to a moral dilemma in a way that indicates they are reasoning within Kohlberg’s Stage 4, their behavior might not correspond to this, due to different psychological and situational factors. For example, although adolescents might be advanced in their reasoning about hypothetical moral dilemmas, this does not necessarily translate to their moral behavior in real-life situations. This might in part be due to the

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fact that mere understanding and reasoning according to moral principles is not completely tied to moral motivation—a person’s willingness to actually abide by the moral principles they are asked about in the dilemmas. Interestingly, research on moral motivation reveals gender differences when taking identification into account. Women who identify strongly with their stereotypical gender role show more moral motivation, beginning at the age of 8 years and progressing through adolescence and early adulthood. The opposite effect is seen with males who strongly identify with their gender role, who show less moral motivation as they develop. However, in males and females who do not strongly identify with their gender role, there is no difference in moral motivation. Emotional influences on moral development may reflect the evolutionary adaptations mentioned earlier. For example, infants’ imitation of others is considered by social-cognitive psychologists to be the foundation of perspective taking and empathy. Children who more readily imitate their parents at a young age develop more of a conscience (e.g., displaying guilt when appropriate; not cheating) when older. Empathy, which emerges among toddlers, is the emotional reaction to someone else’s condition in a way that is more congruent with that other person’s situation. Empathy and the cognitive ability to take another’s perspective are deemed essential to developing moral reasoning. Indeed, as seen with development through Piaget and Kohlberg’s stages, an essential component is interaction with others and understanding the similarities and differences between one’s own and others’ minds. As seen previously, infants show empathetic responses as early as age 1 year by, for example, seeking comfort after seeing someone else being injured. These responses are the same for female and male infants. However, at a later age, empathetic responses differ based on gender, with women displaying more empathy than men. It is possible that this is a result of socialization, as seeking comfort from a parent might be responded to differently (encouraged or discouraged) based on gender. Indeed, the difference in empathy shown later on in life reflects a difference in motivation to self-present and not actual ability to empathize. Laure Brimbal and Angela M. Crossman

See also Children’s Cognitive Development; Children’s Social-Emotional Development; Criminal Justice System and Gender; Gender Identity and Childhood; Gilligan’s Moral Development Theory; Kohlberg’s Stages of Moral Development; Psychodynamic Feminism; Socioeconomic Status and Gender

Further Readings Damon, W. (1988). The moral child: Nurturing children’s natural moral growth. New York, NY: Free Press. Gibbs, J. C., Basinger, K. S., Grime, R. L., & Snarey, J. R. (2007). Moral judgment development across cultures: Revisiting Kohlberg’s universality claims. Developmental Review, 27, 443–500. Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, England: Cambridge University Press. Hamlin, J. K. (2013). Moral judgment and action in preverbal infants and toddlers: Evidence for an innate moral core. Current Directions in Psychological Science, 22, 186–193. Jaffe, S., & Hyde, J. S. (2000). Gender differences in moral orientation: A meta-analysis. Psychological Bulletin, 126, 703–726. Killen, M., & Smetana, J. (2006). Handbook of moral development. Mahwah, NJ: Lawrence Erlbaum. Kohlberg, L. (1969). Stage and sequence: The cognitivedevelopmental approach to socialization. In D. A. Goslin (Ed.), Handbook of socialization theory and research (pp. 380–437). Chicago, IL: Rand McNally. Nunner-Winkler, G., Meyer-Nikele, M., & Wohlrab, D. (2007). Gender differences in moral motivation. Merrill Palmer Quarterly, 53, 26–52. Piaget, J. (1965). The moral judgment of the child (M. Gabain, Trans.). New York, NY: Free Press. (Original work published 1932) Stams, G. J., Brugman, D., Deković, M., van Rosmalen, L., van der Laan, P., & Gibbs, J. C. (2006). The moral judgment of juvenile delinquents: A meta-analysis. Journal of Abnormal Child Psychology, 34, 697–713.

Children’s Social-Emotional Development Social-emotional development focuses on the child’s expression of, experience with, and management of emotions, as well as the child’s ability to interact with others, including the child’s social

Children’s Social-Emotional Development

behavior and relationships with peers. There is growing recognition that children’s socio-­emotional development has consequences not only for children’s long-term adjustment and mental health but also for children’s success in school. Therefore, factors that relate to children’s acquisition of social and emotional skills, including both environmental and biological influences, are an important research topic. Gender, of course, is one factor that has been explored by researchers as an important variable that influences children’s socio-emotional development. Overall, the findings regarding gender and children’s socio-emotional development are mixed; whereas there are clear gender differences in some domains (e.g., physical aggression), these differences are not as clear in other domains (e.g., ­prosocial behavior). Discussing all of the potential domains of socio-emotional development that have been linked with gender is beyond the scope of this entry. Instead, this entry focuses on those domains that have received substantial attention from researchers, including children’s emotional expression, experience, and regulation; children’s social behavior; and children’s close relationships with peers.

Emotional Competence Emotional Expression

The ability to express emotion effectively is an important part of communication and is closely linked with children’s social competence and mental health. Children’s ability to effectively express emotion is linked with other aspects of emotional intelligence as well, including awareness of their own emotions and those of others. Gender stereotypes regarding the expression of emotion are part of the cultural fabric of the Western world (e.g., “Boys don’t cry”), and there are reasons to believe that these stereotypes shape children’s emotional expression. Research supports the idea that there are small, but consistent, gender differences in children’s expression of both positive and negative emotions. In laboratory studies on emotional expression, girls have been found to display more positive affect and more internalizing negative emotions (e.g., sadness, shame, fear, anxiety) than boys. Boys, in contrast, have been found to display more externalizing negative emotions (e.g., anger,

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contempt, disgust) than girls across laboratory studies. These differences in the expression of emotions do not seem to be present during infancy and toddlerhood but emerge during the preschool years. The one exception is for some of the internalizing negative emotions on which girls outscore boys relatively early in development. It is important to point out that these gender differences in emotional expressions are heavily influenced by contextual factors. Thus, gender differences in emotional expression are more marked when children are interacting with unfamiliar adults or peers but are far less pronounced in the company of parents. Moral Emotions

Research has also suggested that there may be differences between the genders in their propensity for experiencing moral emotions such as empathy, guilt, and shame. Empathy (i.e., an emotional response that arises from the comprehension of another person’s emotional state and is similar to the emotion of the distressed other) has received the most attention by researchers. The work on empathy and gender has been mixed, but in general, girls seem to be higher in empathy than boys. This difference appears to increase across development and is consistent with gender stereotypes of females being more nurturing, compassionate, and relationally oriented. It is important to point out that the magnitude of gender differences varies depending on how empathy is assessed. Methods that rely on self-report, teacher report, and parent report typically find stronger and more consistent gender differences in empathy than observational studies or studies that use physiological measures to assess empathy. It is not clear why this is the case. However, it may be that raters are influenced by their own beliefs about gender, and as a result, studies that rely on questionnaire or rater reports may inflate the links between gender and empathy. However, observational studies have found that girls are more likely to express empathy in response to the distress of others, lending support to the idea that girls may actually have higher levels of empathy than boys. Other moral emotions, such as guilt and shame, have also shown reliable gender differences. Both shame and guilt are negative emotions that are

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experienced after violating moral or social norms (e.g., by harming someone else). The target of the negative emotion, however, differs between guilt and shame. In guilt, feelings of regret and remorse surround a particular act (e.g., lying) or failure to act, whereas with shame, the negative affect typically manifests as feelings of inadequacy that are directed at the self. Some have argued that guilt is the more moral of the two emotions, because it is linked with making amends, whereas shame has been linked with avoidance. Most of the work on guilt and shame has involved self-reports and has been done with older children and adolescents, and this work has suggested that girls tend to rate themselves as being more prone to both guilt and shame than boys do. Some work suggests that these gender differences are present relatively early in development. Longitudinal research suggests that gender differences in young children’s response to a mishap for which they feel responsible emerge by 33 months and are consistent across early childhood. Thus, observational work suggests that females may be more prone to guilt and shame even at a young age. Emotion Regulation

Research has also suggested that gender plays an important role in children’s development of emotion regulation skills. Emotion regulation consists of the internal and external processes that are involved in the monitoring, evaluating, and controlling of emotion to achieve goals. Early in development, children rely heavily on parents to control their emotions (e.g., through soothing), but by the ages of 3 to 5 years, children begin to develop their own strategies for controlling emotion. Children’s ability to regulate their emotions is closely linked with children’s self-regulation (e.g., their ability to inhibit and control their behavior), which develops around the same time. Work on both emotion regulation and self-regulation suggests that girls in early childhood display superior regulation skills compared with boys. Thus, for example, girls show a small but distinct advantage over boys in delaying gratification and in masking emotions when receiving a disappointing gift. The reasons why girls show superior emotion regulation skills are up for debate. It does not seem that girls possess more knowledge of cultural

display rules (e.g., that one should express gratitude and not disappointment when one receives a disappointing gift) or that girls are more motivated to suppress emotion in laboratory paradigms. Both boys and girls seem to increase their emotion regulation skill levels when the motivation to mask emotion is high. However, girls are more successful in controlling emotion (e.g., hiding disappointment) than are boys, potentially because they have more practice due to socialization pressures from parents, teachers, and others to be mindful of ­relationships. It may also be that girls are more emotionally aware of their own or others’ emotions (e.g., affective perspective taking) than are boys, but the research on this issue is equivocal. A number of explanations have been proposed to explain the advantage that girls have in emotional competence, including those that implicate biology, evolution, and socialization. Given that many of the gender differences in emotional competence seem to emerge during the preschool years, it seems likely that socialization is part of the explanation for these differences. It is clear that parents have different expectations regarding the emotional expressions that are appropriate for boys versus girls and the degree to which each gender should be responsive to the emotions of others. For example, research suggests that parents expect girls to inhibit angry responses, whereas boys are expected to inhibit sad and fearful responses. It seems likely that these beliefs influence the strategies that parents use when socializing emotional competence in children, but how these beliefs directly influence socialization practices has not been well examined in the literature. Research has not always found clear differences in the emotional socialization tactics used with boys and girls, but some studies provide hints to how these gender ­differences might be socialized. For example, observational studies suggest that mothers make more references to emotions and initiate emotion talk more frequently with girls than with boys in everyday discourse. Mothers also emphasize different emotions when talking about the child’s past emotional experiences; mothers are more likely to emphasize ­sadness with girls and anger with boys. These differences in emotion language are important because discourse is a key way through which children construct an understanding of emotion and display rules and learn how to regulate their emotions.

Children’s Social-Emotional Development

Social Competence Social Behavior

The one place where researchers have found consistent and strong gender differences is in children’s social behavior. Gender differences in ­ aggressive behavior have been extensively studied in the developmental literature. Decades of work support the idea that boys are more physically aggressive (e.g., hitting, punching, inflicting bodily harm) than girls, with these differences emerging in toddlerhood. Physical aggression in young children is a relatively stable trait that has consequences for a child’s long-term adjustment and standing in the peer group. Some subset of aggressive boys are rejected by normal peers, and as a result, they end up being friends with other deviant youth. These early-onset aggressive boys have poor outcomes (in part because their association with other deviant youth only serves to magnify their behavioral problems) and end up having early contact with the justice system. It is important to note that there is a subset of physically aggressive girls and that physical violence among girls is on the rise, but these youth have been less extensively studied. There is also a subset of aggressive youth (including both boys and girls) who are socially accepted and fare better than boys who display early-onset aggression. It is believed that these children use aggression skillfully and have positive qualities, such as prosocial behavior, that offset their aggressive qualities. For several decades, it was believed that girls were just as aggressive as boys but that the types of aggressive behavior girls participated in were different. These forms of aggression were more indirect (e.g., did not involve victim confrontation) and were more likely to target relationships or the reputations of individuals (e.g., through exclusion or gossiping). Indirect and relational aggression is more covert, unfolds over a longer time scale than physical aggression, and may require more social skills to enact (e.g., knowing how to manipulate or harm others). Relational and indirect aggressive behaviors are more stereotypically female, and it was believed that girls are more relationally aggressive than boys. Despite this, recent work has suggested that there are no large differences between boys and girls in their use of relationally aggressive behavior.

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There is also some indication that girls may engage in more cooperative/prosocial behavior than boys but these differences emerge later in development. In the toddler years, there seem to be few links between children’s helping and cooperative behavior and the child’s gender (although as discussed earlier, there is some evidence that girls are more likely to show empathy for the distress of an unfamiliar victim). By middle childhood (7–10 years of age), parents and teachers consistently rate girls as more prosocial and cooperative than boys. Once again, however, it is not clear if gender stereotypes are biasing reporters’ ratings of social behavior. It appears that the effects of gender on prosocial behavior are the strongest when parents, teachers, or the children themselves give ratings of prosocial behavior. Nonetheless, observational work supports the idea that females are more likely to engage in prosocial behavior than boys and that this effect increases with age. The context matters, however, because research with adolescents and college ­students suggests that boys may be more likely than girls to engage in helping behavior in certain ­circumstances (e.g., during emergency situations). Peer Relationships

There is clear evidence that gender influences the kinds of peers who children interact with, the nature of their friendships, and the size of their peer network. Research suggests that children’s preference for same-sex play partners begins in early childhood (by the age of 3 years) and remains in place through adolescence. This preference for same-sex peers strengthens across childhood. The crossover to opposite-sex friendships happens mostly in adolescence, but even then, the influence of same-sex friends remains important throughout the life span. It is important to note that it is not adults who determine these preferences for samesex interaction. Rather, children themselves seem to segregate themselves along gender lines; sex segregation is strongest when adults are not involved and playtime is unstructured. Segregation by sex has consequences for children’s development of socio-emotional competence. Both male and female peer groups typically engage in different types of activities and experiences, and this leads to children adopting skills that facilitate interaction with same-sex peers.

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In addition, gender stereotyped behavior is often strongest among peer groups; peers provide pressure to conform to those stereotypes. In terms of peer group interactions, play among boys is often rougher, more active, more competitive, and more likely to involve physical contact and fighting than play among girls. Male playgroups are also more likely to have a hierarchical order, and this order tends to be somewhat stable over time. The playgroups of boys are more likely to be further away from adult supervisors, and as a result, they involve less parental intervention. Girls, in contrast, are involved in smaller peer groups that are less hierarchical and are more likely to involve cooperative play and verbal interaction. Girls are also more likely to engage in structured activities that are closer to adults or involve adult interaction. Thus, there is good reason to expect that the playgroups of girls foster disclosure, cooperation, and regulation of emotion, whereas the playgroups of boys foster more physically aggressive, assertive behavior and less regulation of behavior. There is evidence that the more time children spend in same-sex segregated play, the more likely they are to conform to gender stereotypes regarding their social and emotional behavior. Open to debate, however, is why children have such strong preferences to engage in sex-segregated peer networks. A number of researchers have suggested the importance of evolutionary influences. Thus, boys, who will eventually compete for mates, will need to hone assertive and aggressive behavior, whereas girls may need to learn skills like nurturance for caring for children. Thus, the preference for sex-segregated play may have its roots in evolution to ensure that each gender will learn the skills needed for subsequent reproductive success. Other researchers have suggested, however, that gender segregation has more to do with the fact that boys and girls prefer to engage in different types of activities and it is this preference that ultimately leads to the separation of the sexes in the classrooms and on the playground. However, recent observational research with preschool children did not find support for the idea that activity preference initially drew same-sex peers together. Research suggests that children have a positive bias toward their own gender but do not hold a negative image of the opposite gender. Thus, it is not negative stereotypes about the other gender that lead to segregation by sex. Ultimately, the

factors that draw same-sex playmates together remain unclear. Regardless, research suggests that children are learning sex-stereotyped behavior in these gender-segregated groups. Children who engage in high levels of sex-segregated play are more likely to engage in sex-stereotyped behavior than those who do not. As a result, there is reason to believe that children’s exposure to sex-based interaction styles in gender-segregated playgroups leads to some of the differences in socio-emotional development seen between the genders. There are also differences in the nature of interactions in a friendship dyad based on the gender composition of the dyad. Girls are more likely to be exclusive in their friendships and to have more stable best friendships than boys. Girls, especially in adolescence, are more likely to share feelings and disclose personal conflicts with their friends and have higher expectations about loyalty than boys. As a result, there is some indication that girls exhibit more intimacy, closeness, and commitment in their friendships than boys. This intimacy may come at a cost. Girls are also more likely to engage in high levels of corumination (rehashing and discussing conflicts that make them anxious). Interestingly, corumination in female friendships seems to be associated with higher-quality friendships, but it may also be associated with other risks, such as internalizing problems and empathic distress. In contrast, male friendship dyads are more likely to connect through shared activities (e.g., sports) and do not spend as much time as girls do ruminating over or disclosing conflicts. The level of intimacy in male-male friendships is also perceived to be high. Male friendships are more likely to have shared connections outside the primary clique (or small group of adolescent friends) because of the activity-based nature of male friendships. Moreover, boys are less exclusive than girls and seem more willing to accept new close friends into their networks. Thus, boys entering a new school are less likely to have problems forming new relationships than girls. In sum, there do seem to be consistent, if weak, influences of gender on children’s socio-emotional development. Many of the differences (e.g., in prosocial behavior) emerge in the preschool years, which lends support to the idea that socialization influences from parents, peers, and the media likely play an important role in fostering these differences. This does not rule out the possibility that

Christianity and Gender

some of these differences are due to biological influences, such as differences in hormones or neural structures, because there is some work that suggests that this is the case. It is important to remember that these gender differences are culturally specific. Thus, although some of the influences of gender (e.g., gender segregation in peer groups) seem to transcend cultures, others (e.g., specific differences in emotion expression) might be specific to Western or European cultures. Furthermore, given that people begin to develop their gender identity during childhood, it is important to consider how socio-emotional development may affect individuals who identify as transgender or gender noncomforming (TGNC). While research on TGNC children is scarce, psychologists may consider how healthy socio-emotional development can be both protective and a risk factor for TGNC children who are struggling with their ­gender identities. Finally, it is important to understand how socio-eomotional development may be influenced by the intersection of TGNC children’s gender identities with race, ethnicity, socioeconomic status, religion, and other identities. Deborah Laible, Clare Van Norden, Erin Karahuta, and Wyntre Stout See also Adolescence and Gender: Overview; Biological Sex and Social Development; Biological Theories of Gender Development; Gender Socialization in Adolescence; Gender Socialization in Childhood; Parental Messages About Gender

Further Readings Brody, L. R. (2000). The socialization of gender differences in emotional expression: Display rules, infant temperament, and differentiation. In A. H. Fischer (Ed.), Gender and emotion: Social psychology perspectives. Studies in emotion and social interaction (2nd ed., pp. 24–47). New York, NY: Cambridge University Press. Card, N. A., Stucky, B. D., Sawalani, G. M., & Little, T. D. (2008). Direct and indirect aggression during childhood and adolescence: A meta-analytic review of gender differences, intercorrelations, and relations to maladjustment. Child Development, 79, 1185–1229. doi:10.1111/j.1467-8624.2008.01184.x Chaplin, T. M., & Aldao, A. (2013). Gender differences in emotion expression in children: A meta-analytic review. Psychological Bulletin, 139, 735–765. doi:10.1037/a0030737

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Eisenberg, N., & Lennon, R. (1983). Sex differences in empathy and related capacities. Psychological Bulletin, 94, 100–131. doi:10.1037/0033-2909.94.1.100 Eisenberg, N., Miller, P. A., Shell, R., McNalley, S., & Shea, C. (1991). Prosocial development in adolescence: A longitudinal study. Developmental Psychology, 27, 849–857. doi:10.1037/0012-1649.27.5.849 Else-Quest, N. M., Hyde, J. S., Goldsmith, H. H., & Van Hulle, C. A. (2006). Gender differences in temperament: A meta-analysis. Psychological Bulletin, 132, 33–72. doi:10.1037/0033-2909.132.1.33 Martin, C. L., Kornienko, O., Schaefer, D. R., Hanish, L. D., Fabes, R. A., & Goble, P. (2013). The role of sex of peers and gender-typed activities in young children’s peer affiliative networks: A longitudinal analysis of selection and influence. Child Development, 84, 921–937. doi:10.1111/cdev.12032 Michalska, K. J., Kinzler, K. D., & Decety, J. (2013). Age-related sex differences in explicit measures of empathy do not predict brain responses across childhood and adolescence. Developmental Cognitive Neuroscience, 3, 22–32. doi:10.1016/ j.dcn.2012.08.001 Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: Potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132, 98–131. doi:10.1037/0033-2909.132.1.98 Ruble, D. N., Martin, C. L., & Berenbaum, S. A. (2006). Gender development. In N. Eisenberg, W. Damon, & R. M. Lerner (Eds.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th ed., pp. 858–932). Hoboken, NJ: Wiley. Smith, R. L., & Rose, A. J. (2011). The “cost of caring” in youths’ friendships: Considering associations among social perspective-taking, co-rumination, and empathetic distress. Developmental Psychology, 47, 1792–1803. doi:10.1037/a0025309 Underwood, M. K., Galen, B. R., & Paquette, J. A. (2001). Top ten challenges for understanding gender and aggression in children: Why can’t we all just get along? Social Development, 10, 248–266. doi:10.1111/1467-9507.00162

Christianity

and

Gender

Many Christian churches and groups have definitive ideas and policies related to gender. These ­policies often outline acceptable gender roles both within their Christian organizations and in

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everyday life. Given the prevalence of Christianity, it is important to understand the range of Christian views on gender. Although the religion as a whole has moved toward gender equality over time, disparities continue to exist in most Christian organizations. In fact, some denominations adhere to complementarianism, allowing men to hold leadership and pastoral positions and limiting opportunities for women. In addition, there is often a lack of understanding and support for transgender, gender nonconforming, and genderqueer individuals. This entry explores the diversity of Christian views on gender and focuses on the experiences of women in the Church and of gender nonconforming Christians.

Gender To understand the topics of Christianity and ­gender, it is important to first define gender and distinguish it from biological sex. Biological sex has to do with genetic and physical characteristics, and sex is typically assigned at birth as male or female. Gender, on the other hand, is developed over time and is influenced by both biology and societal norms. Gender includes gender roles, gender expression, and gender identity. Gender roles are tasks and behaviors performed based on one’s gender. For instance, females may be expected to do housework such as cooking and cleaning. Gender expression has to do with one’s appearance, characteristics, and behavior. For instance, males may express their masculinity by wearing their hair short and presenting as tough. Finally, gender identity is how one identifies oneself. Overall, gender has historically been defined using a binary understanding of masculine and feminine, with contemporary understandings including a more fluid continuum of gender. This continuum, although including masculine and feminine, acknowledges androgyny and gender fluidity. In fact, there are a range of gender identities, including those who are cisgender, transgender, and gender nonconforming. People whose sex assigned at birth and gender identity are congruent are labeled cisgender. The term transgender, on the other hand, is an umbrella term that describes individuals whose sex assigned at birth does not match their gender identity. Some people prefer the term transsexual—to highlight their use of hormone

therapy or sex reassignment surgery. Additional terms associated with the transgender population include female-to-male individuals, male-to-female individuals, and transition—to refer to the personal process of changing gender. Transition may include hormone therapy and sex reassignment surgery. Another group, cross-dressers, are those who sometimes express their gender by dressing in clothing associated with a different sex. Note that crossdressing is a way in which individuals express themselves, but it is different from “drag queens” and “drag kings,” who change their appearance as part of a performance. Finally, there are individuals who identify as gender nonconforming, gender variant, androgynous, or genderqueer to highlight the fact that they do not adhere to societal norms for gender expression and gender roles. Rather than listing all of the various terms, this entry will utilize the umbrella term of transgender unless specifically noting information on a particular population. History has shown various levels of understanding and acceptance of those who do not conform to the male/female gender binary. The American Psychiatric Association (APA) introduced the diagnosis of gender identity disorder, which was later modified to gender dysphoria, in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the early 1980s. Although the diagnosis has been helpful in obtaining equal rights and medical coverage in some cases, many argue that the inclusion of gender dysphoria in the DSM incorrectly labels transgender and transsexual individuals as having a mental health disorder. Those who argue for removing the diagnosis explain that any distress experienced by transgender individuals is because of oppression and discrimination. Public views about people who are transgender often mirror views about the gay and lesbian population. However, transphobia seems to be more prevalent than homophobia in some cases, and the general public has less of an understanding of what it means to be transgender than they do of what it means to be gay or lesbian. Furthermore, transgender individuals sometimes report marginalization within the gay and lesbian community.

Christian Views Related to Gender Like the general public, there are a range of beliefs and practices related to gender in the Christian

Christianity and Gender

community. Most Christian groups accept a binary view of gender, and women and men are typically socialized to adhere to traditional gender roles. For example, women are often socialized to be nurturing, supportive, and emotional. Men, on the other hand, are taught to be tough, leaders, and stoic. These socialized traits often relate to the types of roles and positions that women and men are encouraged or allowed to hold in Christian churches. Most Christian denominations and organizations have a hierarchical structure that is patriarchal in nature, with men assuming positions of power and influence. Women and transgender individuals are often not allowed to serve in these positions. For instance, of the more than 100 members of the general authority of the Church of Jesus Christ of Latter-day Saints, all are men. It is not surprising, then, that being religious is positively associated with having sexist and transphobic attitudes. Despite the fact that there are generally more women than men in Christian denominations and organizations, patriarchal structures are common in these groups. This is true even in some churches that are affirming and welcoming to lesbian, gay, bisexual, and transgender members. In fact, even in denominations that allow females to serve as clergy members, women in these positions tend to earn less money than men, be promoted at slower rates than men, and take on certain types of nurturing and supportive duties typically associated with women. These hierarchical and patriarchal structures in Christian groups are often based in part on their interpretations of Bible verses about gender. Bible Verses

There are numerous Bible verses related to gender, and they begin in the Book of Genesis, where God, who is male, creates Adam in his image. When God realizes that Adam needs a companion, he creates a woman, Eve, to be a helper for Adam. In this story, Eve eats fruit from the forbidden tree, committing the first sin, which results in ­banishment from the Garden of Eden. The Book of ­Genesis also explains that, in creating Adam and Eve, God created a male and a female. No other gender identities are mentioned. Some groups will cite these passages in Genesis as evidence to

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support a binary view of gender and to dispute gender identities outside the male/female binary. Additional Bible verses address matters of gender expression and behavior. For instance, in 1 Corinthians, Paul instructs women to pray with their heads covered and to refrain from speaking during church gatherings and meetings. On the other hand, Paul asserts that men should pray with their heads uncovered. Likewise, the Book of Deuteronomy teaches women and men to wear clothes associated with their gender. In 1 Peter and 1 Timothy, women are provided further instruction on clothing; they are instructed to focus on inner beauty rather than dressing lavishly or immodestly. In addition to these passages on gender identity and expression, the Bible addresses gender roles. Ephesians 5, Colossians 3, and 1 Peter 3 all instruct wives to be submissive and respectful to their husbands and husbands to love and honor their wives. Based on their interpretations of these passages, there are cases in which Christian groups have gone so far as to condone abusive relationships, advising women not to pursue separation or divorce in these situations. Fundamentalist Christians who promote patriarchy and chauvinism may interpret additional passages like Titus 2 literally and argue that women must work in the home rather than seek careers. In fact, based in part on Psalm 127, Titus 2, and other passages, a movement emerged among some groups in the 1980s called Quiverfull. Adherents follow a patriarchal structure and do not use any form of birth control. In fact, women in these families assume subservient roles and defer to men as leaders who make decisions for the family. Other Christian groups will critically interpret these same Bible passages with attention to the cultural, historical, and linguistic contexts in which they were written. These groups, for instance, do not interpret 1 Corinthians to mean that women should not be allowed to speak in church settings, and instead they welcome female elders and/or clergy. Complementarianism Generally, there are two types of beliefs in Christianity regarding the role of women, and these beliefs are often based on interpretations of the Bible. Some believe in complementarianism, which

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promotes complementary, serving, supportive, and helping roles for women. This view is endorsed by the Council on Biblical Manhood and Womanhood, an evangelical organization formed in the late 1980s. Interestingly, of the 34 Board and Council members serving in 2015, only six are women. Congruent with the complementary approach, five are homemakers and one is a p ­ astor’s wife. Egalitarianism Those who do not support the complementary approach tend to endorse gender equality and egalitarianism. These groups argue that complementary roles are subservient and have the same impact as fundamentalist, patriarchal systems. In fact, egalitarians believe that women should have the same opportunities as men and that there should be an equal distribution of power rather than a hierarchy in families and in churches. To support their beliefs, they often point to important women in the Bible, including Mary, the mother of Jesus, and Mary Magdalene. Whether they utilize an egalitarian, complementarian, or patriarchal approach, many groups have outlined policies related to gender roles and gender identity in their organizations. Denominational Policies

Based in part on their interpretations of Bible verses related to gender, some Christian churches and organizations have developed policies and position statements on gender and gender-related topics. These policies typically fall into one of two categories: (1) those related to gender roles and ordination or (2) those related to gender identity and being transgender. Although these policies provide helpful information on gender in Christian organizations, it is important to note that the denominational policies do not necessarily reflect the beliefs and practices of specific churches or individual church members. For instance, although the Catholic Church bans the use of contraception, most Catholic women do not abide by this policy and some Catholic priests do not discuss this topic in their homilies. Gender Roles and Ordination A number of denominations ordain both male and female ministers, including African Methodist

Episcopal churches, Episcopal churches, the Evangelical Lutheran Church in America, the Metropolitan Community Church, the Presbyterian Church of the USA, Unitarian Universalists, the United Church of Christ, and United Methodists. In addition, the Metropolitan Community Church, Episcopal Church, Unitarian Universalists, and the United Church of Christ ordain transgender individuals. Several groups, including the Church of Jesus Christ of Latter-day Saints, Roman Catholics, and Southern Baptists, only ordain men. Roman Catholic priests, in addition to being male, must be celibate and single. It is important to note that although women in these three denominations are sometimes able to pursue other, nonclerical positions of service or leadership, this concession does not extend to transgender members. Gender Identity Although almost all denominations have policies related to sexual identity and gay and lesbian individuals, only a handful have developed ­positions on gender identity and the transgender population. In fact, some denominations do not recognize gender identities other than male and female. Southern Baptists, for example, believe that gender identity is based on sex assigned at birth and that transgender individuals should not pursue any form of transition. Similarly, in the early 2000s, the Vatican reportedly said in writing that Roman Catholics who obtain sex reassignment surgery should continue to be treated as having the sex identity that was assigned at birth and that these individuals should be barred from marrying or being ordained in the Church. Other groups, like the Metropolitan Community Church, were formed specifically to minister to gay, lesbian, bisexual, and transgender individuals and have a long-standing history of being ­welcoming and affirming to the transgender population. Unitarian Universalists and the United Churches of Christ also have a tradition of being affirming to the transgender population.

Women in the Church Some denominational policies clearly show a predisposition toward patriarchy and subordination of women in the Christian Church. In fact, former U.S. president Jimmy Carter notably left the

Christianity and Gender

Southern Baptist Church due to its stance on ordaining women. As noted previously in this entry, even in denominations that ordain women, female ministers earn less money and are promoted less than men. Women in leadership positions also tend to serve in certain areas of ministry considered more suitable for women, such as children’s ministry, women’s ministry, and hospitality ministries. Given the prevalence of inequality in most churches and church policies, advocates have formed organizations to promote equality and women’s rights. These include overarching groups that are not specific to one denomination, such as Christians for Biblical Equality and the Evangelical and Ecumenical Women’s Caucus. In addition to promoting equality, some of these egalitarian groups advocate for a view of God that is not gendered and does not use male pronouns. There are also groups seeking equal rights within specific denominations, although most are not officially recognized by their associated denominations. For instance, Women Advocating for Voice and Equality works for gender equality within the Church of Jesus Christ of Latter-day Saints.

Transgender Christians Like women, transgender and gender nonconforming individuals who grow up as Christians often experience gender socialization in their homes, churches, and beyond. Many learn binary views of gender and gender roles and are socialized to fit these expectations. However, they often experience conflict between their identities or views of themselves and how they are socialized and raised. For many, there are few resources and a lack of information on gender identity from their faith ­ communities. Perhaps because of the lack of information, many transgender individuals who decide to talk with family members or people from their churches about their experiences will face transphobia. In fact, transgender Christians who come out to others may hear that they are simply going through a phase, that they are an abomination to God, that God made them to be the sex they were assigned at birth, or that they should not consider transitioning in any way. Likewise, based on Deuteronomy 23’s directive prohibiting castrated men from entering the temple, some will tell transgender Christians that they should not pursue surgery.

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Even if they want to be supportive, many families and churches do not know how to assist their transgender members. Despite the lack of resources in faith communities, information about gender identity is becoming more common. In the 2000s, with celebrities like Chaz Bono and Caitlyn Jenner transitioning and coming out as transgender, the mainstream media and faith groups started to cover transgender topics and issues. Popular Christian magazines and blogs featured a number of stories about gender identity. Still, many churches and faith leaders are not adequately prepared to discuss this topic with their congregations, and many denominations have not developed official policies on gender identity or transgender members. In addition to a lack of information in faith communities, there has been a lack of research with transgender individuals. The existing research with transgender Christians highlights the difficult process of self-acceptance and of integrating both Christian and transgender identities. A significant aspect of this process includes forming a more individualized faith rather than relying on the institutional Church. In fact, some transgender Christians no longer attend church services for fear of being ridiculed and excluded due to their identity and appearance. This is especially true in denominations that have strict ­gender roles for male and female members. As long as patriarchal and complementarian Christian groups remain, egalitarians and Christian women will undoubtedly continue to advocate for equality. Likewise, transgender advocates and their allies will continue to educate the general public and Christian communities on gender variance and the experiences of transgender individuals. With a slow trend toward equality over time, more churches are recognizing the importance of female and transgender members to their congregations. Denise L. Levy See also Gender Identity; Gender Roles: Overview; Spirituality and Gender; Trans*; Transphobia; Transsexual

Further Readings Colander, C. W., & Warner, S. C. (2005). The effect of egalitarian and complementarian gender role attitudes on career aspirations in Evangelical female

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undergraduate college students. Journal of Psychology and Theology, 33(3), 224–229. Levy, D. L., & Lo, J. R. (2013). Transgender, transsexual, and gender queer individuals with a Christian upbringing: The process of resolving conflict between gender identity and faith. Journal of Religion & Spirituality in Social Work: Social Thought, 32(1), 60–83. doi:10.1080/15426432.2013.749079 Norton, A. T., & Herek, G. M. (2013). Heterosexual’s attitudes toward transgender people: Findings from a national probability sample of U.S. adults. Sex Roles, 68, 738–753. doi:10.1007/s11199-011-0110-6 Padgett, A. G. (2008). The Bible and gender troubles: American Evangelicals debate scripture and submission. Dialog: A Journal of Theology, 47(1), 21–26. doi:10.1111/j.1540-6385.2008.00364.x Rodriguez, E. M., & Follins, L. D. (2012). Did God make me this way? Expanding the psychological research on queer religiosity and spirituality to include intersex and transgender individuals. Psychology & Sexuality, 3(3), 214–225. doi:10.1080/19419899.2012.700023 Scholz, S. (2005). The Christian right’s discourse on gender and the Bible. Journal of Feminist Studies in Religion, 21(1), 81–100. Stichele, C. V., & Penner, T. (2009). Contextualizing gender in early Christian discourse: Thinking beyond Thecla. New York, NY: T&T Clark International. Thatcher, A. (Ed.). (2015). The Oxford handbook of theology, sexuality, and gender. New York, NY: Oxford University Press. Yarhouse, M. A., & Carr, T. L. (2012). MTF transgender Christians’ experiences: A qualitative study. Journal of LGBT Issues in Counseling, 6(1), 18–33. doi:10.1080/ 15538605.2012.649405

Christianity Orientation

and

Sexual

With the majority of people in the United States identifying as Christian, it is important to understand the history and diversity of Christian views on sexual orientation. For the most part, Christian churches and organizations have labeled same-sex sexuality as sinful and have rejected lesbian, gay, and bisexual (LGB) individuals. Although Christianity as a whole has become more welcoming and affirming to the LGB population over time, some evangelical and fundamentalist groups continue to view same-sex sexuality as sinful and as an

abomination. As such, many LGB individuals who grow up as Christians experience conflict between their sexual identity and religious beliefs. They resolve this conflict in various ways, including integrating their LGB and Christian identities, leaving the Christian faith, rejecting or trying to change their sexual orientation, or living with the conflict. This entry explores the diversity of Christian views on sexual orientation and discusses the experiences of LGB individuals who grow up as Christians.

Sexuality Before discussing sexual orientation and Christianity, it is important to first define sexuality. Sexuality encompasses sexual attraction, sexual behavior, and sexual identity. For instance, a female may be attracted to women (attraction), may be in a monogamous sexual relationship with a woman (behavior), and may identify as a lesbian (identity). However, attraction, behavior, and identity may not appear to be congruent. For example, a male may be attracted to men, may be celibate, and may identify as heterosexual. Although same-sex attraction and behavior have existed since at least ancient Greece, the concept of sexual identity was first delineated by scientists in the late 1800s and early 1900s. With the creation of sexual identity, heterosexuality was viewed as normative, healthy, expected, and the opposite of same-sex sexuality. In fact, as early as the 1920s, scientists and psychotherapists tried to assist patients experiencing same-sex attraction in changing their sexual orientation to heterosexual. In 1952, “homosexuality” was officially added by the American Psychiatric Association to its Diagnostic and Statistical Manual of Mental Disorders (DSM), utilized by mental health professionals for diagnosis. Around the same time, Alfred Kinsey introduced the continuum model of sexuality with the publication of the Kinsey reports. This model placed individuals along a continuum of exclusive heterosexuality to exclusive same-sex sexuality based on their behaviors. Kinsey’s model distinctly rejected the notion that same-sex sexuality is evidence of a mental disorder and introduced bisexuality as a sexual identity. Queer identified individuals also oppose a binary view of sexuality that only includes heterosexual and same-sex sexuality. In the 1990s, the term queer, previously a

Christianity and Sexual Orientation

slur, was reclaimed. The term makes a political point by being difficult to define and typically refers to nonnormative sexuality.

Christian Views on Sexuality Most research on religion, religiosity, and attitudes toward LGB individuals has shown a correlation between being Christian and homophobic, especially for fundamentalist and evangelical ­ groups. In fact, the early Christians promoted heterosexuality and rejected same-sex sexuality, ­ going so far as to kill people engaged in same-sex behaviors during the 13th and 14th centuries. Although these views reflected public opinion, they were also based on interpretations of six key Bible passages (Genesis 19, Leviticus 18, Leviticus 20, Romans 1, 1 Corinthians 6, and 1 Timothy 1). Based on these Bible verses, some Christians believe that same-sex sexuality is a sin and that they should “hate the sin and love the sinner.” For instance, some interpret the Genesis passage to mean that God destroyed the city of Sodom because of the sin of same-sex sexuality. This is where the term sodomy comes from, and at one time, every state in the United States had a sodomy law that made it illegal to have anal or oral sex. However, there are varied interpretations of these six Bible passages, and some believe that Sodom was destroyed because of inhospitality and arrogance rather than same-sex sexuality. LGB ­ advocates sometimes cite examples of what they believe are LGB relationships in the Bible, such as that of Ruth and Naomi or Johnathan and David. Debate continues on the meaning and interpretations of Bible verses related to same-sex sexuality and whether or not the six passages mentioned specifically condemn same-sex sexuality, particularly since sexuality as an identity was not discussed until centuries after the Bible was written. In addition to condemning same-sex sexuality within churches, some Christians believe that it is their duty to promote their views in the public sphere. For example, beginning in the 1970s, groups of Christian conservatives, also known as the Christian Right, tried to influence national and state policies on many issues, including same-sex sexuality. Leaders like Jerry Falwell considered the United States to be a Christian nation and advocated for laws consistent with conservative

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Christianity. A major focus of the Christian Right beginning in the late 1990s was to prevent the legalization of same-sex marriage and to assist same-sex-oriented individuals in becoming heterosexual.

Same-Sex Marriage The Christian Right has argued that the legalization of same-sex marriage will erode the institution of marriage, force churches to perform same-sex ceremonies, and lead to negative outcomes for children, families, and society. In 1996, based in part on efforts from the Christian Right, the Defense of Marriage Act defined marriage as between a man and a woman. Since 1996, groups for and against same-sex marriage have devoted a great deal of time and money to their campaigns. For instance, the Church of Jesus Christ of Latter-day Saints was connected to a campaign that raised millions of dollars to fund Proposition 8, a measure to ­prohibit same-sex marriage in California. Despite their efforts, Proposition 8, the Defense of ­Marriage Act, and many other laws were eventually found unconstitutional in the 21st century, and states steadily began to legalize same-sex marriage before the Supreme Court legalized same-sex m ­ arriage in 2015. Reorientation Therapy and Ex-Gay Ministries

Based on the notion that same-sex sexuality is sinful or immoral, some Christian groups have said that same-sex behaviors are simply a phase that people go through. Furthermore, these groups advocate for LGB individuals to undergo therapy in order to change their sexual orientation. Although same-sex sexuality was removed from the DSM in 1974, some faith communities and counselors have continued the practice of trying to change sexual orientation, which became known as reorientation therapy or conversion therapy. Reorientation therapists have used techniques ranging from hormonal therapy and electric shock to prayer. In faith communities, reorientation groups known as ex-gay ministries also utilized these ­techniques. However, beginning in the late 1990s, major organizations such as the American Psychiatric Association, American Psychological ­ Association, American Counseling Association,

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and National Association of Social Workers issued position statements on conversion therapy, calling such practices unethical, harmful, and ineffective. Still, it was not until 2013 that Exodus International, a major ex-gay organization, voted to close the ­organization and apologize to its clients. Many organizations, such as the National Association for Research and Therapy of Homosexuality (now the Alliance for Therapeutic Choice and Scientific Integrity), continue to promote reorientation therapy despite the statements made by mental health organizations and statewide bans on this type of therapy. Recognizing that reorientation therapy does not work, some faith-based organizations and churches have shifted their focus to celibacy. In fact, both the Roman Catholic Church and the Church of Jesus Christ of Latter-day Saints distinguish between same-sex attraction and behavior. Both organizations acknowledge the existence of same-sex attraction and, rather than trying to change it, encourage members to refrain from acting on this attraction. In other words, they promote a life of celibacy. Denominational Policies

Over time, most Christian denominations and groups have developed official policies on sexuality that include topics ranging from same-sex marriage to ordination of LGB individuals. Christian denominations and theologians have largely focused their policies and position statements on gay men and, to a lesser extent, on lesbian women. There is much less information related to the bisexual population. Those that do acknowledge bisexual individuals will often direct them to conform to God’s plan by choosing to be in a heterosexual relationship. Finally, there is almost no information on or for asexuals. It is important to note that although information about denominations and faith-based groups is helpful in understanding the stances of various groups, it does not necessarily equate to the ­climate in individual churches or beliefs of individual members. In fact, some denominations will defer to individual churches to decide whether or not they want to perform same-sex marriage or ­blessing ceremonies, rather than having a denominational policy for all churches. The policies and practices of several denominations are outlined in

the following paragraphs and are listed from the least to the most affirming. Several denominations, including Free Will Baptist, Southern Baptist, Church of Christ, Jehovah’s Witness, Lutheran Missouri Synod, African Methodist Episcopal, and Seventh Day Adventist, stand firmly against same-sex sexuality and believe that it is a sin. It is not uncommon to hear this message in member churches, and it is typically assumed that individuals are heterosexual. In addition to hearing anti-LGB messages in churches, the denominations as a whole will often release position statements or information related to sexuality. For instance, the Southern Baptist Convention has issued multiple resolutions against same-sex sexuality, same-sex marriage, ordination of LGB clergy, service of LGB individuals in the military, adding sexual orientation to hate crime legislation, and others. For denominations that do not support same-sex sexuality, nonaffiliated groups have formed that affirm same-sex sexuality. These nonaffiliated groups are often not recognized or acknowledged by the denomination. As mentioned previously in this entry, the Roman Catholic Church and the Church of Jesus Christ of Latter-day Saints both acknowledge same-sex sexuality as a part of life but promote celibacy. As such, they accept same-sex attraction but condemn samesex behavior and identity. In the Catholic Church, celibate men without deep-seated same-sex desires may become priests, and individuals with same-sex attractions are referred to Courage, a Catholic group that promotes celibacy. In the Church of Jesus Christ of Latter-day Saints, celibate LGB individuals may hold any position that is open to single, celibate heterosexual individuals. Some denominations, including United Methodist, Episcopal, Evangelical Lutheran Church in America, and Presbyterian Church of the United States, have become more inclusive over time. For instance, the Episcopal Church voted in the late 1990s to restrict ordination to celibate LGB individuals. After several failed attempts to approve ordination of LGB individuals in monogamous relationships, the Church finally voted to make these individuals eligible for ordination. Although many Christian churches and faithbased groups have become more welcoming and affirming of LGB people over time, some were formed specifically with that intent. For instance,

Christianity and Sexual Orientation

the Metropolitan Community Church was formed in the late 1960s by a gay pastor as a ministry for LGB and transgender individuals. Other groups, such as Unitarian Universalists and United Church of Christ, although not explicitly formed with the purpose of ministry to LGB individuals, have a long-standing history of affirming same-sex sexuality. Since the 1980s, the United Church of Christ has ordained LGB clergy, and the Unitarian Universalists have supported same-sex commitment ceremonies and weddings. These welcoming faith organizations often provide support to LGB individuals whose former churches are antigay.

LGB Christians Because many Christian churches are becoming more welcoming and affirming, some LGB Christians will not experience conflict between these aspects of their identities. However, LGB individuals who grow up in homophobic Christian f­ amilies, churches, or communities will often experience conflict between their LGB identity and religious beliefs. Because religion can encompass all areas of life and can be a foundation on which people build their lives, the conflict between r­ eligion and sexual orientation may lead to confusion, anxiety, depression, and, in some cases, ­suicide. Furthermore, many LGB Christian youth experience this conflict alone due to fear of the consequences of coming out to others. For those who suffer in silence, television, the Internet, and social media can offer valuable resources and information. This is particularly helpful to those who are in rural communities that do not have welcoming or affirming Christian groups. For instance, the Gay Christian Network offers an online presence and a way for people to meet others, obtain resources, and learn about events in their area. Same-sex-attracted individuals who experience conflict between their sexual identity and religious beliefs resolve it in various ways. Some will integrate their LGB and Christian identities by developing Christian beliefs that are more affirming of their sexual orientation. They will often critically analyze the six key biblical texts that discuss samesex sexuality and develop new understandings and meanings. These individuals may begin attending an affirming church, or they may identify as Christian without joining a new congregation. ­

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Regardless, a hallmark of their integrated identity is an individualized Christian faith. Rather than simply relying on a religious institution for guidance, these individuals critically reflect on and personalize their beliefs. As such, they tend to develop their faith identity more quickly than others who do not experience a faith conflict. On the other hand, these individuals develop an LGB identity slower than those who do not grow up believing that same-sex sexuality is a sin. Another way in which people address the conflict between sexual orientation and religious beliefs is to accept their LGB identities and reject their Christian upbringing. This is often a painful and difficult process since religion is a critical ­component of their lives. These individuals may convert to another religion that is more affirming, identify as spiritual, or become atheist or agnostic. Members of this group, like the previous group, develop their faith or moral identity at a faster rate and their sexual identity at a slower rate. Some Christian same-sex-attracted individuals will continue to believe that being LGB is a sin and will reject an LGB identity. They may try to undergo reorientation or conversion therapy or may focus on celibacy as a resolution. Regardless of the approach, these individuals stand firmly in their Christian beliefs that same-sex sexuality is sinful and immoral. Although most people experiencing the conflict between sexual orientation and religious beliefs will eventually come to a resolution, there are individuals who continue to live with the conflict and cognitive dissonance. Some individuals in this group will, for instance, secretly engage in samesex behavior despite continuing to identify as heterosexual and Christian. In fact, there have ­ been examples of married politicians who are wellknown for their antigay rhetoric and legislation later admitting to same-sex behavior. Regardless of the type or extent of the resolution, it is important to understand that the resolution is a lifelong process rather than a one-time event. The resolution process often includes seeking information and resources, reflecting about self and others, discussing ideas with other people, forming new concepts of self and identity, and perhaps speaking to a therapist. Those who identify as LGB often face continued discrimination and judgment. In fact, some LGB teens and young adults

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Cisgender

who do not have support from their families or communities are kicked out of their homes. ­Community resources, including homeless shelters and support from affirming churches, often assist those who do not have family support. As long as people continue to believe that samesex sexuality is a sin, LGB Christians and Christian churches will undoubtedly continue to wrestle with and debate these ideas and conflicts. L ­ ikewise, LGB Christians, allies, advocates and educators will continue to address oppression, discrimination, and homophobia within Christian groups and churches and beyond. Denise L. Levy See also Bisexuality; Gay Men; Homophobia; Lesbians; Sexual Orientation: Overview; Sexual Orientation Change Efforts; Spirituality and Sexual Orientation

Further Readings Anderton, C. L., Pender, D. A., & Asner-Self, K. K. (2011). A review of the religious identity/sexual orientation identity conflict literature: Revisiting Festinger’s cognitive dissonance theory. Journal of LGBT Issues in Counseling, 5(3–4), 259–281. doi:10 .1080/15538605.2011.632745 Foster, K. A., Bowland, S. E., & Vosler, A. N. (2015). All the pain along with all the joy: Spiritual resilience in lesbian and gay Christians. American Journal of Community Psychology, 55(1–2), 191–201. doi:10.1007/s10464-015-9704-4 Jackle, S., & Wenzelburger, G. (2015). Religion, religiosity, and attitudes toward homosexuality: A multilevel analysis of 79 countries. Journal of Homosexuality, 62(2), 207–241. doi:10.1080/0091836 9.2014.969071 Levy, D. L. (2014). Christian doctrine related to sexual orientation: Current climate and future implications. In A. B. Dessel & R. M. Bolen (Eds.), Conservative Christian beliefs and sexual orientation in social work: Privilege, oppression, and the pursuit of human rights (pp. 11–41). Alexandria, VA: Council on Social Work Education Press. Levy, D. L., & Reeves, P. (2011). Resolving identity conflict: Gay, lesbian, and queer individuals with a Christian upbringing. Journal of Gay & Lesbian Social Services, 23(1), 53–68. doi:10.1080/10538720.2010.530193 Rodriguez, E. M. (2010). At the intersection of church and gay: A review of the psychological research on gay and lesbian Christians. Journal of Homosexuality, 57(1), 5–38. doi:10.1080/00918360903445806

Thatcher, A. (Ed.). (2015). The Oxford handbook of theology, sexuality, and gender. New York, NY: Oxford University Press. Thomas, J. N., & Olson, D. V. A. (2012). Evangelical elites’ changing responses to homosexuality 1960–2009. Sociology of Religion, 73(3), 239–272. doi:10.1093/socrel/srs031 Toft, A. (2014). Re-imagining bisexuality and Christianity: The negotiation of Christianity in the lives of bisexual women and men. Sexualities, 17(5/6), 546–564. doi:10.1177/1363460714526128 Whitehead, A. L. (2013). Religious organizations and homosexuality: The acceptance of gays and lesbians in American congregations. Review of Religious Research, 55(2), 297–317. doi:10.1007/s13644-012-0066-1

Cisgender Cisgender is a single term that refers to a characterization of persons at two different time points in their development: (1) a description of the gender category to which they were assigned at birth based on the appearance of external genitalia and (2) a description of the current gender identity that the person has self-assigned (also called gender selfcategorization). Because cis- is the Latin prefix for “on the same side,” a cisgender person can be described as having the same label for the selfassigned identity as her or his birth-assigned gender label. Specifically, if a person was assigned to the female gender category at birth (based on external genitalia) and also identifies as female currently, then this person is considered a cisgender woman (or cis woman). Similarly, if a person was assigned to the male gender category at birth (based on external genitalia) and also identifies as male now, then this person is considered a cisgender man (or cis man). Cisgender (or shortened to cis) is a complementary term to transgender. This entry examines the use of cisgender terms (and other pronoun preferences), the normativity of the cisgender experience, and cisgender’s related concepts.

Incidence in U.S. Population and Pronoun Use Cis women and men appear to be the most common profile of gender experience in the United States (and likely other countries). Because it is the

Cisgender

most common profile of gender experience, people who have cis profiles often times do not mark this profile explicitly in language. In effect, “cis women” are often referred to as simply “women,” and likewise, “cis men” and are often referred to as simply “men” since they are numerically majorities within those groups. Accordingly, only some individuals who are describable as cis women or cis men actually refer to themselves as such. In any case, virtually all cis women use and prefer female pronouns (she/her/hers) to communicate their gender selfcategorization. And virtually all cis men use and prefer male pronouns (he/him/his) to communicate their gender self-categorization.

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understood as a larger term for several related but separable phenomena. Instead, scholars used different meanings of the same two terms—­ ­ femininity and masculinity—to describe all these different phenomena. In the 2000s, the work of David Perry and his colleagues and, later, Charlotte Tate and her colleagues created theoretical positions that made these different phenomena explicit. Perry and colleagues created a multidimensional understanding of gender in which ­gender has different dimensions (e.g., felt typicality with in-group members, pressure to conform to gender stereotypes, contentment with assigned category). Tate and colleagues created a facet ­ structure or bundle understanding of gender in which gender has d ­ifferent facets (e.g., birthNormativity of Cisgender assigned category, self-assigned category, gender Experience and Its Consequences role expectations, social presentation of selfOwing to its numerical majority status in many assigned gender category) whose interrelationships cultures, the understanding of gender self-­ are not necessarily clear at present. Because the categorization often becomes cisnormative— dimensions or facets of gender were not clearly whereby social perceivers expect most people to be demarcated by past literature, some sectors of cisgender. Cisnormativity brings with it an expectasocial science have treated cisgender as a synonym tion that gender self-labeling also conveys inforfor heterosexuality, for conformity to the expectamation about genital anatomy, such that those tions of the social p ­ resentation of gender, and for self-labeling as women are expected to have vagithe adherence to traditional gender roles. Hownal/vulval genital structures and those self-labeling ever, under either the dimensional or the facet as men are expected to have penile/scrotal genital understanding of gender, cisgender may only refer structures. However, the existence of transgender to a subset of phenomena and not the ones previ­individuals shows this expectation to be too ­narrow ously considered as synonyms. (and ultimately false). Additionally, cisnormativity From a facet understanding of gender, for examalso rests on a binary assumption of gender self-­ ple, cis women vary in their social presentation of categorization—that is, that there are only two gender when it involves attire-based appearance ways by which people self-label: as either female or (i.e., clothing and accouterments). Some cis women male. Yet the existence of nonbinary transgender have attire-based appearances that are common persons renders this expectation too narrow and for women in their society. Other cis women have ultimately false. Despite counterexamples to its attire-based appearances that are less common for usefulness, cisnormativity permeates nonscholarly women in their society (including attire-based (and sometime scholarly) discussions of gender appearances that are associated with men in that self-labeling and sexual orientation (and other topsociety). In any case, being a cis woman is about ics). In the extreme, cisnormativity leads to cisgenthe psychological experience of being in a female derism, or the denial, denigration, or dismissal of gender category by self-assignment. Attire-based any noncisgender experience of the social world. presentation is often an easy way for other people The use of gender normal and associated terms in to categorize a person into a gender group based some discussions is evidence of cisgenderism. on cultural standards. However, this attire-based presentation is not the complete picture of the individual’s self-categorization into a gender group Distinguishability of because attire-based appearance is gender expresCisgender From Other Gender Concepts sion (based on cultural stereotypes for groups), not From the 1900s until the early 2000s in the United gender self-labeling as such. The same is true for States and Europe, gender was not consistently cis men: They may vary in their attire-based

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appearance along common and less common ­cultural standards. Nonetheless, being a cis man is about the psychological experience of being in a male gender category by self-assignment—­ irrespective of others’ inferences or perceptions. Additionally, there is tacit consensus in social science that cis women and cis men have a range of sexual orientations and may or may not adhere to the gender role expectations for their respective groups. This is because, in both cases, cis women and cis men are the majority profiles that constitute the gender groups implicated in those findings. Charlotte Tate See also Gender Expression; Gender Identity; Gender Pronouns

Further Readings Ansara, G. Y., & Hegarty, P. (2012). Cisgenderism in psychology: Pathologising and misgendering children from 1999 to 2008. Psychology & Sexuality, 3, 137–160. Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychological adjustment. Developmental Psychology, 37, 451–463. Tate, C. C., Ledbetter, J. N., & Youssef, C. P. (2013). A two-question method for assessing gender categories in the social and medical sciences. Journal of Sex Research, 50, 767–776. Tate, C. C., Youssef, C. P., & Bettergarcia, J. N. (2014). Integrating the study of transgender spectrum and cisgender experiences of self-categorization from a personality perspective. Review of General Psychology, 18, 302–312. Tobin, D. D., Menon, M., Menon, M., Spatta, B. C., Hodges, E. V. E., & Perry, D. G. (2010). Intrapsychics of gender: A model of self-socialization. Psychological Review, 117, 601–622.

Cissexism The term cissexism stems from the Latin root cis, meaning “on the same side.” This root also presents itself in the related term cisgender, used to describe an individual who self-identifies with the gender

assigned at birth. For example, an individual would be cisgender (or “cis” in short) if that individual was described as male (or female) at birth, stated as male (female) on the birth certificate, and then grew up to experience himself (herself) as being male (female). Cisgender as a category contrasts with transgender from the Latin root trans, ­meaning “across.” A transgender individual self-identifies with a gender identity other than what was assigned at birth. For example, an infant described as a male on birth may grow up with a sense of self characterized as female. This individual may utilize female pronouns (e.g., she, her, hers) and may engage in activities typically associated with the female sex, such as socializing with primarily female peers or enjoying the use of makeup. Some noncisgender individuals may identify with neither a male nor a female identity. Such an individual might self-identify as transgender or might identify by terms such as genderqueer. Within the context of these cisgender, transgender, and otherwise noncisgender identities, cissexism refers to the normalization of cisgender identities and therefore to the stigmatization and/or ­exclusion of noncisgender identities. Cissexist perspectives include the view that noncisgender identities are not legitimate gender identities, a view that can result in unequal treatment, limited resources, and negative psychological outcomes. This entry briefly touches on definitions of related terms including sex, gender, gender identity, and transphobia before exploring manifestations of cissexism at interpersonal, organizational, and structural levels. Last, psychological impacts of cissexism, including health disparities, are discussed.

Related Terms In discussing cissexism, it becomes useful to distinguish between the terms sex, gender, and gender identity, as well as to mention the related term of transphobia. Sex, as defined by major organizations such as the World Health Organization and the American Psychological Association, refers to biological and physiological characteristics of males and females. This includes chromosome configurations as well as secondary sex characteristics such as genitalia, breasts, or a protruding Adam’s apple. Gender refers to a collection of socially constructed roles, attitudes, and behaviors considered

Cissexism

acceptable by a given society. Gender identity refers to one’s sense of self within the context of both sex and gender. Individuals whose gender identity aligns with the sex assigned to them at birth are cisgender. Individuals whose gender identity does not align with that assigned to them at birth may identify as transgender or by other terms such as genderqueer, as previously described. While societal attitudes regarding sex, gender, and gender identity contribute to the perpetuation and maintenance of cissexism, one additional factor warrants mention: transphobia. Transphobia is a term often confused with cissexism and refers to a set of negative attitudes and/or hostility toward individuals who identify as transgender or who do not conform to gender norms. A phobia is defined as an “irrational fear”; therefore, transphobia refers to an irrational fear of transgender individuals and others who transcend gender norms. Transphobia and cissexism together create invalidating and hostile environments for noncisgender individuals.

Portraits of Cissexism Cissexism manifests at three levels: (1) interpersonal, (2) organizational, and (3) structural. Each level cumulatively depends on the last. ­Organizational cissexism reinforces and maintains interpersonal cissexism, and structural cissexism allows for the perpetuation of both organizational and individual levels. Whereas interpersonal ­cissexism occurs at the individual level and organizational cissexism occurs at the level of specific organizations, structural cissexism functions at the level of the overall society. Interpersonal Cissexism

The interpersonal level includes individual perceptions. An individual who holds cissexist beliefs may perceive noncisgender individuals as having less legitimate gender identities or as having less worth than cisgender identified individuals. Interpersonal cissexism often presents through microaggressions, or brief, subtle acts of discrimination against marginalized groups, which communicate negative messages. Examples include grimacing at a transgender individual walking down the street, refusing to use the proper pronouns, or shouting

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derogatory terms such as tranny. Such actions communicate the message that noncisgender identities are not accepted or are less valid than cisgender identities. Individuals may internalize these messages, or incorporate them into their own selfimage, such that they may view themselves as unacceptable or invalid. Internalization of cissexist messages can have harmful consequences and has been demonstrated to contribute to the increased rates of depression, anxiety, substance abuse, and suicide risk among this population. Organizational Cissexism

Cissexism also occurs at the organizational level, where specific organizations enact policies that stigmatize or exclude noncisgender identities. This stigmatization and exclusion normalize cisgender identities and thus hold the potential to perpetuate cissexism at the individual level. For example, as of January 2015, the different branches of the U.S. military still upheld a ban on transgender military service, which not only prevents the enrollment of transgender individuals into the military but also allows for the honorable ­discharge of individuals who come out as transgender or seek to transition during their military service careers. In the United States, military organizations view noncisgender identities as “psychosexual medical conditions,” which render individuals unfit for service despite mounting medical evidence to the contrary. Organizational cissexism communicates the message that noncisgender identities are unfit to represent certain organizations as a result of gender identity rather than merit. Structural Cissexism

Structural cissexism includes a societal set of attitudes and behaviors that place a higher value on cisgender identities compared with noncisgender identities. These reinforce perceptions of ­cisgender identities as “normal” and noncisgender identities as pathological. Cisgender identified individuals may often remain unaware of the structural cissexism of a system, which inherently privileges cisgender identities. For example, on many general medical forms or online surveys, the question “What is your gender?” is often accompanied by two options: “male” or “female.” On some

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occasions, a third option of “transgender” appears, yet this still excludes noncisgender individuals who do not identify with the term transgender. In addition, some forms will include the option of “other,” thus implying that gender identities that do not fit into the boxes provided are invalid and deviant. An individual who identifies as cisgender has the privilege of quickly checking a readily provided box that reinforces and supports his or her identity, whereas an individual who does not identify with the categories offered is faced with an internal struggle. The noncisgender individual must choose between not checking a box (the consequences of this decision may include aroused suspicion, unwanted public attention or ridicule, or discrimination) and checking a box that incorrectly describes their identity (where the consequences may include internalized stigma, a sense of oneself as invisible or unworthy of recognition, or potentially harmful miscategorization depending on the nature of the form involved). A second manifestation of structural cissexism often overlooked by cisgender individuals involves the use of public restrooms. Restrooms frequently bear one of two symbols: (1) a human form in a dress, meant to signify that the restroom is meant for females, and (2) a human form without a dress, meant to signify that the restroom is meant for males. While gender neutral or “family” restrooms appear in some locations, the binary male/female options are far more commonplace. Two primary concerns arise from this predominant configuration. The first involves passing, a term common in noncisgender circles that denotes the extent to which transgender individuals can go about their days in public without being “clocked,” or without being identified by strangers as noncisgender. ­Passing involves both appearances (e.g., clothing, hairstyle, or makeup) and mannerisms (e.g., gestures or pitch of voice) consistent with a male or female gender identity. The extent to which a transgender individual passes may play heavily into that individual’s decision to use one restroom or the other. As a result of stigma and transphobia, this decision resembles more a matter of personal safety, perhaps of life and death, than a coin toss. Cisgender individuals are spared this risky decision-making process. The second concern with binary gender options in restrooms relates to cissexism at a conceptual level. Cissexism includes the societal-level

normalization of cisgender identities and casts noncisgender identities as pathology or deviance. The common occurrence of two categorical restroom options, accompanied by their two ­ human-like symbols recognized across the world as relating to male/female designations, demonstrates both the dominance and the frequent invisibility of cissexism. Worldwide acceptance of these ­categories as fact reinforces a conceptualization of gender as existing in only two forms: (1) male or (2) female. This furthermore reinforces perceptions that there is only one way to be “male” or “female,” dependent on genital anatomy and the alignment of self-presentation with social norms. Cissexism is maintained by the widespread assumption and belief that gender only exists as a male/female dichotomy and that to be perceived as valid, gender identity and presentation must conform.

Cissexism and Well-Being Cissexism, and the discriminatory attitudes and behaviors it reinforces, can contribute to negative outcomes for noncisgender individuals. These outcomes include physiological health concerns such as a transgender individual refraining from seeking medical services for a wound or illness for fear of facing discrimination, unequal care opportunities, stigmatization, or situationally inappropriate questions (e.g., “Have you had ‘the surgery’ yet?”). Cissexism in this case perpetuates the flawed belief that all transgender individuals will seek to surgically modify their bodies in order to conform to social expectations for their gender identity, reinforcing the cissexist belief that there is one ­ acceptable physical form that can be considered “female” and one that can be considered “male.” Cissexism in this case also highlights the cisgender privilege necessary to ask the transgender individual about the current state of their genitalia. These fears of seeking health services are compounded by the increased rates of HIV/AIDS and of experiencing physical violence. Noncisgender individuals with these increased risks have a heightened need for identity-affirming and culturally competent health services; however, this need is met by a system biased to their detriment by cissexism. Noncisgender individuals also face heightened psychological risks, with increased rates of depression, anxiety, substance abuse, and suicide risk, as

Cognitive Approaches and Gender

well as lifestyle barriers including heightened rates of homelessness and negative interactions with the criminal justice system. As a result of systemic cissexism, many noncisgender individuals face a cycle of illness worsened by a lack of available resources and a lack of culturally competent professionals to direct them toward identity-affirming resources. Researchers largely agree that these disparities of health and risk do not result directly from the noncisgender identity itself but, rather, that these disparities grow out of systematic cissexism and its associated discrimination and microaggressions. The cumulative impact of experiences with discrimination and stigma for individuals with ­ marginalized identities has been called minority stress. Living daily in circumstances of high minority stress perpetuated by cissexism limits the immune system and coping strategies, thus leaving marginalized populations at heightened risk physically, mentally, and socially. Chassitty N. Whitman See also Cisgender; Gender Conformity; Gender Identity; Transphobia

Further Readings Bieschke, K. J., Perez, R. M., & DeBord, K. A. (2007). “I’d rather get wet than be under that umbrella”: Differentiating the experiences and identities of lesbian, gay, bisexual, and transgender people. In Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 19–49). Washington, DC: American Psychological Association. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Kiesling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Harrison, J., Grant, J., & Herman, J. L. (2012). A gender not listed here: Genderqueers, gender rebels, and otherwise in the National Transgender Discrimination Survey. LGBTQ Policy Journal at the Harvard Kennedy School, 2, 13–24. Retrieved from http:// escholarship.org/uc/item/2zj46213 Hussey, W. (2006). Slivers of the journey: The use of photovoice and storytelling to examine female to male transsexuals’ experience of health care access. Journal of Homosexuality, 51(1), 129–158. doi:10.1300/ J082v51n01_07

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Johnson, J. R. (2013). Cisgender privilege, intersectionality, and the criminalization of CeCe McDonald: Why intercultural communication needs transgender studies. Journal of International and Intercultural Communication, 6(2), 135–144. doi:10.1 080/17513057.2013.776094 Nadal, K. L. (2013). That’s so gay!: Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association. Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressions toward transgender people: Implications for counseling. Journal of LGBT Issues in Counseling, 6(1), 55–82. doi:10.1080/15538605.2012.648583

Cognitive Approaches

and

Gender

A cognitive approach to gender considers the impact that cognition has on behavior and emotion and recognizes that therapeutic approaches may vary according to different gender experiences. The cognitive approach is based on the principle that one’s thought processes directly and indirectly influence one’s behavior as well as one’s mood. In addition, individuals’ behaviors and experiences, in turn, influence their thoughts and emotions. An awareness of the “cognitive triangle” (thoughtsbehavior-emotion) is an essential part of the practice of professionals who work within a cognitive behavioral therapy (CBT) modality. This entry concentrates specifically on the cognitive aspect of CBT and how these approaches can best be considered in terms of and with sensitivity to gender. A discussion of gender follows, with a brief overview of gender and gender bias in research practices. Further elaboration will then be provided regarding research on cognitive processes and gender. Finally, a discussion of common cognitive approaches and how they can be considered in light of gender research and findings will be provided.

Gender Differences While sex is determined by biological makeup at birth, gender is a social construction that is ­influenced by complex personal and sociocultural contributions. Because the construction of gender relies on social transactions understood to be appropriate to one sex, gender may be

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independent of the individual’s biological sex and also may not necessarily align exclusively with male or female traits. Throughout history, the complex discussion of gender differences has carried political and sociocultural biases consistent with the cultural context of its time and was ­commonly confounded with differences in sex. The feminist movement of the 1960s was an important influence on theories of gender and the nature/nurture debate. The conversation on gender differences prior to this feminist movement held a staunch conviction on the side of nature— stating primarily that women’s biological differences led to a natural membership in a socially marginalized group. In the 21st century, researchers recognized the diverse array of women’s ­personality types and normalities and theorized that both nature and nurture interact and contribute to the differences in gender. In addition, research in the past century has found that men and women appear to have stronger similarities than has been discussed in the past. The magnitude and direction of gender ­differences depend largely on the context and a consideration of intersectional identities outside gender (e.g., race, ethnicity, socioeconomic status, etc.). Gender differences in cognition have generally not been found to be large or stable, and as such, therapists should base their practice primarily on the most current scientific evidence. When comparing gender differences in research, it is important to note that conclusions may be skewed by a researcher’s or therapist’s gender biases. Gender bias can occur, for example, when mental health professionals mislabel or misevaluate women’s behaviors as pathological without ­considering appropriate responses to context (e.g., societal or institutional oppression). Thus, a multicultural competency can help the professional engage and consider the larger socio-environmental influences on the person’s behaviors and thought processes. This entry will now briefly discuss common cognitive factors and cognitive approaches related to gender, with guidance from current research. Cognitive Factors and Gender

The majority of findings on gender differences within psychopathology research are in the area of

depression. Researchers report that twice as many women as men are depressed and have offered a number of different vulnerability/stress models to help explain this significant difference. One proposed model considers the affective, biological, and cognitive factors that contribute to the development of depression. More specifically, ­ researchers have found three forms of cognitive vulnerabilities leading to depression that differ between men and women: (1) cognitive style, (2) rumination, and (3) objectified body consciousness. Researchers have found that individuals with certain ­ negative cognitive styles who experience negative or stressful life events may be at greater risk of developing depression. Those who suffer from the cognitive vulnerability of rumination, more commonly found in women, think repetitively and focus on the negative emotions that result from facing a negative situation. While there are apparent gender differences in cognitive patterns, most significantly among those diagnosed with depression, it is important to also take into account potential environmental influences on cognition. An understanding of these underlying trends and causes can help inform best practice in determining the most effective treatment options. Cognitive Approaches

CBT, the gold standard treatment for anxiety and depression, focuses on the connection between thoughts and behaviors and recognizes that by addressing maladaptive thoughts and changing related behaviors unwanted symptoms can be reduced. Individuals’ underlying beliefs about a situation are hypothesized to influence their perception and affect their emotional, behavioral, and physiological reactions to a situation. Erroneous cognitive processing of a situation can ultimately lead to symptoms common to depression, anxiety, and other psychological disorders. Common cognitive distortions can be targeted in cognitive therapy through a number of specific techniques. Detecting Automatic Thoughts

Automatic thoughts are the result of an interaction between environmental information, cognitive processes, and beliefs. Although considered the most superficial form of cognition, automatic

Cognitive Approaches and Gender

thoughts reflect an individual’s underlying core belief. Although some automatic thoughts may be accurate, many individuals who suffer from a psychiatric condition can be susceptible to common errors in thinking. These common cognitive errors (e.g., catastrophizing, fortune telling, ignoring evidence) are referred to as thinking traps and can prompt problematic automatic thoughts. Typically, through cognitive approaches in therapy, individuals may learn to be aware of common thinking and then learn how to more effectively evaluate the validity and utility of their associated automatic thoughts. Researchers have examined gender differences in automatic thoughts specifically among those who suffer from depression. It has been hypothesized that men and women may think and interpret situations in different ways, which can lead to differences in the content of automatic thoughts and in the development of different psychological disorders. For example, some research has revealed that girls tend to have more negative content in their automatic thoughts, focusing on themes of failure, poor self-evaluation, and self-blame. Furthermore, girls compared with boys have been found to be more concerned with others’ perception and evaluation of themselves, which can put females at risk of developing depression. While no research exists on differing cognitive techniques to use with men versus women, therapists should be aware of patients’ common themes within their automatic thoughts to accurately conceptualize the patient and choose the most helpful cognitive restructuring techniques. Problem Solving

Problem solving is one of the most common and useful skills taught in CBT. Depressed and anxious individuals frequently have trouble when faced with a problem and act in an avoidant or helpless manner, instead of carefully and rationally working through the problem. Teaching and practicing problem solving can help improve cognitive flexibility, an ability that can be useful in coping with stressful or difficult situations. The main steps in problem solving include identifying the problem and the goal, developing a list of possible solutions, assessing the strengths and weaknesses of the solutions, picking a solution, and implementing it.

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Researchers have found differences in problemsolving behaviors between girls and boys that have been linked to increased depressive tendencies in women and increased delinquent behavior in boys. When faced with social problems, girls have been found to more frequently doubt their own abilities and to assume that the problems they face are unsolvable. These types of negative cognitions in problem-solving behaviors can make it increasingly difficult to cope when faced with life stressors and conflicts. Boys, on the other hand, have been found to have a more impulsive style of problem solving, in which they tend to settle on the first solution that they think of, without carefully evaluating the alternatives. Researchers note that boys’ lack of careful information processing may put them at risk of participating in more delinquent activity. Clinicians should work carefully in developing and practicing problem-solving skills with their clients as they can be effectively applied when confronting stressful life events, in addition to a number of other facets of an individual’s life. Cognitive Restructuring

Cognitive restructuring requires the clinician to first detect an individual’s automatic thoughts. When a problematic thought is isolated, it can be critiqued and changed to a thought based more in reality. Distorted and negative thoughts can be restructured, which can affect mood and/or behavior. Testing the evidence and reframing are cognitive approaches used to dispute maladaptive thoughts. Testing the Evidence Negative thoughts influence behavior and mood when an individual believes and ruminates on those thoughts. Testing the evidence gives the individual an opportunity to gather evidence for and against the veracity of these typically irrational thoughts. For example, a person overly concerned with their health may be thinking, “I am going to get sick.” Concentrating on this thought may lead to feelings of anxiety, interfering with the person’s well-being. Challenging the thought, the person may ask, “How do I know that I am going to get sick? What else might cause me to feel this way? Is it possible that I will not get sick?”

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In considering gender, once the individual has identified the maladaptive thought, the mental health professional should aid the individual in considering the societal and institutional influences on the person’s thoughts. For example, for women and minority individuals, negative thoughts may be derived from past or current experiences of oppression and prejudice. Thus, best practice would be to not immediately discount the reality of negative thoughts and to consider the larger context and intersecting identities of the individual. When helping clients test the evidence of their thoughts, the clinician should include questions of past and present experiences in addition to considering potential thinking traps (see above) and alternatives to the problematic thought. When testing the evidence, the person thinks like a detective who investigates the truthfulness of his or her thoughts. Sometimes, it is possible that the anxious thought is based in reality (e.g., a person with messy hair might think, “My hair is a mess!”). In such a case, problem solving the situation is the best course of action. However, if no such evidence can be found to support the thought or the thought is found to be an exaggeration, misinformed, or incomplete, that thought will then need to be replaced with a more realistic thought. Reframing Cognitive reframing helps change the meaning ascribed to experiences. Once a maladaptive thought has been identified and found to be unrealistic, that thought can then be altered to reflect a more realistic and positive frame of mind. Identifying one’s thinking traps and testing the evidence of one’s thoughts give one an improved ability to consider alternatives to one’s original thoughts and, in turn, change one’s perspective and behavior. When determining a new thought (i.e., a coping thought), it is important that the thought maintain a realistic and positive perspective. Additionally, it is helpful for the new thoughts to be formed in individuals’ own words and reflect their own subjective experience. This can help individuals to more readily accept the new thought into their worldview. Often, a person’s automatic thoughts can be found to be exaggerated and catastrophic. In these cases, decatastrophizing will be necessary to identify a new coping thought.

Decatastrophizing Decatastrophizing is a cognitive restructuring technique that helps challenge the catastrophic thinking that is common in individuals suffering from anxiety. Typically, an anxious individual experiences a trigger situation, which may be an ambiguous stimulus or one that has the potential to be upsetting but has unclear meaning or impact. In response to the situation, the individual focuses on the worst-case scenario, or catastrophizes the situation, in an attempt to find meaning or predict what might happen next (e.g., a mother of a child with separation anxiety is late picking him up from school, and he immediately thinks, “My mom must have gotten into a car accident!”). As a result, messages are sent to the brain that the individual is in danger, and the individual experiences physical and emotional symptoms that are not only associated with the body’s “fight-or-flight response” but also typical of anxiety. Decatastrophizing, a restructuring technique that can be used to help reframe the situation, is done by helping the individual explore alternative explanations for the situation and assess the probability of each alternative to figure out what is most realistic. Decatastrophizing encourages the individual to reassess his or her cognitive distortions in a systematic way. Although little research exists related to gender differences in catastrophizing, studies have revealed a greater tendency for women, compared with men, to catastrophize when experiencing pain. When using cognitive therapy to help with pain management, it might be useful to pay attention to catastrophic thinking among patients and to challenge distorted or irrational thinking through reframing techniques such as decatastrophizing.

Research Directions The experience of gender in an individual’s life has been shown to be a fluid and sociocultural experience not isolated from other intersectionalities of identity. The history of gender research has had many transformations, moving over time from a primarily heteronormative, sexist perspective to a more complex understanding of gender similarities and the gender spectrum. Cognitive approaches have been developed traditionally with little to no regard for gender ­

Cognitive Disorders in Men

differences. Relatively little research exists concerning the varied cognitive techniques and their influence on different genders. As more research develops, clinicians should consider concurrently feminist and minority perspectives to better inform their practice. Additionally, the potential for gender or sexist bias may still be present in the construction and implementation of empirical studies. Due to limitations in scope and sampling sizes, most social research lacks an appropriate representation of diverse populations and tends ­ to represent primarily Caucasian and high–­ socioeconomic status individuals. Practitioners should consider and stay consistent with the most up-to-date research while maintaining a critical eye on methodology. The shift in gender research at the turn of the 1960s feminist movement helped transform past common assumptions of gender differences. While research has begun to touch on gender complexities that go beyond men versus women, individuals who identify according to different genders nonetheless have unique experiences based on these loci of identity (e.g., race, e­ thnicity, gender, etc.). The influences of these experiences on cognition can inform both the approach and the process of treatment. Because the field of feminist research and gender bias–free approaches is still burgeoning, little research exists on the impact of therapeutic approaches on different genders and much less on transgender individuals. More research is still needed generally on the impact of cognitive approaches on gender and other intersectional identities to better inform the field. Sarah Koenig, Annette Cantu, and Kevin Stark See also Anxiety Disorders and Gender; Behavioral Approaches and Gender; Biological Sex Differences: Overview; Cognitive Disorders in Men; Cognitive Disorders in Women; Cultural Competence; Depression and Gender; Depression and Men; Depression and Women; Feminist Therapy; Gender Bias in Research; Research Methodology and Gender; Sampling Bias and Gender

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Beck, A., Rush, A., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press. Calvete, E., & Cardenoso, O. (2005). Gender differences in cognitive vulnerability to depression and behavior problem problems in adolescents. Journal of Abnormal Child Psychology, 33, 179–192. Ceglie, D. (2009). Engaging young people with atypical gender identity development in therapeutic work. Journal of Child Psychotherapy, 35, 3–12. Cornish, J. A., Schreirer, B. A., Nadkarni, L. I., Metzger, L. H., & Rodolfa, E. R. (Eds.). (2010). Handbook of multicultural counseling competencies. Hoboken, NJ: Wiley. Hyde, J. S. (2005). The gender similarities hypothesis. American Psychologist, 60(6), 581–592. Hyde, J. S., Mezulis, A., & Abramson, L. (2008). The ABC’s of depression: Integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression. Psychological Review, 115(2), 291–311. Unger, R. (2001). Handbook of the psychology of women and gender. New York, NY: Wiley.

Cognitive Disorders

in

Men

Due to structural differences in the nervous system, hormonal processes during prenatal and postnatal development, genetic factors, and variability in life experiences and demands, there are gender differences in how cisgender women and men perform on cognitive tasks and in their susceptibility to disorders affecting cognition across the life span. This entry first explores cognitive patterns in men, describing the kinds of skills at which men tend to be especially proficient and those skills at which men perform poorly compared with women. Next, this entry discusses the cognitive impairments associated with selected developmental disorders, brain insults, neurological conditions, and medical disorders that disproportionately affect males compared with females.

Cognitive Skills Across the Life Span Further Readings Beck, S. (2011). Cognitive behavior therapy, basics and beyond. New York, NY: Guilford Press.

This section describes the patterns of male intellectual skills. In doing so, it also defines the various domains of cognitive abilities that are used to

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characterize the patterns of intellectual deficits that are seen in cognitive disorders. These domains will be mentioned many times when describing the cognitive features of specific clinical disorders. Studies of gender differences in cognitive function suggest that there are gender differences in cognitive abilities in some domains of function; these findings reflect group differences, in which one sex outperforms the other. There is a great deal of overlap, however, in which some individuals perform at very high levels regardless of their gender. Research on gender and cognition indicates that general intelligence is equal in the two sexes despite the larger brain size in men. On tasks assessing academic knowledge, men tend to be better at mathematics and arithmetic, an advantage that appears around seventh grade and is especially notable on tasks assessing complex mathematical problems. Men show stronger visuospatial skills than women on many kinds of tasks, though sometimes these differentials are stronger in adults than in children. For example, males are better on average at putting blocks together to replicate designs that are presented to them, sequencing pictures to tell stories, drawing visual designs, recognizing angles correctly, locating geographic areas on maps, and recognizing the correct outline of objects that are presented in incomplete form. Men’s processing speed tends to be a strength; for example, they can correctly recognize target symbols in a visual array faster than women can. Men are generally described as being less adept verbally and at tasks requiring learning verbal material, though there is no female advantage on tasks like naming pictures of objects. On average, men perform better than women on many tasks that assess attention. As a group, their reaction times are faster than those of females, but they make more errors of certain types than women do on continuousperformance-type attention tasks, committing commission errors in which they have a greater tendency to respond to incorrect stimuli; for example, if looking at a series of letters in which they are asked to respond to the letter S, they may respond to other letters as well as S. Men tend to be quicker at simple visual-motor skills like finger tapping, in which a key on a form board or a computer button is tapped as quickly as possible within a time period. However, they are on average slower than

women at pegboard completion, a task in which pegs are turned manually in a form board. Boys and girls show a number of differentials in their capacity to plan, strategize, reason, and track information that they are processing, skills that are known as executive function and working memory, though in adulthood abilities in these domains are similar. Executive function and working ­memory allow individuals to carry out complex reasoning tasks (including deductive and inductive reasoning), develop strategies for completing complex intellectual challenges, and keep track of visual or verbal information while completing a task or work assignment. Overall, males’ strengths in the domain of learning and memory include the capacity to learn and remember visual information and designs. This visual memory skill can be demonstrated in their capacity to examine a complex, abstract visual design and draw it from memory. However, women generally outperform them on verbal memory tasks, such as learning lists of words, paragraphs of material, or word pairs ­presented orally. Prosopagnosia, a cognitive syndrome marked by the inability to recognize faces, is more common in men.

Cognitive Disorders This section describes the cognitive disorders that appear in conditions to which men are particularly susceptible. In each case, the particular expressions of cognitive dysfunction are related to the specific brain structures that become damaged due to the illness or injury. Of course, men may also acquire conditions that occur disproportionately in women, and the cognitive consequences are often quite similar. Developmental Disorders

Males are especially prone to developmental disorders affecting cognition that appear in childhood. This is generally attributed to the greater vulnerability of the male brain to exogenous insults in utero. These can include prenatal exposures to environmental toxicants such as lead in the home or mercury in the mother’s diet; maternal use of alcohol, tobacco, or other recreational drugs; and maternal infections during pregnancy. However, developmental disorders affecting

Cognitive Disorders in Men

cognition also have genetic determinants and are often found concurrently in a parent of an affected child. Attention-deficit/hyperactivity disorder diagnosis is twice as prevalent in boys as in girls and is the most common cognitive disorder of childhood. This disorder is associated with impulsivity and problems with attention, executive function, and organization. Boys with attention-deficit/hyperactivity disorder often cannot sit still in the ­classroom, concentrate on their work or class activities, complete homework assignments on time, organize reports and writing, or organize their rooms and home projects. These kinds of dysfunction affect school performance. Although these symptoms can be controlled by the use of medications such as Ritalin or Adderall, they persist into adulthood and are associated with poorer educational, vocational, and adjustment outcomes. Dyslexia is three to four times more prevalent in boys than in girls. Relative to general intelligence and skills in other functional domains, children with dyslexia have problems with learning to read, reading comprehension, writing, spelling, and sometimes other verbal abilities (e.g., vocabulary). In very bright individuals, compensation can occur, and interventions can improve verbal and reading skills, with strong vocabularies and reading comprehension emerging; often, subtle issues remain throughout life under challenging circumstances (e.g., complex writing, learning foreign languages). Dyslexia is associated with educational delays, and in some children, it can affect ultimate educational attainment. Some individuals with dyslexia have strong visuospatial, arithmetic, or reasoning skills, and these abilities improve their ultimate academic and vocational success. Autism spectrum disorder is seen four times more frequently in boys than girls. Cognitive problems vary with the severity of the disorder (i.e., where it is on the “spectrum”). Cognitive issues can be quite mild but can include difficulties interpreting social cues and information; delayed or limited speech; a tendency to be easily overwhelmed by people; noise, or other stimulation; and an inability to engage in cognitive and intellectual tasks. Children with autism sometimes require special educational milieus. Ultimately, their cognitive and social problems can result in substantial social estrangement, vocational

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disability, or a complete inability to work, as well as limited education. Some individuals with autism are very bright, and some have special skills (these individuals are sometimes known as “savants”), but their special skills tend to exist within the context of other cognitive or social impairments. Early-onset schizophrenia is four times more common in boys and is more severe when it occurs. Patients with schizophrenia can have varying patterns of cognitive dysfunction, which often include difficulties with attention, executive function, learning, and memory; some patients have visuospatial or language deficits. Their dysfunction can include thought disorder marked by delusions or auditory hallucinations as well as problems with concentrating on, organizing, synthesizing, evaluating, and remembering new information. The degree of cognitive deficit and the severity of psychotic symptoms (delusions, hallucinations) ­ correlate with the degree of relationship, educational, and occupational disability that occurs across the life span. Exogenous Brain Insults in Adolescence and Adulthood

Brain insults caused by chronic alcohol use, traumatic brain injury (TBI), and exposures to industrial chemicals all produce cognitive consequences and appear to be more common in men than in women. Chronic alcohol abuse is known to occur more frequently in men. It is associated with especially poor outcomes in men of lower educational and economic status and in men relative to women, though the latter may be due to more head injuries in males and sex differences in alcohol metabolism. When there are cognitive sequelae from chronic alcoholism that are seen after drinking cessation, they can range from mild to severe. At the milder end of the spectrum, difficulties with attention and working memory are seen, in which the individual is easily distracted and has trouble with problem solving. In its most severe form, chronic alcoholism can lead to Korsakoff syndrome or Korsakoff’s amnesia, in which the individual is unable to learn new information, forgetting previously learned information and memories. Head injuries associated with playing professional sports and other occupations such as

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military service can result in TBI, although the most common causes of TBI also include falls and car accidents. TBI is more prevalent in males. Associated deficits include problems with attention, impulse control, inhibition of inappropriate behaviors, and visual-motor function. Even mild forms of TBI can interfere significantly with educational and occupational pursuits. In severe cases, posttraumatic brain damage can lead to a progressive dementia syndrome (referred to as traumatic encephalopathy), with significant memory loss and inability to perform activities of daily living. Occupational exposure to industrial chemicals such as organic solvents, heavy metals, and pesticides can result in cognitive dysfunction and disorders. Attentional problems are commonly seen, and other cognitive skills such as visual-motor speed and dexterity, visuospatial abilities, and learning and memory can also be affected. The cognitive effects of exposure depend on the chemicals to which the individual is exposed and the dosage and duration of exposure. Specific chemicals can differ with regard to the specific brain structures that they affect, producing different types of cognitive impairments. Lead exposure, for example, can cause significant memory impairment, while pesticides often affect visual-motor and visuospatial functions. Neurological Disorders

Clinical stroke occurs more commonly in men than in women, as does vascular dementia, which is marked by multiple strokes. The associated cognitive disorders depend on the size and site of the stroke and can include aphasia (inability to speak or severe speech limitations), memory problems, difficulties with attention and working memory, and visuospatial and visual-motor deficits. Strokes affecting specific areas of the brain can result in inability to perceive visual stimuli on the opposite side of the stroke’s location in the brain, and in some cases, patients are unable to use one side of the body effectively. Some recovery from the immediate effects of an acute stroke can often be seen, with improvement in speech, writing, motor movement, and other intellectual abilities. However, vascular dementia is associated with chronic cognitive impairment. Parkinson’s disease (PD) is a disorder that affects the basal ganglia, which are structures

within the brain’s motor systems. In addition to the motor rigidity and tremor typical of the disorder, cognitive deficits associated with the disease can include problems with visuospatial functioning, rigidity in thinking and in interpreting emotional cues and information, and impaired attention and working memory. These problems appear in up to 75% of PD patients at some point in their illness. A related disorder, dementia with Lewy bodies (DLB), can be difficult to differentiate from PD because both disorders present with movement problems (“parkinsonism”). DLB, which is named after the abnormal lesions, called Lewy bodies, that appear in the brain of affected individuals, is also more common in men than in women. It progresses at a much more rapid rate than PD and is more disabling; in addition to early problems in paying attention and in executive function, patients with DLB have hallucinations and other highly disabling behavioral deficits. Primary progressive dementias that occur in adulthood include Alzheimer’s disease, which is more common in women, and frontotemporal dementia, which tends to occur at a younger age than Alzheimer’s disease. In men, the cognitive changes associated with frontotemporal dementia are more likely to be seen in language (inability to remember words, aphasic-like symptoms) and in behavioral disinhibition, while women are more likely to lose language function completely. Medical Conditions

Sleep apnea is more prevalent in men than in women. This condition is associated with snoring and oxygen deprivation, which can cause inattention and memory problems in daily living. There is a dearth of research on other cognitive medical conditions affecting cisgender men more than women. Roberta F. White and Maxine Krengel See also Alcoholism and Gender; Brain Lateralization; Cognitive Disorders in Women; Substance Use and Gender

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

Cognitive Disorders in Women Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th ed.). New York, NY: Oxford University Press. Strauss, E., Sherman, E. S., & Spreen O. (2006). A compendium of neuropsychological tests (3rd ed.). New York, NY: Oxford University Press. White, R. F. (2011). Cognitive disorders in adults. In D. H. Barlow (Ed.), The Oxford handbook of clinical psychology (pp. 574–600). New York, NY: Oxford University Press.

Cognitive Disorders

in

Women

As a group, women differ from men in the skills at which they excel and in their susceptibility to illnesses and exogenous brain insults that influence cognitive function and lead to cognitive disorders. Hormonal effects, especially the influence of female hormones like estrogen, which can protect the brain early in life but negatively influences cognition when its levels drop during aging or illness, are particularly salient for women’s functioning. Women’s brains differ structurally from those of men: Although brain sizes are initially similar for females and males at birth, boys’ brains begin to grow more quickly in early childhood and are larger when full brain size is achieved. This entry begins with a description of sex differences in certain types of cognitive skills that appear by adulthood, followed by the types of cognitive disorders that affect women disproportionately relative to men that are related to developmental disorders and exogenous brain insults, neurological diseases, psychiatric disorders, and medical conditions.

Cognitive Skills Across the Life Span On average, women outperform men on cognitive challenges related to several specific domains of cognition function; however, they are disadvantaged when compared with men when carrying out other kinds of cognitive tasks. In this section, we describe these patterns of abilities, defining the cognitive domains that are generally employed to characterize normal and disordered cognition. These domains will also be mentioned in subsequent sections of this entry that address illnesses and disorders.

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In considering female versus male patterns of cognitive function, it is important to recognize that studies of gender differences in cognitive function suggest that there are gender differences in cognitive abilities in some domains of function. These findings reflect group differences, in which one sex outperforms the other, but there is a great deal of overlap since some individuals perform at very high levels regardless of their gender. Summaries of the research on gender differences in intelligence overall conclude that general intelligence or intellectual capacity is equal in women and men, though women are consistently described as being better at verbal and language skills, such as word definitions. Relative to men, women are found in many studies to be disadvantaged in visuospatial abilities (copying designs, geographic knowledge, visual constructions) and arithmetic calculations; these two types of abilities are often related. Interestingly, the arithmetic advantage does not appear until around seventh grade. Women are sometimes characterized as being better at challenges that draw on the capacity for focused attention, but this appears to vary by the type of task. A test of sustained attention known as the continuous-performance test requires the examinee to identify a critical stimulus in a series of similar stimuli as quickly as possible. For example, a series of letters may appear on a computer screen, requiring a key press every time the letter S appears and only when it appears. Women and girls make fewer mistakes on this task—that is, they are less likely to push other letters besides S—but men on average are faster at it (men have faster reaction times). Responses to other attention tasks show a similar pattern of slower response times among females, though they make fewer errors. Executive function and working memory are highly related skills that refer to the ability to develop strategies for task completion, reason, handle complex material, and keep track of the elements of a cognitive challenge while completing it. This can be assessed by measuring speed and accuracy in moving from one kind of stimulus to another (e.g., back and forth between numbers and letters), the number of verbal responses generated according to certain rules during a defined time period (verbal fluency), and the capacity to deduce answers based on limited structured feedback; women are reportedly better at a number of these tasks, but men do better when the stimuli

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involve visual material. Interestingly, women are consistently reported as being more accurate and faster at coding tasks, in which symbols matching a code are drawn as quickly as possible. Although women have been found to be better at visualmotor tasks, such as turning the pegs in a form board, men are faster at tapping a key on a fingertapping apparatus. Women are consistently described as being better than men at tests that assess learning and short-term memory; this is repeatedly seen in data from tests that assess the ability to learn and remember word lists and includes the development of strategies to enhance new learning and to inhibit interference (aspects of working memory and executive function). Some data suggest that men are better at short-term memory tasks than women when visual stimuli are involved, but the data are somewhat inconsistent. Women have been shown to outperform men on tasks assessing other skills such as odor perception and emotional perception and tend to earn higher scores on measures assessing activities of daily living in older adults.

Cognitive Disorders The following discussion explores the cognitive disorders that appear in various conditions and illnesses that occur disproportionately in women relative to men. The features of cognitive dysfunction that characterize each disorder are described. Of course, disorders that affect males more consistently than females can also be seen in women, and the cognitive characteristics are generally similar. Developmental Disorders, Exogenous Brain Insults

Cognitive disorders that have their onset during early childhood or adolescence are generally significantly less common in women than in men. These include attention-deficit/hyperactivity disorder, most specific learning disabilities (i.e., impaired reading or dyslexia), autism spectrum disorder, and schizophrenia. This gender discrepancy may be due to the greater resiliency of the female brain in utero and in early life, as well as sex-linked differences in the heritability of these disorders. A possible exception is arithmetic disorder, which is

sometimes reported to be more common in girls. It affects the capacity to carry out calculations and learn complex mathematics and may be linked to other kinds of dysfunction, including difficulties with visuospatial skills such as drawing, reading map locations, or constructing objects. Women certainly experience traumatic brain injuries and exposures to toxic substances such as alcohol, recreational drugs, and occupational/industrial chemicals, but these insults appear to occur less commonly in women. Exceptions include specific occupations that predominantly involve women, such as solvent exposure in nail salon workers. Hormonal Influences

The presence of estrogen is generally considered to be neuro-protective for younger women. However, hormonal fluctuations have also been associated with cognitive dysfunction during menses, pregnancy, and immediately postpartum, giving rise to problems with short-term memory, word finding, and attentional capacity. The perimenopausal period, when hormonal levels decline, and the menopausal period are also thought to result in cognitive changes, with similar symptomatology. These can temporarily affect productivity at work and in other pursuits. Psychiatric Disorders

Epidemiologic research has consistently and repeatedly found that women are more prone to major depression, a debilitating condition that is highly heritable (40%) and can result in disability and cognitive dysfunction, particularly in the capacity to concentrate (distractibility) and in short-term memory. Similarly, depressive symptomatology associated with medical conditions is more common in women. Bipolar disorder occurs at similar rates in men and women and is associated with poorer performance on cognitive tests among the affected individuals compared with normals, but women with bipolar disorder are more likely to experience rapid cycling between manic and depressive states, are more prone to depressive symptoms, and have higher risk for alcohol use disorder than men with bipolar disorder. Alcohol abuse disorder is much more common in women with bipolar disorder than in

Cognitive Disorders in Women

women in general. Thus, alcohol-associated cognitive deficits contribute to the cognitive disorders experienced by some women with bipolar disorder. General anxiety disorder, which begins predominantly in middle age, occurs twice as often in women as in men. It is associated with distractibility, inattention, and cognitive inefficiency. Similarly, the prevalence and duration of posttraumatic stress disorder are higher across the life span among women than among men, although this may not hold in specific populations where everyone is exposed to interpersonal violence. Imaging and cognitive evidence consistently report cognitive problems such as impaired short-term memory and reduced attention and executive function in persons with posttraumatic stress disorder, accompanied by shrinking of the brain’s hippocampus, a structure that mediates short-term memory. Neurological Disorders

A number of neurological disorders occur disproportionately in women compared with men. Alzheimer’s disease, a progressive cognitive disorder, is more prevalent in women than in men, even when controlling for the demographic imbalance between the two sexes (i.e., women live longer, and AD is associated with advancing age). AD initially affects short-term memory, resulting in forgetting of information and events, repeating sentences or ideas during conversations, and inability to remember names or phone numbers. Deterioration in the ability to report memories and information known throughout the patient’s life (remote memory) begins with the most recent memories, extending to memories from early adulthood and childhood as the disease progresses. Interestingly, procedural memory, the capacity to carry out motor routines like housework, is relatively intact in the initial stages of the disorder. Early symptoms also include problems with attention, executive function, and working memory, resulting in losing things and impaired judgment and reasoning. As the disease progresses, patients with AD forget words and may begin to use the wrong words or mispronounce them, ultimately becoming mute. Their visuospatial and visual attention skills decline, with associated tendencies to become lost and

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unable to drive safely. Although writing skills deteriorate rather quickly, single-word reading remains intact until the later stage of the illness (and can be used to help estimate premorbid intelligence, or intelligence before the onset of the disease). A genetic variant, the apolipoprotein E-4 genotype (APoE-4), predisposes to AD in both men and women, but in women, this variant is associated with greater damage to the hippocampal formation and poorer memory function than in men. Although stroke and multiple strokes (leukoariosis) are more prevalent in men than in women, it has been reported that women have more “silent strokes,” in which there is evidence of stroke on brain imaging but no clinical stroke symptoms are identified. Poststroke depression is more common in women than in men. Multiple sclerosis (MS) is a demyelinating disorder that affects the myelin sheaths of the brain’s white matter. This disorder is more prevalent in women than in men, though affected men show more cognitive impairment and become disabled more quickly. Cognitive dysfunction associated with MS can vary dramatically over the course of the illness. When MS patients have acute episodes, severe, generalized losses of cognitive function can sometimes be seen, followed by substantial improvement as the patient recovers. The plaques that are found in the brain following episodes of demyelination can be associated with focal signs of brain dysfunction, such as aphasic or disordered speech with lesions in the speech areas of the brain. Because white matter is affected and there are often disruptions to the white matter tracks of the brain, many patients with MS have mild or significant problems with attention, executive function, working memory, visuospatial abilities, and visualmotor skills; slowing of mental processing can also be seen in the context of normal intellectual skills. Depressive symptoms are common. Medical Conditions

Systemic lupus erythematosis (SLE) is an a­utoimmune disorder that affects multiple body systems and causes fatigue, skin abnormalities, and other symptoms. It often involves the nervous system, particularly the white matter of the brain. Patients with central nervous system involvement in SLE frequently have cognitive disorders similar

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to those described for MS, including problems with attention and concentration, fine motor coordination, visuospatial function, and visual ­ memory. Women above the age of 75 years are more likely than similar-age men to have hypertension (high blood pressure), hyperlipidemia (high ­cholesterol), and diabetes. These disorders are all associated with cognitive impairments in some individuals, especially problems with attention, working memory, and executive function. They are on the pathway to stroke development as well. Chronic fatigue syndrome, multiple-chemical sensitivity, and fibromyalgia all occur more commonly in women than in men. Chronic fatigue syndrome is a disorder characterized by chronic fatigue that is not alleviated by sleep. Patients with multiple-chemical sensitivity are extremely sensitive to chemical odors and experience symptoms in multiple body systems when exposed to cleaning agents, gasoline, tobacco smoke, solvents, insecticides, and other agents. Fibromyalgia is characterized by pain in the muscles and joints that is chronic and occurs disproportionately in specific body areas. All three disorders can have cognitive sequelae, including inattention and problems with complex cognitive processing (working memory). Roberta F. White and Maxine Krengel See also Alcoholism and Gender; Brain Lateralization; Cognitive Disorders in Men; Substance Use and Gender

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th ed.). New York, NY: Oxford University Press. Strauss, E., Sherman, E. S., & Spreen, O. (2006). A compendium of neuropsychological tests (3rd ed.). New York, NY: Oxford University Press. White, R. F. (2011). Cognitive disorders in adults. In D. H. Barlow (Ed.), The Oxford handbook of clinical psychology (pp. 574–600). New York, NY: Oxford University Press.

Cognitive Theories Development

of

Gender

Cognitive theories of gender development seek to identify the information processes underlying people’s understanding of gender and people’s genderrelated beliefs and actions. Most cognitive theories of gender development are complementary and constructivist in nature. That is, they are similar to one another and see people as playing an active role in organizing the information encountered in everyday life. Cognitive theories recognize that information processing is most effective when completed quickly but that efficient decision making can be less accurate and stereotypical. ­ However, each theory places different emphasis on the steps involved in information processing about gender and the influence of outside factors such as social interactions, environment, and biology. This entry explains the primary cognitive theories of gender development and further considers how outside factors may affect gender development.

Cognitive Developmental Theory Lawrence Kohlberg was the first to propose a ­cognitive developmental approach to gender development. Cognitive developmental theory (CDT) is based on the ideas of Jean Piaget, who identified the stages of children’s cognitive development. Kohlberg is heralded as the first theorist to identify that children’s cognitive understanding of gender is a driving factor in their gender development. Furthermore, Kohlberg highlighted the constructivist nature of cognition and gender, asserting that children actively seek information from the world around them and organize it based on their cognitive understanding or the frameworks held about gender groups. He maintained that this processing of gender-related information influences children’s behaviors and their beliefs about appropriate actions for boys versus girls, and men versus women. Thus, his view was novel in that it emphasized the active role the child plays in gender socialization. At the time, the popular belief was that children are passive in the socialization process and merely receive the effects of the social environment around them.

Cognitive Theories of Gender Development

Although CDT was the first to include the idea that early gender cognitions influence children’s behaviors (and that gender cognitions become more salient as children gain higher levels of understanding), Kohlberg was unclear about the specific gender cognitions underlying gender ­development. He stated that gender was a “stable organizer” of incoming information once children understand that their own gender group is unchangeable. This statement has been discussed and interpreted in many ways over the years, with investigations into what level of gender cognition is truly needed to initiate a child’s active processing of gender information (e.g., the basic recognition of gender as a concept, formal gender constancy, acquisition of the cognitive stage of gender ­consistency, a global gender identity). Regardless of the answer to this specific question, this idea has influenced all future cognitive theories, with a common theme being that children’s understanding of gender is the foundation of their gender development.

Gender Schema Theory Gender schema theory (GST) is a constructivist theory that proposes that children create gender schemas, or cognitive knowledge structures, that represent what they believe about gender. These gender schemas act as filters during information processing and influence children’s attention, memory, preferences, and behaviors. GST is grounded in CDT, in that gender schema theorists believe that children actively create gender schemas by incorporating or discarding the information that they gain from their life experiences. However, GST adds to that theory the idea that children need only a basic understanding of the concept of gender to begin the cognitive process of building their gender schemas. Two main versions of GST were simultaneously yet individually presented in the early 1980s. In 1981, Sandra Bem presented the theory, focused on how children create gender schemas from the pervasive gender messages within their environments, and highlighted the individual differences in children’s schemas. These gender schemas are used as an effective way to make more rapid decisions. During the same period, Carol Martin and Charles Halverson’s

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research focused on the developmental aspects of gender schemas, the importance of children recognizing their own gender, the different types of gender schemas, and the role of schematic consistency in understanding children’s gender-related choices. Today, most people who subscribe to GST recognize that two main types of gender schemas exist: (1) superordinate schemas and (2) own-sex schemas. Superordinate schemas are broad, encompassing schemas about each of the gender groups. Own-sex schemas are more specific gender schemas that children hold about what is acceptable for themselves as a member of their own gender group. Children’s gender schemas organize information about gender, thus simplifying their ­decision-making processes. For example, if a girl categorizes playing with dolls as an acceptable activity for girls, when given a doll she may quickly determine that the doll is “for her” and may choose to play with the doll. In contrast, a boy with the same gender schema might reject the doll, concluding that dolls are “for girls” and “not for him.” Gender schemas act as filters through which information and life experiences are processed, and empirical evidence supports the view that gender schemas influence children’s decision making, attention, memory, and, ultimately, their behaviors. Although this simplification of information processing is positive in some ways, negative consequences can arise from rigid gender schemas, such as overgeneralizations and gender stereotypes. Furthermore, rigid gender schemas can lead to unnecessary gender differentiation across domains (e.g., gender-segregated play, gender-segregated career paths). Trying to predict or understand children’s ­gender-related behaviors is complicated. In ­addition to there being individual differences and uniqueness in children’s gender schemas, there are also times when children do not conform to their ownsex and superordinate schemas and vary in how rigid they are in following their own schemas as guides. That is, there are times when gender is a more salient schema than others. This is particularly true when the development of a child is considered. It has been proposed that children’s gender schemas develop across three phases. The early years are characterized as a learning phase, when children recognize their own gender group and begin building their schemas. The next phase typically occurs

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around the ages of 5 to 7 years and is called the consolidation phase. This is when children often use an “either/or” strategy, categorizing people and items rigidly via their gender schemas. Finally, around age 7, children become more flexible and begin holding more realistic beliefs about gender. A dual-pathways model of GST expanded GST in the early 2000s to include two paths toward gender differentiation. In addition to children’s view of the world and decision making filtering through their gender schemas, this theory notes that a child’s life experiences can filter back inward, changing the child’s cognitions. Thus, a girl’s gender schema may include the idea that soccer is for girls and thus an acceptable activity to enjoy. But also, after a girl is introduced to programming robots, she may decide that computer programming is an activity that both boys and girls may enjoy.

Social Identity Approach The term social identity approach encapsulates two related theories: (1) social identity theory (SIT) and (2) self-categorization theory (SCT). Both of these theories are designed more to describe, understand, and interpret people’s ­conceptions about group membership, group processes, and intergroup relations, rather than to explain gender development specifically. However, they are often applied to better understand gender development and gender stereotyping and are at the cornerstone of other cognitive theories (particularly developmental group theory). There is clearly an important intergroup dimension underlying gender relations and stereotypes. SIT was theorized first, and SCT, which encompasses a more cognitive focus, is an outgrowth of SIT. SIT, which developed in the 1970s, asserts that social identity occurs when individuals recognize that they belong to a social group and attach emotional significance to their membership. A person creates a self-concept by comparing themselves with others within the group and to others in outgroups. Furthermore, groups that share similar social identities compete with one another for ­status and distinction, which leads to intergroup relations. SCT further explains the individual cognitive processes that underlie the creation of a person’s social identity. Specifically, the cognitive

process of self-categorizing oneself as a member of a group is thought to then influence the group as a whole and have an impact on intergroup relations. Also, a process called referent informational influence was outlined in this theory. This refers to the way in which people cognitively create rules or norms about acceptable behavior by witnessing other members of the in-group. Thus, one’s selfcomparison with others is important, the perception of others in an in-group is important, and the stereotyping of the characteristics of others in ­out-groups is important. The theory also includes statements about the hierarchy of members within a group, about the hierarchy of groups in relation to one another, and how power differentials within and between groups can have an influence on individuals. It is easy to see how this theory has been useful to those desiring to understand gender stereotypes, sexism, and relations between and within gender groups.

Developmental Intergroup Theory Developmental intergroup theory (DIT) is designed to address the causal factors of prejudice and stereotyping. DIT is grounded in the social identity approach and CDT, including the modern versions of CDT. The theory suggests that cognitive biases are shaped by social environments including education systems, cultures, and legal systems. Although broad in scope, it has often been applied to explain how children’s gender categorizations, cognitive stereotypes, and prejudices are shaped and maintained throughout development. DIT posits that there are three core processes that underlie stereotyping and prejudice. The first process is establishing psychological salience. DIT suggests that children readily categorize people into groups and that the cognitive process of deciding which characteristics are important enough to use as the bases of these categories is environmentally influenced. Gender is commonly used to ­categorize people into groups (among other characteristics, e.g., race), and developmental intergroup theorists suggest that four main sources of influence contribute to why children choose gender as a salient category: (1) adults using gender labels (explicit labeling), (2) group size (with minorities being more readily noticed as different), (3) children witnessing de facto gender-segregated

Cognitive Theories of Gender Development

groups (implicit labeling), and (4) perceptual discriminability (e.g., visually noticing differences such as different hair styles or clothing trends for girls vs. boys and thus deciding that these differences must signal an underlying important ­ category). The s­econd process is “categorizing encountered individuals by salient dimensions.” This occurs when children actively use these categories and cognitively place people into groups to make decision making simpler. This process changes as children develop, become more cognitively skilled, and gain life experiences. The third process is the development of stereotypes and prejudices regarding the categorized social groups. The theory proposes that c­ ategorizing people leads to children constructing and attaching beliefs (i.e., stereotypes) and affects (i.e., prejudice) to the groups. Empirical support for DIT includes a variety of experimental, intervention-based studies and can be useful to those trying to understand how people decide the criterion to use when cognitively categorizing people and how the process of categorizing people results in stereotypes and prejudice across the life span. Although the theory is broad based, it is applicable to understanding the use of gender as a criterion and the negative implications of such categorizations.

Social Cognitive Theory of Gender Development and Differentiation As noted in the introduction of this entry, many of the theories designed to best understand gender development recognize the importance of other sources of influence besides, or in conjunction with, cognition. Particularly given the constructivist nature of the theories described thus far, the importance of children’s cognitions combined with their environment is readily recognized. SCT, a more contemporary model of social learning theory, is a theory that places emphasis on a child’s social interactions as an influential source; however, particularly in later clarifications of the theory, the importance of learning and cognitions is also included. In this theory, conceptions of gender are constructed based on a combination of life experiences, motivation, and self-regulation, all of which are thought to guide children’s gender-related actions. Although biological differences found

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between males and females are recognized as important, the majority of the gender differences in attributes and roles are assumed to be culturally based and transmitted via society (for a child, this can include schools, peers, etc.) and family. The term sociocognitive determinants is used to describe these factors. Thus, SCT asserts that the transmission of gender differentiation is a result of “triadic reciprocal causation”—meaning that three causal factors exist and the direction of these effects is bidirectional. The transmission process has personal factors such as cognitions and biology as one cause, environmental events as a second, and actions and behaviors as a third. Furthermore, it is noted that gender development is a lifelong process, rather than primarily focusing on childhood or only on adulthood. A hallmark of SCT is the emphasis on observational learning. People can learn through watching others model behaviors without actually having to experience the action themselves. Even more than just being models whose behavior can be copied, the individuals in people’s lives can transmit information about rules and standards as to what can and should be done, particularly by the members of each gender group. People can process this information, categorize it, and then regulate their behaviors appropriately.

Biology, Cognitions, and Gender Development Biology is consistently mentioned in cognitive ­theorists’ work as an important influence of the gender development process. However, although most cognitive theories are similar to one another, they differ in the degree to which they believe that other influential factors contribute to gender development. Interestingly, there is no popular cognitive development approach that primarily highlights the interplay of biology and cognitions. The gender development field has solid examples of biologybased research indicating that gender-related biological processes, cognitions, and socialization are interconnected. For example, prenatal androgen exposure has been shown to affect behavior, and research indicates that girls with congenital adrenal hyperplasia have some play preferences and behaviors that are similar to those of boys. Moreover, research indicates that genes and ­

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physiological processes work in concert with ­environmental input, and brain plasticity investigations highlight the importance of environmental influences. Calls have been made for gender development experts to incorporate biological ­ contributions into their work and not allow the historical denigration of the skills and abilities of women that misused biological explanations to dissuade them from integrating biology into their work. Thus, a cognitive theory with a biological focus is potentially on the horizon.

Future of Cognitive Development Theories Kohlberg’s expansion of Piaget’s developmental stage perspective to include cognitive processing was revolutionary. It is now clear that cognitive categorization and information processing are at the foundation of people’s understanding of gender. Specifically, cognitive theories of gender development explain how children gain a sense of their own gender and come to understand how they relate to others within their gender group. Furthermore, cognitive theories explain how children learn about gender groups overall and how they compare, contrast, and relate to individuals in other gender groups. It has been empirically confirmed that attention, memory, perceptions, and, ultimately, behavior are based on gender cognitions. Moreover, emphasis has been placed on the developmental aspects of gender, such as how gender can become more flexible as children grow and mature. In the future, further investigation can help decipher the degree to which social, environmental, and biological factors influence gender cognitions and better identify the underlying processes associated with these factors. It is clear that cognitive theories of gender aid our understanding of how in-groups and out-groups are created and explain the information processes that lead to faulty cognitions, such as the creation of a false dichotomy of gender (i.e., men vs. women, rather than gender being on a continuum). Importantly, cognitive theories of gender development explain how gender stereotypes are formed, and they can be applied to mitigate the negative impacts of ­gender stereotypes, discrimination, and prejudice. Lisa M. Dinella

See also Behavioral Theories of Gender Development; Gender Development, Theories of; Kohlberg’s Stages of Moral Development

Further Readings Bem, S. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42, 155–162. doi:10.1037/h0036215 Bigler, R. S., & Liben, L. S. (2007). Developmental intergroup theory: Explaining and reducing children’s social stereotyping and prejudice. Current Directions in Psychological Science, 16, 162–166. doi:10.1111/j.1467-8721.2007.00496.x Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106, 676–713. Kohlberg, L. A. (1966). A cognitive-developmental analysis of children’s sex role concepts and attitudes. In E. E. Maccoby (Ed.), The development of sex differences (pp. 82–173). Stanford, CA: Stanford University Press. Liben, L. S., & Bigler, R. S. (2002). The developmental course of gender differentiation: Conceptualizing, measuring, and evaluating constructs and pathways. Monographs of the Society for Research in Child Development, 67(2), vii–147. doi:10.1111/1540-5834 .t01-1-00187 Martin, C. L., & Dinella, L. M. (2002). Children’s gender cognitions, the social environment, and sex differences in cognitive domains. In A. V. McGillicuddy-DeLisi & R. De Lisi (Eds.), Biology, society, and behavior: The development of gender differences in cognition (pp. 207–239). Westport, CT: Ablex. Martin, C. L., & Halverson, C. F. (1981). A schematic processing model of sex typing and stereotyping in children. Child Development, 52, 1119–1134. doi:10.2307/1129498

Colonialism

and

Gender

Colonialism refers to the dominance of one culture over another through imposed ideals and belief systems, instituted sociopolitical and hierarchical structures, assimilation and cultural conformity, and the exploitation of resources from specific geographic settlements. It is important to understand the process of colonization, how it affects all

Colonialism and Gender

facets of society, and the legacies it leaves on the social norms of a society (even long after colonialism has formally ended), in order to accurately grasp contemporary constructions of gender, which are understood in this entry as the societal creation and implementation of roles, norms, and the appropriateness of behavior as it applies to men and women. Contemporary conceptions of gender were instituted under colonialism in binary terms of masculinity and femininity. This colonial notion of gender is grounded in biological sex: Those who are born anatomically male or female are socialized to act in prescribed masculine and feminine ways, respectively. However, while biological sex, sexual orientation, and culture are related to gender, they are not synonymous; gender is a social construction. Under colonialism, gender has generally been understood to follow from sex (biology), not culture (identity), and to this end, it generally pitted male against female, even in societies where gender was conceived of in more fluid terms prior to colonization. As colonialism shaped gender within the reformulated societies, convention dictated that men were strong, educated providers with social powers related to decision making, ownership, and community and government participation. Gender norms and roles were shaped within the context of colonialism and were the product of patriarchy (the male domination of all aspects of society). Male colonizers and then colonized men carried the unique privilege of having the right to vote, divorce, and take part in government and education. Women and the colonized were inherently othered, with women being viewed as weak physically, emotionally, and intellectually and the colonized being viewed as uncivilized, unintelligent, and savage. Eurocentric cultures viewed men as more intelligent and stronger than women. The man’s role was to follow intellectual, decisional, and influential pursuits; the woman’s role, as the supposedly weaker sex, was to help and serve the man, keep the home, and take care of the children. Only necessities such as war or economic hardship required a woman to supersede her role within the home. This entry examines precolonial indigenous gender roles in North America, examples of societies with nonbinary conceptions of gender, and the psychological impacts of colonialism on gendered relations.

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Precolonial Indigenous Gender Roles In North America, the colonists were disturbed by the reality of the Native woman. Unlike the ­Pocahontas myth, where Native women are docile creatures at one with nature, Native women were powerful within their societies. They had the right and the ability to marry and divorce as they chose, and they often had positions of instrumental authority and influence alongside their male counterparts. Even during early colonial times, Native women had agency, acting as guides, traders, and interpreters. In many Alaska Native and Native American societies, men and women shared duties, roles, and positions of power. For example, in Tlingit culture, both men and women could hold the respected and revered title of traditional healer, becoming influential and wealthy within the community. Women were also required to broker the trading of goods, and kinship ties were designated and passed down through the clan of the mother. It is important to note that while some indigenous, precontact societies did have designated roles for men and women (e.g., men hunted, and women took care of the home), many of these societies did not utilize these roles with the intent of dominating women, but rather, gender roles were predominantly an equitable and functional division of labor. In many precontact societies, gender roles were egalitarian and reciprocal. The Bari of Colombia were nomadic in nature, moving between temporary structures in communal bands of 40 to 80 people. Their societies were stratified by three groups, which delineated where one was to live within the home, what role one had in resource gathering, and the order in which one was to walk among the group when traveling. The groupings would often change when the societies moved from one dwelling to another, and no one asked anyone to do anything, as people knew what to do within their community by their role. While the work was shared between men and women, tasks specifically assigned to gender were carried out by both genders. A Bari’s role was always interdependent on the other gender’s task and complementary to that task. However, Western colonialism altered the Bari society; men were situated in positions of power that synchronously put women into subordinate roles, which not only affected their

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ceremonies and traditional healing practices but also compromised their subsistence, nomadic, and communal ways of life. Even though colonialism was established through and perpetuated by patriarchy, the effects of colonialism have endured through systemic hierarchy. For example, during American colonial times, White women were expected to be modest and virginal and also perceived to be physically weak and incapable of manual labor. On the other hand, Black slave women, while still viewed as inferior and weak compared with men, were perceived as sexually voracious and nefarious and capable of performing the extensive and arduous labor forced on them. The subjugation of gender during colonialism was twofold: (1) it introduced an androcentric social hierarchy that encouraged men to have power over women and (2) it advanced a social system of binary genders that excluded all other ethnicities/races and alternatives on the gender continuum. In other words, society is stratified where men dominate women, European race/ethnicity is preferred over racial/ethnic minorities, and heterosexuality is superior to all other sexualities. While colonialism created a gendered society based on the precepts of dominance and subjugation, it was not an isolated incident on the timeline of history. The reconstruction of gender has ­persisted over time and has spilled into the contemporary notion of what it means to be a man, a woman, or anything in between. While many precontact cultures constructed gender in an encompassing and continuous manner, modern society acknowledges the strict binary of male and female genders and is suspicious of any perceived or actual deviations. In other words, while gender is a part of all societal systems, it is also entrenched in interpersonal interactions and maintained by gendered behavioral frameworks. For example, in Western societies, men are expected to be protectors of women, whereas the conventional role for a woman is to be protected. While this is seemingly innocuous and even advantageous for both men and women, it maintains an idealized view of gender that ultimately places the man in a position of power and control over the woman. This societal standard is bolstered through media representations, interpersonal behavior, and social systems. For example, women are often depicted in film and

television as damsels in distress and are socialized to not do work that is ascribed to men. Even children’s toys are blue for boys and pink for girls, encouraging and implementing categorical gender norms that do not account for anyone who does not identify as a stereotypical girl or boy.

Beyond Men and Women Gender goes beyond the imposition of Eurocentric culture and binary roles for men and women and is embedded in power, race, and sexuality. In the postcolonial world, there are distinct differences between being a Black man and a White man, a White woman and a Native women, a cisgender person (i.e., when one’s birth sex and gender identity align) and a transgendered person, and the list goes on. The intersectionality of personal identities and gender is directly influenced by colonialism. Compound colonialism refers to the multidimensional and multidirectional effects of colonizerimposed oppression. Colonization, by definition, was gendered; men usurped the colonized and took ownership of the land and its people (specifically, the women and children). This was done under the authority of Christianity, with the intent of enforcing and validating the processes through divine right. Religion was the basis for reordering the structure of indigenous families to ensure that they conformed to heteronormative gender roles, whereby heterosexuality is favored and recognized as normal. Indigenous cultures were restructured from communal to nuclear families, formerly respected gender nonconforming individuals were denigrated and ridiculed, and the oppression ­propagated by colonialism was internalized by the colonized, resulting in hypermasculinity and exaggerated gender roles. In other words, internalized gender oppression resulted in colonized men acting in aggressively masculine and compensatory ways that simultaneously othered them and reinforced their oppressed role. Colonized women, in turn, became submissive and feminine, while transgender or androgynous individuals were forced to conform to male or female gender roles. Gender diversity or alternative genders (e.g., transgender, third gender, two spirit) were also a common expression of gender identity in cultures and societies the world over before colonialism. For instance, the Navajo people recognized five

Colonialism and Gender

genders, consisting of (1) feminine men, (2) masculine women, (3) masculine men, (4) feminine women, and (5) androgynous individuals. These gender distinctions were not understood in terms of sexual orientation but, rather, were an accepted representation of an individual’s inherent gender. The mahu of Hawaii were considered a third gender, being neither man nor woman but possessing traits of both genders. The mahu were important culture bearers, were accomplished hula dancers, and had coveted and superior male and female attributes. With the colonization of Hawaii, however, the mahu were considered to be perversions of the Eurocentric and religious ideals of the colonizers and were declared to be shameful and bad. Colonialism had a decidedly heteronormative and paternalistic approach to gender. In India, the hijras (a third-sex people who are born men but live as women) were also affected by the gendered impositions of colonialism. Hijras are castrated men who live as women, adopting female names and dressing as women, but identify as neither the male nor the female gender. They performed ceremonial fertility blessings, held sacred powers, and had an important role within Hindu tradition. British colonizers, however, regarded hijras as moral aberrations and a menace to male dominance. Due to colonial efforts to eradicate and discredit the nonconforming, nonbinary threat to Eurocentric culture and religion, hijras were systematically marginalized and disenfranchised within Indian society. Colonialism reduced hijra to a derogatory term used to mean “transgendered” or “transsexual,” serving as yet another example of how the flowing and dynamic gender trajectory of many indigenous peoples was undeniably halted and replaced by colonialism.

Psychological and Mental Health Implications The effects of colonialism on gender have been far-reaching, laying down firm roots within the ­ pedagogy and epistemology of mental health. The process of colonization is evident in psychological discourse and psychopathology. Women experience mental health disparities, with higher rates of mental disorders. In addition, women express predominantly internalizing symptomology (e.g., depression and anxiety). In contrast, men typically

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experience mental disorders externally (e.g., substance misuse and antisocial personality disorder). Gender differences in mental health reflect historical gender roles, where women are socialized toward emotionality and complex internal lives and men are socialized to express themselves behaviorally and through outward manifestations of internal processes. For instance, female hysteria (i.e., uncontrollable emotional responses typically attributed to abnormalities within the uterus) was the cause of mental distress for centuries within Eurocentric societies. This disorder both accounted for and supported the belief that women are emotionally inept and inferior. Reproductive functioning is still a factor in women’s mental health today; premenstrual dysphoric disorder is a diagnosis given to women who experience depressive symptoms during the onset of the menstrual cycle. In other words, biological processes can be pathologized to not only maintain gendered norms but also reinforce them. Power differentials, access to resources, and socioeconomic status are all intersecting factors in the colonial artifacts of gender within the field of mental health. Transgender and gender nonconforming persons and other individuals on the nonbinary gender continuum also experience the ramifications of  colonization. Systemically, there is a lack of laws and social programs for transgender individuals, and there are barriers to health care, insurance, and other essential resources. These disparities are correlated with poorer mental health outcomes than for the general population. Because colonial gender norms are embedded in sexual orientation and biological sex, gender variant people have historically been misunderstood, discriminated ­ against, and othered. Through this colonial lens, indigenous and precontact expressions of gender are indubitably glossed over and ultimately erased. This smudging of gender has simultaneously edified the gender norms of the colonizer and denigrated those of the colonized. The new gender subjugation and oppression is expressed subtly, through long-established social structures, systems, and rhetoric. Maria C. Crouch and E. J. R. David See also Native Americans and Gender; Native Americans and Transgender Identity; Third Gender; Two-Spirited People

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Further Readings Arvin, M., Tuck, E., & Morrill, A. (2013). Decolonizing feminism: Challenging connections between settler colonialism and heteropatriarchy. Feminist Formations, 25(1), 8–34. Balestrery, J. (2012). Intersecting discourses on race and sexuality: Compounded colonization among LGBTTQ American Indians/Alaska Natives. Journal of Homosexuality, 59(5), 633–655. doi:10.1080/0091836 9.2012.673901 Correll, S. J. (2007). Social psychology of gender. Amsterdam, Netherlands: Elsevier JAI Press. Etienne, M., & Leacock, E. B. (1980). Women and colonization: Anthropological perspectives. New York, NY: Praeger. Fanon, F., & Philcox, R. (2004). The wretched of the earth. New York, NY: Grove Press. Ghosh, D. (2004). Gender and colonialism: Expansion or marginalization? Historical Journal, 47(3), 737–755. doi:10.1017/S0018246X04003930 Hinchy, J. (2014). Obscenity, moral contagion and masculinity: Hijras in public space in colonial north India. Asian Studies Review, 38(2), 274–294. Lugones, M. (2007). Heterosexualism and the colonial/ modern gender system. Hypatia, 22(1), 186–219. doi:10.1111/j.1527-2001.2007.tb01156.x Matzner, A. (2001). ‘O au no keia: Voices from Hawai’i’s Mahu and transgender community. Philadelphia, PA: XLibris. Meade, T. A., & Wiesner, M. E. (2004). A companion to gender history. Malden, MA: Blackwell. Moane, G., & Campling, J. (1999). Gender and colonialism: A psychological analysis of oppression and liberation. New York, NY: St. Martin’s Press. Office of the Disease Prevention and Health Promotion. (2014). Lesbian, gay, bisexual, and transgender health [Fact sheet]. Washington, DC: Author. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/ topic/lesbian-gay-bisexual-and-transgender-health World Health Organization. (2014). Gender and women’s mental health. Geneva, Switzerland. Retrieved from http://www.who.int/mental_health/prevention/ genderwomen/en/

Coming Out Processes for LGBTQ Youth Lesbian, gay, bisexual, transgender and queer (LGBTQ) is a common term used to describe all

nonheterosexual and cisgender (nontransgender) people. The moniker brings together some of the many labels that have been generated by the LGBTQ community (e.g., pansexual, questioning, ally, gray asexual). These multiple and constantly evolving labels are evidence of the diversity within the LGBTQ community and an important and long-standing commitment to allow people to label their own experience. LGBTQ youth is used to designate preadolescent through college-age LGBTQ individuals. LGBTQ youth come from all racial/ethnic groups, all religious groups, all socioeconomic groups, and all geographic locations. They are of all genders. Same-sex-attracted and gender nonconforming people have been estimated to make up 3% to 10% of the population. However, some studies have estimated that about one third of ­millennials identify as not exclusively straight. Most LGBTQ youth go through a process of coming to internalize an aspect of their identity that has a negative stigma attached to it: sexual orientation and/or gender identity. The processes of reconciling these identities are unique to each individual and are referred to as coming out. Understanding the common themes and unique aspects of individual coming out processes is integral to appreciating the experiences of LGBTQ youth. This entry briefly describes the coming out process for LGBTQ youth. Risk and resilience factors that contribute to successful navigation of this process are described later. The entry concludes with an overview of strategies for supporting youth in the coming out process.

Coming Out One common understanding of the term coming out involves revealing a hidden part of oneself to important others or, in some cases, everyone. While this is an important step in the coming out process for many people, this is not the primary meaning of the term. Coming out is the process of internalizing aspects of identity that have a negative stigma attached to them into one’s sense of self. Typically, these aspects of identity were previously not well understood or not even ­ recognized. The coming out process can be understood to begin when an individual recognizes that their

Coming Out Processes for LGBTQ Youth

lived experience of the world does not match up with the expectations into which they have been socialized. For example, a boy moving through puberty may begin to realize that his attractions are not for women, or a young person being raised as a boy may begin to understand that this does not match their experience of their own gender. As this understanding grows, a process of acceptance and/or rejection may begin. For many, an internalizing process begins in which they are able to detoxify negative messages about these aspects of identity and begin to accept them. Other LGBTQ youth describe a feeling of always having known that they were different and realizing that it was others who had the problem and not them. The degree of internalized homo/bi/ transphobia (or preexisting negative beliefs and feelings about LGBTQ people) that a person has seems to contribute to the difficulty with which one accepts these realizations about oneself. For many people, the early parts of the coming out process involve investigating the reality of the stigmatized aspect of identity that they are coming to understand. These explorations can take the form of reading books about people with similar experiences or attending social events for LGBTQ people. People in this part of the process may observe, talk with, or even become intimate with LGBTQ identified people as a way to explore this part of their identities. This time in the coming out process is often referred to as in the closet. In the second part of the coming our process, many people begin to reveal their important differences to their friends and family. This is a particularly challenging time for many individuals as they may not have yet developed a very strong sense of self-worth around these aspects of identity. People at this point in the coming out process may appear awkward, needy, or unsure about these aspects of their identity. For many, once this aspect of their identity is shared and accepted by their social supports, like all other aspects of identity, it can become stronger. At this point in the process, some LGBTQ people will find themselves foregrounding their gender identity or sexual orientation. They may appear to become militant or devalue other aspects of their identity. It is not uncommon for people in the later stages of coming out to devalue heteronormative culture as a way to help others understand these important diversities. Some will

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prioritize their gender identity or sexual orientation as a way to make up for having devalued them in the past. For some, there exists an ongoing ­process of balancing a positive self-identity with childhood lessons of shame and guilt. This struggle can take many forms and sometimes has tragic or fatal outcomes. For many, the process of integrating these often negatively stigmatized aspects of ­identity into their sense of self reaches a state of balance as these aspects of who they are become more integrated into the tapestry of their lived experience. It is important to emphasize that coming out is a highly variable process. While it can be useful to describe average experiences in a somewhat linear model, it must be recognized that stage models of development are often unable to capture any one individual’s experience. Intersections of various aspects of identity can affect the process of coming to understand one’s sexual and gender identities. Multiple paths to self-discovery are likely. For example, some LGBTQ people describe an intellectual process of figuring out their identities, while others describe falling in love as the primary way by which they knew. Just as the amount of stigma attached to sexual orientation and gender nonconforming individuals is highly variable across time and geography, so too is the difficulty that LGBTQ youth may experience as they navigate the coming out process. Because there is less negative stigma attached to these identities than in the past, many youth seem to begin the coming out process at earlier ages than their predecessors. However, this may leave them more vulnerable to difficulties navigating their coming out process as they have fewer resources, internal and external, to rely on. Similarly, youth who have access to global information via the Internet may find their struggles exacerbated if their local community is hostile to them. Finally, it is important to recognize that while the scientific evidence strongly supports the idea that sexual orientation and gender identity cannot be forcibly changed, many LGBTQ youth report experiencing a degree of flexibility in their identities that hints at the need to more clearly explore the difference between identity and expression of sexuality in much the same way we have come to understand the difference between gender identity and gender expression.

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Difficulties in Navigating Coming Out Processes There is an impressive body of research that documents a heightened risk for psychosocial problems among LGBTQ youth. This research describes greater risk for suicidal ideation, suicide attempts, and completed suicides. Greater risk for substance abuse and mental health issues including depression and anxiety has also been well documented. LGBTQ youth are overrepresented in the population of homeless youth in the United States. LGBTQ youth are also at increased risk of losing their social supports compared with their straight/ cisgender counterparts. For example, straight male men are unlikely to be ostracized from their church community or family because of their sexual orientation or gender identity. Despite this evidence, not all LGBTQ youth struggle with these problems. Many LGBTQ people navigate their coming out processes with only minimal difficulty. Many LGBTQ adults describe themselves as having gained significantly from the experience of having to go through a period of such deep introspection. For instance, many LGBTQ adults describe becoming more aware of social justice issues or developing a greater sense of empathy because of their coming out processes. While it is important to recognize that LGBTQ youth are at a greater risk for psychosocial and other problems than their heterosexual/cisgender peers, it is even more important to ask which LGBTQ youth are at risk for greater problems and when they are at greater risk. Without understanding these two important factors, LGBTQ youth are at increased risk of being overly pathologized by those who would like to help them. Resilience Factors

When considering which LGBTQ youth are at risk for struggles during their coming out process, it is important to consider three factors: (1) family support, (2) peer/social support, and (3) degree of struggle or confusion about their identity. If one or two of these elements is a problem, then an LGBTQ youth is likely to be at greater risk of encountering problems in the coming out process. If all three factors are problematic, then these youth should be particularly targeted for support.

Conversely, if one or two elements are a strength for the youth, then those elements should be built on as much as possible. A brief discussion of each of these resilience factors follows. Family support has been identified as one of the most important insulating factors against risk during the coming out process. As for all youth, when LGBTQ youth are rejected by their families, this removes their primary support and isolates them from the important role that parents and family play in their growth. LGBTQ youth who do not have family support may also lack important resources to keep themselves safe and attend to normal developmental tasks. For instance, LGBTQ youth may become homeless or may no longer have access to funding for school. LGBTQ youth who are bullied or harassed by their peers or adults in their social systems are also at a greater risk for difficulties in the coming out process. Harassment may take the form of physical abuse, hazing, verbal insults, or creating a hostile environment in which LGBTQ youth feel threatened. In many cases, the full impact of toxic environments is offset by friends or “chosen family” who serve to provide a safe harbor for LGBTQ youth. Institutional harassment can contribute to an unsafe environment for LGBTQ youth as well. For instance, if school policies do not recognize sexual orientation and/or gender expression as aspects of diversity, teachers and students may be more likely to contribute to an unsupportive environment. Conversely, schools that have recognized student organizations (e.g., Gay Straight Alliances) have been shown to have a more accepting environment for LGBTQ youth. As the coming out process unfolds, it seems that youth with a higher degree of identity confusion are at a higher risk for problems. This may be somewhat intuitive but is worth reflecting on as one considers which LGBTQ youth are at greatest risk for troubles in their coming out process. Many LGBTQ youth struggle with negative messages that they have internalized from a young age related to their unfolding sexual and/or gender identities. As youth move through their coming out processes, the conflict that is created between the old messages and the new can sometimes be overwhelming. Many youth move through their coming out experiences with a core sense of their truth. However, those youth with greater negative

Coming Out Processes for LGBTQ Youth

messages to work through seem to be more vulnerable to encountering problems in the coming out process. Coming out processes are highly variable and are, in essence, about change. As one comes to accept something that was once considered negative or even impossible, one must by necessity grow and change. In addition to being aware of the three factors outlined above, it is also important to recognize that LGBTQ youth may be at greater or lesser risk for troubles at different moments in their coming out process. For example, youth who are just beginning to share their identity with one or two people are more likely to struggle with thoughts of suicide than youth who have made their sexual orientation known to their family and peers. Conversely, youth who are “out” are likely to be targeted by more violence and harassment than youth who are “not out.” While not all LGBTQ youth will struggle through their coming out process, many do. Recommendations for strategies to support coming out processes follow.

Facilitating Positive Outcomes in Coming Out Programs and resources for LGBTQ youth are more likely to be successful if they recognize that the bulk of the problems that LGBTQ youth must manage are related to living in hostile environments. As outlined above, programs and resources aimed at facilitating coming out processes should target family support, social support, and identity confusion. Additionally, interventions targeted at different moments in a typical coming out process can be useful. Increasing family support for LGBTQ youth most often involves working with the entire family to deconstruct the negative biases that caregivers may have about people with minority sexual orientations and gender identities. The focus of this work is most often on helping parents recognize that their child needs them to be parental and to support them through a difficult time. Depending on the cultural background of the family, this can be quite challenging. As in all aspects of the human experience, ­culture plays an important role in the conceptualization and expression of sexual orientation and gender identity. Families that come from cultural

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groups that value individual achievement are likely to engage in individual paths of self-discovery in ways that families with roots in collectivist cultures may not. If the primary unit of identity is the family or community, the process of self-discovery writ large will need to incorporate the larger systems in question. In addition, families that come from culturally traditional and conservative backgrounds may view LGBTQ people as significantly deviating from social expectations. This background can seriously affect parents’ ability to adequately engage with their children around these issues. For families struggling to support their LGBTQ children, The Family Acceptance Project, spearheaded by Caitlyn Ryan, is an important resource. The Family Acceptance Project rejects the idea that parents cannot learn to accept these aspects of their children’s identities and provides educational materials targeted at specific cultural groups. Also, national organizations like PFLAG (previously Parents, Families, and Friends of Lesbians and Gays) provide education and support for parents if they struggle to accept their LGBTQ children. In essence, PFLAG helps parents through their own coming out experience. Increasing social support for LGBTQ youth can be achieved in a number of ways, but often, it involves policy, education, and programmatic changes. For instance, creating policies that are inclusive of LGBTQ youth sends a message to communities and organizations that LGBTQ people are accepted and valued. This is noticed by LGBTQ youth and helps detoxify some of the internalized negativity that they may be struggling with. Also, providing accurate information about a diversity of sexual orientations and gender ­identities can help LGBTQ youth and their straight/ cisgender peers more clearly understand the challenges of inclusion. Programs aimed at increasing social support for LGBTQ youth can be calibrated to different moments in the average coming out process. LGBTQ youth in the early phases of a coming out process need to see examples of healthy LGBTQ people and need to be exposed to accurate information. For example, a speaker’s panel presented by older LGBTQ youth can reach audiences that include closeted LGBTQ youth in a very safe manner. More direct peer support from other LGBTQ youth can be extremely useful in the middle phases

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of the coming out process. Support groups are very common examples of this kind of support. These groups are ideally facilitated by trained LGBTQ people who can provide guidance and ground rules for the group. Engaging in activism for social change and being involved in providing programming for other youth can be a very useful experience for LGBTQ youth who are interested in advocacy or are in a more activist moment of their development. The final of the three risk factors outlined above is identity confusion. Education, support, and time are the key ingredients for helping LGBTQ youth work through confusion about their identities. Giving accurate information from credible sources can dispel inaccuracies, but sometimes LGBTQ youth just need help learning to tolerate ambiguity as they work toward their own conclusions. Professional counseling can be a valuable resource for LGBTQ youth who are having trouble resolving conflicts related to their sexual orientation and/or gender identities. Andy Dunlap See also Black Americans and Sexual Orientation; Coming Out Processes for Transgender People; Intersectional Theories; Sexual Orientation: Overview; Sexual Orientation Identity Development

Further Readings Dunlap, A. (2014). Coming out narratives across generations. Journal of Gay & Lesbian Social Services, 26(3), 318–335. doi:10.1080/10538720.2014.924460 Dunlap, A. (2014). Supporting youth in the coming out process: Theory based programming. Smith College Studies in Social Work, 84(1), 107–129. doi:10.1080/0 0377317.2014.861173 Grierson, J., & Smith, A. (2005). In from the outer: Generational differences in coming out and gay identity formation. Journal of Homosexuality, 50(1), 53–70. doi:10.1300/J082v50n0103 Grov, C., Bimbi, D. S., Nanin, J., E., & Parsons, J. T. (2006). Race, ethnicity, gender, and generational factors associated with the coming-out process among gay, lesbian, and bisexual individuals. Journal of Sex Research, 43(2), 115–121. doi:10.1080/002244906 09552306 Hass, A., Eliason, M., Vickie, M. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., & Clayton, P. (2011).

Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10–51. doi:10.1080/00918369.2011.534038 Rust, P. C. (2000). “Coming out” in the age of social constructionism: Sexual identity formation among lesbians and bisexual women. In P. C. Rodriguez Rust (Ed.), Bisexuality in the United States: A social science reader (pp. 512–534). New York, NY: Columbia University Press. Ryan, C. (2010). Engaging families to support lesbian, gay, bisexual and transgender youth: The family acceptance project. The Prevention Researcher, 17(4), 11–13. Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience. Journal of Research on Adolescence, 21(1), 256–272. Savin-Williams, R. C. (2005). The new gay teenager. Cambridge, MA: Harvard University Press.

Coming Out Processes Transgender People

for

This entry describes developmental processes of coming out for transgender people, how the process may occur with family members and friends, and how institutions may be involved in the coming out process. The entry first describes the definition and history of coming out. It then discusses the differences between coming out for young transgender children, transgender youth (ages 10 years and older), and transgender adults. It then provides a perspective on how transgender individuals first come out to themselves, then how the process may look with friends and family members, as well as specific cultural factors that may influence the process. The entry concludes by describing how workplace environments and schools can either enhance or inhibit the coming out process.

Coming Out as Transgender The term coming out is defined as communicating one’s stigmatized, invisible identity to others. “Coming out” originally referred to gay men who were being introduced at exclusively gay balls in

Coming Out Processes for Transgender People

the early 20th century, but it was redefined in the 1960s as “coming out of the closet.” This process was primarily defined for gay men to share their “shameful secret” about their sexual orientation but became a broader term for lesbian and bisexual individuals in the 1980s. In the 1990s and early 2000s, transgender individuals were embraced under the larger lesbian, gay, bisexual, and transgender umbrella, and revealing a transgender identity was also adopted as a coming out process.

Developmental Stages The coming out process for any person will differ based on personality, environment, level of socialization, and developmental level. The youngest documented child to come out as transgender was 18 months old; however, among younger children, it is more common for children to start coming out around the ages of 3 or 4. Children who are younger than 10 years often do not come out, in the traditional sense. Instead of internally understanding their transgender identity and making a decision to tell others about this identity, they will often communicate their identity by refusing to engage in specific behaviors (e.g., wearing certain types of clothing or not wanting to play with ­certain toys) or letting others know of their behavioral preferences (e.g., wanting to wear stereotypically gendered clothing or play with gendered toys). For example, if a child was assigned a female sex at birth and is dressed in dresses or skirts but feels more masculine, the child may outright refuse to wear the dresses or skirts or indicate that this type of clothing is uncomfortable. This same child may also indicate a preference for playing with toys that are often marketed toward boys, such as trucks and sports-related activities. Conversely, a child assigned a male sex at birth may indicate a preference for wearing princess dresses and a desire to play with dolls. Communicating these preferences does not necessarily indicate that the child is “coming out,” but it does communicate to others that the child does not want to conform to traditional gender norms. Often, coming out for children who are within this age range involves caregivers understanding that the child identifies as transgender, and the caregiver usually communicates this information to doctors, school officials, and other family members. In essence, the

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caregiver usually comes out for the child until the children are older and have a better understanding of how and when they would like to communicate information related to their transgender identity. For older children and adolescents (hereafter referred to as youth), the coming out process is often different from that of younger children. Puberty is a clear marker for youth who consider coming out. When transgender youth are approaching or experiencing puberty, the psychological impact of the biological changes can be very distressing. This distress is often rooted in hormonal and physiological changes (e.g., breast growth, menstruation, testicular volume increase, penis lengthening) and will increase body dypshoria. Body dysphoria is defined as incongruence between one’s sex assigned at birth and one’s gender identity that causes feelings of discomfort, disgust, detachment, and distress with regard to one’s body. Many youth will come out as transgender directly before or during puberty to obtain assistance in alleviating body dysphoria and/or internalized shame. They will often come out to a trusted peer or family member. However, some youth do not choose to come out, but instead, they will be “outed” by someone, usually a family member, by finding hidden items (e.g., a chest binder, a dress, a packer), Internet searches, or text messages that leave clues to their transgender identity. For transgender adults, the process of coming out will look different for each person. There is a cultural narrative that transgender adults “always knew” about their transgender identity but were not able to come out until later for differing reasons. While this narrative is true for many transgender adults, it is not the case for all transgender individuals. Some transgender adults will indicate that they knew they were transgender from a very young age because they engaged in stereotypically gendered behaviors that were not in line with their assigned sex at birth. Other transgender adults will indicate that they felt comfortable with their assigned sex throughout their youth but that something changed when they became older. Research is sparse when it comes to understanding what will lead to certain individuals coming out at certain ages. Even though there is not much information about this process, the research that does exist indicates that most transgender individuals knew about their transgender identity by the time they

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were in their 30s. Even though this is the case, a number of transgender individuals do not come out until much later (in their 60s, 70s, or 80s). The reasons for waiting to come out vary, but most often, they include perceived rejection from loved ones or financial barriers to a social/medical transition.

Coming Out to Self For transgender people, the process of coming out begins with coming out to themselves. This process of discovering their own transgender identity can be broken down into two stages: (1) discovery of transgender people and (2) discovery of language. The discovery of the existence of transgender people and the transgender community is an essential element for this aspect of identity development. Research indicates that many transgender individuals will report that they did not know that being transgender was an option. This awareness not only allows individuals to better understand their experiences of discomfort/dysphoria with their assigned sex and the possible options that better conceptualize their gender(s), but it also validates their experiences, shows that their experiences are not atypical, and lets them know that they are not alone. Transgender communities may be found through various routes, such as environments (e.g., the transgender community in the town, transgender acquaintances, transgender coworkers) or the media (e.g., television shows or movies with transgender characters), due to the increased visibility of transgender people in mainstream society and pop culture. Additionally, the discovery of language is a powerful component of the coming out process, because it gives transgender individuals a voice to begin expressing and communicating their experiences and identities to not only themselves but to others as well. Fortunately, the Internet is a resource rich with information about the transgender community and the various terminologies associated with gender identity; the convenience of the Internet and the accessibility of the language it provides are influential and impactful during this part of the coming out process. Language can also be discovered through the media and social media, such as observing the language someone else uses and modeling after that language to talk about

one’s own transgender identity. These avenues of information allow transgender individuals to learn, explore, understand, and come out to themselves in a way that does not draw attention from people until they are ready to come out to others. It is not atypical for transgender people to seek community support on the Internet (e.g., community forums, social media) prior to coming out to others. The transgender community on the Internet is vast and expansive and, in many instances, anonymous. The Internet can give transgender people a sense of community and connection, while providing them with support and resources on how to come out to their loved ones. This ­process may entail providing them with a space to share their coming out experiences and strategize coming out methodologies, and/or offering resources on how they can keep themselves safe in light of possible rejection or violence. Conversely, the Internet can also be used as a means of information, resources, and support for friends and families of transgender people. The Internet also provides community support for loved ones of transgender people, similar to how it provides community support and resources for transgender people. Utilizing the Internet can help friends and families through their own struggles, to build a community of their own to support one another and better understand their transgender loved ones. Fortunately, the growing visibility of transgender people in the media not only helps transgender people by exposing them to the transgender community, but it also exposes other people to the transgender community. This visibility and exposure can prime friends and families of the existence and normalization of transgender people, on top of educating them about transgender identities; this can help with the coming out process by making information about transgender people more accessible and easier to understand, taking some of the burden and pressure of educating people off the shoulders of transgender people.

Coming Out to Friends and Family Unfortunately, rejection from friends is a common fear among transgender individuals when they come out. Often, before coming out to family members, transgender individuals may attempt to test the waters with their friends. When coming

Coming Out Processes for Transgender People

out to friends, transgender individuals often have to consider the effect that it may have on their social circles and if they can afford to risk losing any of their friends due to rejection. Many transgender individuals opt to come out to their closest friends first because these relationships are perceived as being safer and pose less risk for rejection. This process can still be an anxiety-provoking experience for transgender people because for some this may be the first time they are vocalizing their identity to someone else. Positive reactions and acceptance can help provide transgender people with the confidence and social support they need to begin coming out to other people. Prior to coming out to friends, transgender individuals may observe their friends’ varying reactions to transgender-related topics. Transgender individu­ als can gauge if their friends are reacting positively, negatively, or neutrally to transgender individuals in the media. This analysis can assist them in determining safety and aid in cost-benefit analyses. This cost-benefit analysis process can be more important for transgender individuals who are considering coming out to their families, due to more perceived risk. Transgender individuals may fear being disowned or experiencing violence. This risk can be even more difficult for transgender youth, who still rely on their parents for basic needs (e.g., food, shelter). The cost-benefit analysis of coming out to families usually includes the following two options: (1) come out to be authentic about themselves and risk the possibility of being disowned by their family or (2) stay in the closet and risk harm to their mental well-being. In such cases, it is not uncommon for transgender people to create survival plans in the event of rejection or violence, such as determining where they will go if they are asked to leave their house or if their financial resources are taken away.

Coming Out and Cultural Factors Culture is broadly defined, but for the purposes of this section, we will be discussing the ethnic and racial factors that may influence the coming out process for transgender individuals. For individuals in families that come from more collectivistic cultures, it may be particularly difficult to come out if the transgender individual perceives that they will bring shame on their family. For

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individuals who were raised to take a more individualistic stance, it may be easier for them to distance themselves from their families (should they believe that their family will disapprove) and to have a narrative around their coming out process that it is of utmost importance to live authentically. However, if a family who ascribes to a more collectivistic stance indicates that the transgender individual will affect the entire family (and community) by coming out, it may be a family decision whether the transgender individual will tell others about their gender identity. Culture may also be a factor based on immigration status, language, and acculturation. Often, for a family that has recently immigrated to the United States, there is a push and pull of assimilating into American culture while also retaining rituals and important factors from the family’s previous culture. The language of “trans” can sometimes be difficult to translate— both literally and culturally—and may create some barriers in communicating about the coming out process. There may also be generational differences that can create barriers. For example, some first-generation families may see the second-­ generation children’s coming out process to be solely due to acculturating to the United States and that the trans identity is not “truly” who the person is. Gender identity and roles can also play into cultural processes when coming out. Some cultures value men and masculinity more than others; thus, when an individual comes out as a transgender man, it may be difficult for the family to process, but it will perhaps be also more acceptable than if an individual comes out as a transgender woman.

Coming Out at School For transgender children and youth who are coming out at school, the process can feel daunting. School administrators and teachers working with the youth will need to be notified of the preferences of the youth to support them through their gender transition. For example, some youth may prefer that a new name and different pronouns be used; if it is in the middle of the school year, administrators and teachers will need to work together to inform the other students in the youth’s classes about this change and have support on hand in case peers have questions or are curious about how to appropriately address the

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transgender youth. In addition, the youth will need support to use the bathroom of their choice and to decide which locker room to use, when applicable. Family members are often the primary advocates throughout the process of coming out during the preschool to high school years; transgender individuals often advocate for themselves in university settings. One of the aspects that sets transgender youth apart from other individuals who come out is the constant coming out process. Even though they may be coming out at school for the first time, it is likely that they will need to discuss their identity each year with new teachers. After the youth has been out for some time, they may choose to be stealthy (not disclosing their transgender identity), which would indicate that they are not coming out at school; however, there are certain situations that may require extra support around being outed (e.g., peers may find out about the youth’s history from someone else or notice a packer in the gym).

Coming Out at Work As with youth coming out at school, transgender individuals will often need assistance navigating coming out at work, especially the first time. If the workplace has a human resources (HR) department, it is common for transgender individuals to meet with colleagues in HR to let them know that they are going to begin their transition. If there is no HR department, transgender individuals may choose to meet with their immediate superior at work to discuss the coming out process. Each organization will handle coming out at work differently; however, there is usually a system set up to communicate the person’s transgender identity to all staff at the organization. E-mails are common modes of communication to indicate that a person is coming out as transgender at work. However, team meetings may be the primary mode of communication, or the organization may choose not to communicate the information to staff. Typically, e-mails or meetings will communicate how the transgender person would like to be addressed in the future (pronouns, name) and also indicate support for the transgender individual within the organization. If the organization is not supportive, this process can be very painful for a transgen­der individual. Most states do not have

legal protections for transgender individuals in the workplace; thus, transgender individuals can be fired for coming out at work. It is important for transgender individuals to have external sources of social support while coming out at work as it can be very anxiety inducing. The various kinds of discrimination are difficult to cope with, and losing employment due to coming out at work can be particularly difficult. Not only do transgender individuals need to cope with the psychological process of experiencing discrimination, but they must also cope with the financial hardship of not having employment. Not all transgender individuals will have difficulty coming out at work, but it is often a balance of being prepared for negative outcomes throughout the coming out process while hoping for positive outcomes. In addition to school and work, transgender individuals will need to come out in any situation where their previous names might have been used, where they knew people from their past, or where their bodies might be involved (e.g., medical appointments). Every time a background check is run, it is likely that a transgender person will be outed. In addition, if a transgender person is in a situation requiring medical care, they may also find that their transgender identity is relevant background information for treatment. Research indicates that transgender people experience extensive anxiety when first coming out in all of these settings but that the anxiety decreases as they get used to coming out in multiple settings. As time goes on, transgender people may not need to come out as often, due to having their names changed on all documents or systems having been updated for a long period of time. Also, research indicates that transgender people report the overall process of coming out as being a more positive experience than they expected; thus, even though there may be difficulty at different steps, transgender individuals can also expect to have support, warmth, and understanding that counters the negativity. Stephanie Budge and Jayden L. Thai See also Coming Out Processes for LGBTQ Youth; Gender Identity; Gender Stereotypes; Transgender and Gender Nonconforming Adolescents; Transgender and Gender Nonconforming Identity Development; Transgender Children; Transgender People

Community and Aging

Further Readings Bockting, W. O., & Coleman, E. (2007). Developmental stages of the transgender coming out process: Toward an integrated identity. In R. Ettner, S. Monstrey, & A. Eyler (Eds.), Principles of transgender medicine and surgery (pp. 185–208). New York, NY: Haworth Press. Brown, M. L., & Rounsley, C. A. (2003). True selves: Understanding transsexualism for families, friends, coworkers, and helping professionals. San Francisco, CA: Jossey-Bass. Budge, S. L., Rossman, H. K., & Howard, K. A. S. (2014). Coping and psychological distress among genderqueer individuals: The moderating effect of coping and social support. Journal of LGBT Issues in Counseling, 8, 95–117. doi:10.1080/15538605.2014.853641 Denes, A., & Afifi, T. D. (2014). Coming out again: Exploring GLBQ individuals’ communication with their parents after the first coming out. Journal of GLBT Family Studies, 10(3), 298–325. Gagné, P., Tewksbury, R., & McGaughey, D. (1997). Coming out and crossing over identity formation and proclamation in a transgender community. Gender & Society, 11(4), 478–508. doi:10.1177/08912439701 1004006 Galupo, M. P., Krum, T. E., Hagen, D. B., Gonzalez, K. A., & Bauerband, L. A. (2014). Disclosure of transgender identity and status in the context of friendship. Journal of LGBT Issues in Counseling, 8(1), 25–42. doi:10.10 80/15538605.2014.853638 Lev, A. I. (2013). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York, NY: Routledge. Rowniak, S., & Chesla, C. (2013). Coming out for a third time: Transmen, sexual orientation, and identity. Archives of Sexual Behavior, 42(3), 449–461. doi:10.1007/s10508-012-0036-2 Zimman, L. (2009). “The other kind of coming out”: Transgender people and the coming out narrative genre. Gender & Language, 3(1), 53–80. doi:10.1558/ genl.v3i1.53

Community

and

Aging

Community and aging bring up a range of issues related to self-efficacy and general quality of life for older adults. With substantial increases in average life expectancy over the past century and exponential growth in the part of the population aged

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65 years or older, there is an increased need for services, products, activities, and environments designed to support older adults within our communities. Diverse family structures, changes in family patterns, and economic issues add further complexities. While there is still a need for longterm care and skilled nursing facilities, contemporary perspectives on community and aging also aim to highlight asset-based approaches and address the challenges of loneliness, boredom, and isolation related to institutions, as well as the costs associated with housing and medical care. This entry begins with a general introduction to community engagement in relation to aging and then describes active adult communities (AACs), aging in place, and aging in community as strategies for meeting the physical, social, and emotional needs of older adults. It concludes with notable models of villages designed with the aging-in-community approach.

Community Engagement Community engagement plays an important role in promoting healthy aging in older adults as it provides a means for being connected, staying involved, continuing to learn, and remaining an important part of the community. The term community engagement refers to organizations and individuals building relationships, exchanging skills or ideas, and applying a shared vision for the good of the community. It can include political, civic, artistic, volunteer, and faith-based activities, as well as interactions with family, friends, neighbors, and other community members with shared interests and concerns. Community engagement is a concept that underpins AACs and aging in community.

Active Adult Communities AACs or active adult retirement communities are developer-driven, preplanned, organized, and managed communities to which some older adults choose to move. AACs are for independent adults 55 years or older and do not provide medical or personal care. Various kinds of AACs exist, aiming to meet a variety of residents’ interests, beliefs, and budgets of residents. Some AACs have strict age restrictions, and some are simply marketed to older adults. Depending on the AAC, housing can range

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from modest living in condominiums to larger homes and resort-like settings. There are also specialized AACs designed with the interests of adults of diverse cultural backgrounds and sexual orientations in mind. AACs aim to support residents’ social lives and respect their independence by providing structures for residents to interact through on-site activities and access to nearby cultural attractions, shopping, and medical facilities.

Aging in Place and Aging in Community Aging in place aims to help community members remain in their own homes as safely and as independently as possible. As an approach, it is driven by people’s desire to stay in their homes as they age, economic concerns resulting from the recession, and the rising costs of health care. Home modifications, in-home services, connective technologies, and monitoring devices are factors that enable successful aging in place. Physical and social isolation can be associated risk factors for aging in place as physiological and safety needs tend to be emphasized. Individual homes, pocket neighborhoods, and naturally occurring retirement communities are common examples of where aging in place can occur. Aging in community is a related concept, emphasizing older adults’ ability to sustain connections to places and social relationships within their neighborhoods and communities in order to maintain their standard of living. Aging in community can range from making transportation and community assets physically accessible and inviting to older adults, to older adults intentionally supporting friends and neighbors as they reside in longtime homes. Elder or senior villages, cohousing, and other clustered housing models that support aging in community are increasingly being replicated and sustained. Resident groups are usually behind the organization, planning, and management of these models. Proponents of both aging in place and aging in community posit that interdependence and connectedness between generations make communities more sustainable and resilient. Notable Examples of Aging in Community

Beacon Hill Village in Boston, Massachusetts, is the first and one of the most well-known

member-driven villages designed to meet the needs of older adults. It began in 2002 and currently serves about 400 members. Its founders wanted to stay involved in the community but were concerned that as they aged they would need additional support to have a sense of security. However, they wanted more freedom and control than could be offered by models focused solely on housing, social activities, or medical care. Ultimately, they started a nonprofit organization to coordinate referrals and access to affordable services such as transportation, home repairs, health care, and social and cultural programming. In response to many requests for advice, the founders of Beacon Hill Village developed a manual based on their experiences and founded the Village to Village Network. De Hogeweyk is a self-contained village that opened in 2009 as part of the Hogewey Care ­Center in Weesp, The Netherlands. It is also known as Dementia Village. Hogeweyk is a village of 23 homes, designed with familiar decor and differentiated by lifestyle for 152 older adults living with dementia. Plain-clothed villagers who are trained nurses and caregivers provide constant care, and individuals staffing the businesses are trained in dementia care. Residents participate in cooking and cleaning with staff, go grocery shopping, safely walk in the streets, and are able to go to the park, the restaurant, the bar, and the theater. Residents of the surrounding neighborhoods are able to come into the village too. While some critics are concerned that this environment is misleading to residents, advocates argue that it is one of the most compassionate kinds of care possible for older adults living with age-related dementia. Christine M. Woywod See also Caretakers, Experiences of; Disability and Aging; Isolation and Aging; Long-Term Care

Further Readings Baker, B. (2014). With a little help from our friends: Creating community as we grow older. Nashville, TN: Vanderbilt University Press. Blanchard, J., & Anthony, B. (2013). Aging in community (Rev. ed.). Chapel Hill, NC: Second Journey. McFadden, S., & McFadden, J. (2014). Aging together: Dementia, friendship, and flourishing communities. Baltimore, MD: Johns Hopkins University Press.

Competition and Gender

Competition

and

Gender

Gender, or the presentation of feminine or masculine attributes in human beings, and competition are integrally related. Societal expectations of gender set ideas for how women (girls) and men (boys) should behave in various facets of life, and this includes competitive behaviors. As we seek to understand the motivations of behavior to form supportive and healthy relationships, work effectively with clients, and work and live cooperatively with friends, family, and colleagues, appreciating the underlying cognitions, behaviors, and attitudes that guide competition is essential. This entry offers a definition of gender and competition and explores how competition is shaped by gender role expectation and viewed by societal expectations of gender. This entry further explores major theoretical formulations about gender and competitive behaviors.

The Gendered Dynamics of Competition Gender consists of the feminine, masculine, and transgender characteristics expressed among human beings. These characteristics are observed through one’s biological sex and manifested through gender roles and expectations and gender identity. While feminine characteristics (e.g., nurturing, receptivity, and intuition) are associated with women and girls and masculine characteristics (e.g., strength and courage) are attributed to men and boys, a finite split between these categories is rarely observed. Women (girls) and men (boys) are complex beings, and often their complexity is demonstrated by their gender identity and expression. In fact, in instances where an individual’s felt/experienced gender or gender identity does not conform to the expected or ­ ­conventional gender expression, the individual is considered gender nonconforming. In such cases, individuals may be transgendered and/or identify with a nonbinary gender concept. This incongruence confronts conventional notions of gender— such as “girls like pink and are nice, and boys like blue and are strong”—and encourages a more complex consideration of the ways in which gender influences behaviors, attitudes, and cognitions as it relates to competition.

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It is widely understood that competition is a natural aspect of life. Like the competition of reproductive cells for evolutionary pursuit toward gene expression, human beings experience competitive behavior at the very heart of their existence. While competition is natural, its expression in human behavior is filtered through societal notions of gender and its expression. The differences between masculinity and femininity have defined the field of psychology for some time. Early psychoanalytic theorists such as Carl Jung and Sigmund Freud articulated these differences in terms of archetypes and crises that arise for male and female children as they reconcile their immersion into life from the body of a woman. From a psychoanalytic view, girls struggle to differentiate from the femaleness of their mother’s woman body to articulate their gender identity for themselves. Alternatively, boys seek to cultivate a male sense of self by differentiating themselves from the female body from which they originate.

Psychological Theories on Competition and Gender Contemporary psychologists studying men and masculinity articulate that men and boys seek to confirm their male identity by distancing themselves from the feminine. The pursuit of a male gender identity by seeking approval and connection with men (boys) through male-focused, antifeminine values and approaches to life and living may be comforting to men and boys because they will at least have a sense of their identity by knowing what they are not (e.g., feminine, female, girl, or woman). Though it is possible that this reasoning may work for male identified boys and men, it may not be as effective for those nonmasculine men who are heterosexual, gay, bisexual, or transgendered; for masculine or male identified women; or for men or women who identify with a nonbinary gender. In the 1970s, feminist psychologists began to articulate masculine and feminine differences largely to assert a psychology of women and girls. A critique at the time was that the field of psychology generalized the experiences of men and boys and therefore did not consider the unique ways in which girls and women experienced the world. A number of distinctions between masculine and

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feminine ways of being were identified and have implications for the ways in which gender intersects to influence competitive behaviors. In 1976, Jean Baker Miller’s Toward a New Psychology of Women was published. This text was critical to the development of the field of psychology because prior to then women’s and girls’ emphasis on developing and preserving relationships was seen as dysfunctional. The negative valence around terms such as dependence in the field of psychology, as well as the problematizing of closeness in relationships, such as stating that a parent-child relationship is enmeshed or that a relating pair is codependent, deemed human beings’ natural reliance on relationships unhealthy. This new psychology of women put forth a relational model for human development (i.e., ­ relational-cultural theory), which highlighted the importance of connection to others for healthy development to address psychological dysfunction. Relational-cultural theory articulated human isolation as the primary cause for mental illness in women and men. Accordingly, Miller’s work proposed that there was nothing wrong with women’s relating behavior; rather, there was something wrong with the way in which the modern society normalized isolation to the psychological detriment of men and women. Miller’s work was further developed by other feminist psychologists who continued the reframing of gender to understand, rather than problematize, male and female differences. Carol Gilligan analyzed the differences in moral decision making between boys and girls, and later women, as a means to examine gender differences. She found that girls’ moral development was different from that of boys: Boys sought to pursue justice by reversing wrongs into rights in moral dilemmas, while girls considered the impact of their decisions on others. Interestingly, on later reflection of her work, Gilligan realized that girls’ focus on balancing the effect of their decisions on others was a reflection of their socialization. Specifically, she found that girls and women attempted to offset the potential for exclusion from groups by silencing themselves or not saying what they really think. In a patriarchal society, it can be unsafe for girls and women to articulate points of view that differ from those of the men in their lives—or the male-­ dominated social structure that mandates their

endorsement or requires they remain silent to ensure their inclusion and survival. As a consequence, girls and women learn rules and enforce this patriarchy, such that those whose lives and experiences fall within it are considered good and respectable and those whose do not are bad and problematic. As a result, for women and girls competition is primarily set around negotiating inclusion and exclusion in groups by endorsing some aspects of patriarchal ideas to secure their inclusion and ultimately their survival. Alternatively, men and boys and counterparts in the animal kingdom typically engage in explicit win-lose competition, as is observed in the fields of sports and evolutionary and comparative psychology. On a related note, ideas of manhood and maleness are crafted around demonstrating superiority, typically in direct and public competition. Thus, notions of what it means to be a “real man,” versus demonstrating notions of antimasculine or feminine attributes, are thought to be challenged in this way. Stereotypically, real men or demonstrations of masculinity are characterized by the use of brute force, independence, and bold action to win a competition. Heterosexual men and boys who are unable or unwilling to demonstrate their masculinity in this way are considered less than male, or feminine. Gay, bisexual, and transgendered men may feel the pressure to express masculine gender in this way or be targeted for explicit verbal and/or physical bullying, violence, and possible death, as has been observed in the murders of Matthew Shepard and Brandon Teena. Such violence continues and has inspired social and political change, as demonstrated by the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, signed into law in 2009 by President Barack Obama, and the development of the global Transgender Day of Remembrance (November 20), which aims to call attention to the fact that every 2 days a person is killed for expressing gender nonconformity. At the crux of this violence toward men and boys who do not conform to the male gender ideal is a disdain for the feminine and/or feminine ways of being. Both men and women experience the effects of this social-cultural construction of gender on their lives, and this shapes the ways they compete. While socially expected competition among men and boys is prescribed to be in the form of

Competition and Gender

direct aggressive acts toward winning, women and girl’s socialization promotes competition of an indirect and relational variety. The term relational aggression is defined as the process of using psychological and social behaviors to exert social control on another person and cause them harm. Typical examples of these practices include gossiping about an individual, leading to character defamation, humiliation, or betrayal of trust; ostracizing an individual; and/or withholding information. These behaviors can occur directly or indirectly and between peers or against one higher or lower on the social hierarchy within the group. For women and girls and/or those engaged in nonconforming male gender expression relative to relationships, these behaviors are engaged to compete for status and power within the group. As status and power are marked by one’s inclusion or exclusion as well as the ability to dictate the direction and flow of activity among others, competing for the role of the leader within the group can be rife with competition, as there are a diverse set of expected and unexpected adversaries. For instance, one day a girl or woman can be the most ignored, peripheral member of the group, and the next day she may be the center of attention and adoration from other members should she have competed for and achieved the lead role. Characterizations of this power and competition dynamic have been documented in both academic contexts and popular culture. Psychologists and journalists have explored these dynamics in myriad contexts, such as parenting, dating relationships, sexual expression, work and career development, and comparison of body type and beauty among adult women. Even the term frenemy, though appearing first in print in 1953, has gained contemporary cultural relevance for the ambiguity inherent in relational aggressive tactics to articulate both friendship development and adversarial transition and termination within these relationships. Despite the popularity of conceptions such as relational aggression or frenemies, direct, competitive, win-lose scenarios remain a prevalent form of competition among all human beings. Women and girls continue to seek to differentiate themselves from restrictive gender role expectations about the degree to which they will directly fight to be the

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victor in athletic, arts, and performance competitions. Furthermore, notions of gender and competition continue to be pushed beyond the traditional or conventional gender ideals and expectations, which society is socially and culturally outgrowing. Most notable is the 2015 announcement by former Olympic decathlon champion Bruce Jenner, who now identifies as Caitlyn Jenner. In this recent and harrowing display of gender rearticulation, the culture is confronted with the meaning it makes of masculinity and femininity and the ways these constructs are socially and culturally developed and embodied by actual people. More and more, the permeability of gender constructs in the hands of individuals to live them out as seems most healthy and authentic for them gives way to the myriad pathways of expressing gender, even among those who have previously conformed to the most traditional gender ideals and the corresponding competitive behaviors. Wendi S. Williams See also Behavioral Approaches and Gender; Bi-Gender; Biological Sex and Social Development; Biological Theories of Gender Development; Doing Gender; Femininity; Gay Men and Gender Roles; Gender Conformity; Gender Nonconforming Behaviors; Gender Nonconforming People; Gender Socialization in Men; Gender Socialization in Women

Further Readings Chesler, P. (2009). Woman’s inhumanity to woman. Chicago, IL: Lawrence Hill Books. Dellasega, C. (2005). Mean girls grown up: Adult women who are still queen bees, middle bees and afraid to bees. Hoboken, NJ: Wiley. Gilligan, C. (1982). In another voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press. Gilligan, C. (2011). Joining the resistance. Malden, MA: Polity Press. hooks, b. (2004). The will to change: Men, masculinity and change. New York, NY: Washington Square Press. Miller, J. B. (1987). Toward a new psychology of women. Boston, MA: Beacon Press. Pleck, J. (1983). The myth of masculinity. Boston, MA: MIT Press. Tanenbaum, L. (2003). Catfight: Women and competition. New York, NY: First Perennial.

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Comprehensive Sexuality Education

Comprehensive Sexuality Education The Sexuality Information and Education Council of the United States defines sexuality education as the lifelong process of acquiring information and forming attitudes, beliefs, and values. Comprehensive sexuality education (CSE) is a specialized type of sexuality education that provides learners with the information, values, and skills necessary to have a fulfilling, pleasurable, and healthy sexual life. CSE is designed to support young people on their journey to becoming sexually healthy adults and to help adults live a more authentic and fully realized sexual life. To accomplish this, CSE takes a sex-positive and -affirming approach that empowers learners to define and achieve their own sexual and relationship goals. As opposed to other approaches of sexuality education (which largely focus on the mechanics of sex and/or the prevention of unplanned pregnancy or the transmission of sexually transmitted infections [STIs]), CSE provides a holistic approach to sexuality. This entry introduces CSE and explores its central components, its intended audiences, and the basis on which it is sometimes critiqued.

Defining CSE Research evaluating the effectiveness of CSE has shown that it is effective at reducing negative outcomes for youth, including delaying the age at which young people first engage in intercourse, decreasing the number of times they engage and the number of sexual partners they have, while increasing effective use of condoms and contraceptives. Based on this research, President Barack Obama reversed George W. Bush–era restrictions on CSE and dedicated funding toward the implementation of CSE. In other countries, such as the Netherlands, all young people receive CSE as a part of their schooling, and this is considered the norm. As a result of the CSE approach, the Netherlands has the lowest global rates of teen pregnancy and STI transmission and has significantly lower rates of divorce than the United States. Many proponents and advocates of CSE use the Netherlands as an example of why the widespread implementation

of CSE would help reduce negative sexual outcomes for youth.

Components of CSE When discussing sexuality education, the most common reference point is the formal “sex ed” that takes place in K–12 school settings. Sex ­education differs from CSE in that sex education is generally restricted to a health-based and disease prevention model of teaching young people to avoid the negative outcomes of sexual behavior. In the United States, when it happens at all, a majority of sex education traditionally occurs briefly in middle and high school. Common sex education lessons include basic sexual anatomy, the changes to be expected during puberty, and biological information about pregnancy and birth. For high school students, sex education generally includes additional information on how to prevent unplanned pregnancy and the transmission of STIs. In contrast, CSE views sexual health and disease prevention as one component of a larger spectrum of sexuality. Dennis Dailey’s model, which is known as The Circles of Sexuality, envisions four additional areas of sexuality: (1) sexual identity, (2) intimacy, (3) sensuality, and (4) sexualization and power. Collectively, these four areas represent who we are as sexual beings, our relationships with others, how we experience pleasure, and the exchange of power on an individual and cultural basis. A comprehensive approach to sexuality education includes each of these components and treats each as having equal value and importance. In practice, this includes lessons on topics such as emotional literacy, communication skills, values clarification, navigating abstinence, and sexuality across the life span. A core tenet of CSE is that it is an ongoing learning process that occurs throughout a person’s life, starting in childhood.

Age and Developmentally Appropriate Sex Education CSE requires that the information provided must be age and developmentally appropriate for the target audience. This means that different concepts and topics are taught at different ages. While some people may have concerns about engaging children in educational programming that falls under a

Congenital Adrenal Hyperplasia

sexuality umbrella, the criteria for age and developmentally appropriate information create a safeguard for ensuring that children are only receiving information that helps them become and stay healthy. For example, the foundations of CSE start early in life by teaching children about core values such as respect for self and others, caring/sharing, emotional literacy, active listening, and direct communication. As children mature, more information is included to help them prepare emotionally, psychologically, and intellectually for the next stage of their physical and psychosocial sexual development. To be effective, CSE should be taught consistently throughout childhood and adolescence, rather than the more common approach of trying to cover all information in one lesson or discussion with a teen who is likely to be already sexually active. Ideally, CSE continues beyond the teen years. Access to CSE throughout college and adulthood can help increase the success of romantic and family relationships, bolster the success of parenting, and navigate sexuality while aging.

Medically Accurate One essential component of a CSE approach is that sex education must include information that is medically accurate, based on peer-reviewed academic research and medical science. This includes using the proper names for sexual anatomy, ­providing accurate efficacy rates for the various contraceptive methods, and instruction on the proper use of such methods. While this may seem to be a logical inclusion, some other models of sexuality education (i.e., some abstinence-­ only-until-marriage curricula) rely on false information and/or manipulate statistics to try to shame or scare young people out of being sexually active. Mandating medically accurate information helps ensure that young people receive accurate sexualityrelated information, which they can then use as a basis for their sexual decision making.

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morality often play a role in this; people who believe that all people should be heterosexual, monogamous, and have sex only in a marriage relationship are often opposed to comprehensive approaches to sexuality education. Opposition to CSE is often based on a belief that teaching about sexuality will impinge on the innocence of young people, prompting them to become sexual beings/ sexually active, and that learning about sexual diversity will coerce them into identifying as lesbian, gay, bisexual, transgender, or queer. Other opponents want the autonomy to teach about sexuality in a way that is consistent with their own morality without interference from other approaches. Due to these controversies, true CSE in the United States is rare, and a majority of people today have been denied access to education that would help them lead healthier and more fulfilling lives. Eli R. Green See also Abstinence-Only Education; Children’s Moral Development; Emotions in Adolescence and Gender; Gender Studies in K–12 Education; Intimacy; Parental Expectations; Sex Education; Sex Education in Schools; Sexuality and Adolescence; Sexually Transmitted Diseases; Teaching Human Sexuality

Further Readings Advocates for Youth. (2009). Comprehensive sex education: Research and results. Retrieved from http:// www.advocatesforyouth.org/storage/advfy/documents/ fscse.pdf Lindberg, L. D., & Maddow-Zimet, I. (2012). Consequences of sex education on teen and young adult sexual behaviors and outcomes. Journal of Adolescent Health, 51(4), 332–338. Schroeder, E., & Kuriansky, J. (2009). Sexuality education: Past, present and future. Santa Barbara, CA: Praeger. Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: Why we need comprehensive sex education in the US. PLoS One, 6(10), e24658.

Controversies Related to CSE Given that personal and cultural values vary widely, particularly when it comes to sex and sexuality, it is not surprising that CSE is a controversial approach to sexuality education in U.S.-based K–12 schools. Conservative religious perspectives and individual

Congenital Adrenal Hyperplasia Congenital adrenal hyperplasia (CAH) is a family of inherited enzyme deficiencies that impair normal

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Congenital Adrenal Hyperplasia

corticosteroid synthesis by the adrenal glands. The adrenal glands produce glucocorticoids, mineralocorticoids, and sex steroids ­(androgens). This entry examines the pathophysiology, classification, clinical features, diagnosis, and treatment of CAH and how CAH affects both sex and gender.

Pathophysiology Enzyme blockages in the adrenal pathway cause a constellation of defects in glucocorticoid, mineralocorticoid, and androgen production. More than 90% of cases of CAH are caused by deficiency of the enzyme 21-hydroxylase, resulting in poor glucocorticoid production and excess androgen ­ production. Deficiency of the 11-beta-hydroxylase enzyme is the second most common cause of CAH and also leads to excess androgen production. Deficiencies of these adrenal enzymes cause decreased cortisol production, leading to a lack of negative inhibition of the adrenocorticotropic hormone (ACTH) and oversecretion of ACTH. This drives the adrenal glands to produce more cortisol, but production is blocked by enzyme deficiencies. Adrenal precursors are thus shunted into the androgen pathway, resulting in increased androgen synthesis. Other rare enzyme deficiencies include 17-alphahydroxylase deficiency and 3-beta-hydroxysteroid-dehydrogenase deficiency. These deficiencies cause low androgen production and ambiguous genitalia in males.

Classification The classification of CAH can range widely depending on the severity of the enzyme defect. The degree of deficiency in 21-hydroxylase can be categorized clinically into two distinct forms: (1) classical (salt-wasting and simple virilizing types) and (2) nonclassical. The classical form of CAH, due to 21-­ hydroxylase deficiency, is characterized by genital v­irilization in females at birth. Salt-­ wasting CAH is distinguished from the simple virilizing form by insufficient mineralocorticoid aldosterone secretion, causing a lack of salt ­ retention by the kidneys. If the mineralocorticoid deficiency is severe and untreated, hypotension, cardiac arrhythmias, shock, and death can occur.

In nonclassical CAH, the enzymatic defect is less severe. Thus, females who possess this mild enzymatic defect produce fewer androgens than can be seen in the classical form and do not present with ambiguous genitalia. This type presents later in life with excess androgens, which can cause disturbances in growth and puberty, including early puberty, infertility, and menstrual abnormalities.

Clinical Features of Classical CAH Females with classical CAH generally present at birth with virilization of their genitalia due to in utero androgen production, which masculinizes the external female genitalia during fetal development. Genital virilization can vary greatly, ranging from mild clitoral enlargement to a penile urethra and fusion of the labia in severe cases. Ambiguous genitalia of this type also present with severe defects in glucocorticoid and mineralocorticoid production. Glucocorticoid and mineralocorticoid deficiency can be life threatening and is an emergency when untreated. Thus, diagnosis of CAH in newborns who present with ambiguous genitalia is urgent. An affected female may enter premature adrenarche, with early appearance of acne and pubic hair. Postpubertal females may develop progressive clitoral enlargement, deepening of the voice, increased muscle bulk, hirsutism, medication-­ resistant acne, and male-pattern balding. Growth disturbances, early puberty, and ­infertility are seen in males with classical and nonclassical CAH as a result of the increased androgen production from the adrenal glands. If left undetected, males may also enter premature ­ adreanrche, but with progressive penile enlarge­ ment and small volume of testes. Signs of excess adrenal androgens in the adult male may be difficult to assess, but they may notably lead to decreased testicular size and testicular testosterone production as well as impaired spermatogenesis.

Diagnoses and Medical Treatment Diagnosis of CAH is confirmed through genetic testing and ACTH stimulation testing. Routine newborn screening for 21-hydroxylase deficiency in children born in the United States tests blood taken from a heel stick. Genotyping is used to

Consciousness-Raising Groups

determine the mutation that will cause a specific phenotype. The best method for establishing hormonal diagnosis of 21-hydroxylase deficiency is the ACTH stimulation test. ACTH is administered intravenously, and levels of 17-hydroxylase are measured at baseline and at 60 minutes. These values are then plotted on a nomogram to ascertain disease severity. The main aim of CAH treatment is to provide replacement of deficient glucocorticoid and mineralocorticoid and decrease adrenal androgen production.

Quality of Life Clinical factors in CAH that may affect quality of life include the need for lifelong medication, the risk of a life-threatening adrenal crisis, and symptoms of hyperandrogenism. Recent studies on adults report mixed results. Some studies report impaired health status and working ability among adults with the classical form. Women with CAH have reported concerns regarding fertility, increased anxiety about disclosing the diagnosis to others, and decreased satisfaction with sexual functioning.

Sex Assignment Androgens interact with a large number of genes, leading to the sexual differentiation of the brain and later gendered behavior. The degree of behavioral masculinization is correlated with the degree of androgen excess. The association of the prenatal androgen exposure with gender behavior is closer than with gender identity. When considering the gender a child with CAH should be reared in, the chromosomal sex, the expected degree of masculinization of brain and behavior, the potential for satisfactory sexual intercourse and fertility, and the sociocultural environment in which the child will be raised must be considered.

Gender Reassignment The question of gender reassignment may arise when the initial gender assignment based on genital appearance differs from the later-established definitive karyotype and diagnosis of CAH. This

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occurs with frequency in countries without newborn screening programs. Gender reassignment can be imposed on the infant in cases where there is a well-established gender prognosis and applicable outcome data on the basis of the diagnosis, and where the parents are fully convinced of the appropriateness of the reassignment. Gender reassignment should also be considered in cases where children or adolescents show significant gender-atypical behavior with signs of gender dysphoria. Cases in which the diagnosis of CAH is made late with initial assignment to the male gender must not be routinely reassigned to the female ­gender but must be carefully evaluated on an individual basis. Mabel Yau and Maggie Yau See also Biological Sex and Health Outcomes; Biological Sex and Social Development; Biological Sex Differences: Overview; Gender Affirming Medical Treatments; Intersex

Further Readings Meyer-Bahlburg, H. F., Dolezal, C., Baker, S. W., Ehrhardt, A. A., & New, M. I. (2006). Gender development in women with congenital adrenal hyperplasia as a function of disorder severity. Archives of Sexual Behavior, 35, 667–684. Yau, M., & New, M. I. (2013). Congenital adrenal hyperplasia: Diagnosis and emergency treatment, endocrinology and endocrine emergencies. Retrieved from endotext.org Yau, M., Vogiatzi, M., Lewkowitz-Shpuntoff, A., Nimkarn, S., & Lin-Su, K. (2015). Health-related quality of life in children with congenital adrenal hyperplasia. Hormone Research in Pediatrics, 84, 165–171.

Consciousness-Raising Groups Consciousness-raising groups consist of people who rally around a cause to achieve a common goal, such as persuading voters, changing laws, and ending warfare. Activist in nature, these groups are often dissatisfied with the status quo and focused on raising awareness about issues.

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Consciousness-Raising Groups

Common issues addressed among consciousnessraising groups in the United States include human rights (e.g., feminism, LGBT rights, intimate partner violence), diseases (e.g., breast cancer, AIDS), environmental concerns (e.g., global warming, animal rights), conflicts (e.g., the Darfur genocide, Israeli-Palestinian conflict), and political issues (e.g., the Tea Party or the Occupy movement). Consciousness-raising groups are relevant to the psychology of gender because they are embedded in the history of the women’s movement, feminism, and serve as an important mechanism for advocating for gender equality. This entry provides a brief history of the topic, including a discussion on the critical role these groups played in the feminist movement. This entry also examines the structure of consciousness-raising groups and how and why they can be effective in communicating a core message.

Brief History Consciousness-raising groups were popularized in the 1960s during the civil rights movement and the women’s liberation movement. While not limited to women, they typically consisted of small groups gathering in private homes to discuss gender inequality, share personal testimonies, and make plans to take action. The groups served to transform personal experiences into a political consciousness, stating, “The personal is political.” Through shared experiences, women became aware of the larger social structures that created inequality and were able to see common themes among their shared experiences of gender oppressions. These grassroots efforts mobilized people to come together to form larger social movements to enact social change. Education is a common pathway to consciousness-raising groups, particularly on college campuses. Common influences include courses, peer groups, centers on campus (e.g., women’s centers), and community involvement. The women’s movement influenced growth in women’s and gender studies programs at universities. Many universities require a diversity or cultural course, and women’s or gender studies courses fill this purpose. ­Consciousness-raising groups often start on college campuses and encourage young people to get involved with political issues.

Feminist Movement The feminist movement is connected to consciousness raising on gender issues, but it is not a cohesive group. Beyond the divisions among those who identify as feminists (e.g., liberal, radical, socialist, etc.), the movement has at different times effectively excluded poor women, women of color, ­lesbians, and men from the movement. While this led to greater attention being given to White, heterosexual, and middle-class priorities, it also led to the growth of identity groups within the excluded communities, which sometimes rejected the feminist label but continued the work toward gender equality (often from an intersectional standpoint). That is, taking into account the different identities that influence their social location (e.g., class, race, sexuality, etc.), these groups took on new labels such as “womanist” or “queer feminist” to show their unique standing within the larger movement.

Structure Individual involvement in consciousness-raising groups may be examined at different levels. ­Individuals may be looking to change themselves (individual), get involved with others (interactional), and/or seek social change (institutional). Group membership may provide unexpected benefits. Through their involvement in the group, their perceptions of themselves may change, empowering them to greater action and increased group solidarity. This may be especially true for women, as pressures associated with their social status (as women) are increasingly understood as social issues and not personal ones. As individuals recognize the need for change, they may seek out groups that meet those needs. A difficulty arising from this is the potential for group homogeneity—some groups form as people seek out similar others. This may lead to blind spots related to certain issues, but it helps ease the dissonance from challenging social norms (especially if they are strongly held).

Methods While we may think of consciousness-raising groups as people who meet in person, the spread of the Internet since the mid-1990s has provided an

Contraception

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alternate venue for people seeking and sharing information. While access to the Internet ranges considerably by social class and geographic location (1% to 97% as of 2013), where available, social networking platforms (e.g., Facebook, Myspace, Tumblr, Twitter) help connect people at a distance. While not strictly groups, or particularly cohesive, some of the behaviors associated with these platforms help connect people for a common cause. For example, hashtags (e.g., #consciousness_raising) are used on Twitter to link different posts on the same topic. In the early 2010s, this technology helped mobilize people around the globe in protest and solidarity for social justice. The use of hashtags is not limited to gender. Notable uses have included responses to gang rapes in India, protests against sexism in the gaming industry, advocacy against domestic violence, and mobilizing in response to the Black Lives Matter movement. Some organizations include consciousness raising within their goals and stated missions. These groups vary in size, budget, and effectiveness. For example, political lobbying groups may have mainstream advertising, organize recruitment efforts, and sponsor activities that can raise awareness of inequalities related to gender. Groups with fewer resources may focus on contacting legislators, local protests, community outreach, and education.

be hormonal (e.g., contraceptive pill, vaginal ring, emergency contraceptive pill [ECP]), barrier (e.g., condom, diaphragm), surgical (e.g., tubal ligation, vasectomy), or behavioral (e.g., fertility awareness, withdrawal, abstinence). These methods vary in effectiveness, availability and accessibility, and duration (long acting vs. short acting) and in whether they are reversible or not. According to the World Health Organization, the most common forms of contraception used by married or inunion women of reproductive age are female sterilization and the intrauterine device. The ability to prevent or postpone pregnancy is associated with numerous health benefits, including reductions in maternal morbidity and mortality, and infant and child mortality, and complications resulting from unsafe abortions, as well as with social and economic benefits. Most of the research on contraception has been conducted with young women in the West, with a strong focus on the prevention of teenage pregnancy. Less research has been conducted in ­ non-Western contexts, with men, and with marginalized communities. This entry briefly reviews the research on contraception as it relates to gender and identifies some of the key concerns, including attitudes and knowledge, discourses, and access.

Bettina J. Casad and Alian Kasabian

Much of the research on contraception focuses on attitudes, knowledge, and behavior related to the use of contraception. Primarily focused on women, this research measures attitudes and knowledge related to different forms of contraception and seeks to relate these to women’s likelihood of using a particular method. Type of relationship also ­influences the choice of contraceptive method; hormonal and long-acting methods are more commonly used in long-term relationships and condoms more frequently in “casual” sex. In general, women are more likely to use methods that they believe to be safe and have few undesirable side effects, that do not require invasive procedures or vaginal examinations, that involve no or minimal contact with a health professional, and that they can access directly from a pharmacy without a prescription. Much of this research focuses on attitudes and knowledge related to the ECP. Generally, it has

See also Feminism: Overview; Second-Wave Feminism; Women’s Issues: Overview

Further Readings Gusfield, J. R. (2009). New social movements: From ideology to identity. Philadelphia, PA: Temple University Press. Risman, B. J. (2004). Gender as a social structure: Theory wrestling with activism. Gender & Society, 18, 429–450.

Contraception Contraception refers to a variety of methods used to prevent or to postpone pregnancy. Methods can

Attitudes, Knowledge, and Contraceptive Use

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Contraception

been found that increased awareness of the ECP, through public health campaigns, for example, is associated with an increase in support for this method. The most common barrier in the effective use of the ECP is lack of knowledge related to the correct timing for its use.

Research on Discourses Surrounding Gender and Contraception Discourses of hegemonic femininity and masculinity and compulsory heterosexuality continue to position women as responsible for contraception, both in and outside relationships. At the same time, young women, in particular, are likely to encounter stigma for carrying condoms or for appearing knowledgeable about contraception. Such knowledge signals desire and/or sexual experience, which are seen as inappropriate ­ ­characteristics of hegemonic femininity. Much of this research examines the navigation and negotiation of contraception in sexual relationships characterized by unequal power relations and suggests that increasing women’s knowledge and assertiveness around contraception is not enough to ensure that women are able to manage their fertility and that it may, in fact, increase their risk of experiencing stigma or violence. This research has also found that women experiencing intimate partner violence are more likely to have unwanted pregnancies or rapid repeat pregnancies as reproductive coercion is a common form of intimate partner violence. Women may be forced by their partners to have sex and to practice unprotected sex, and/or women’s contraceptive practices may be sabotaged by their partners. These violent practices can influence women’s choice of contraceptive method, leading them to use methods that can be hidden from their partners.

Access Research on access to contraception largely focuses on barriers to access, though some research also highlights the ways in which certain populations are more likely to be encouraged, coerced, or compelled to use contraception. Some of the principal barriers to accessing contraception are geography, with fewer sexual health services in rural areas and increased concern around confidentiality in small

communities; poverty, with the cost of contraceptive devices being prohibitive and potentially not covered by insurance policies; immigration status, with limited access to medical services for people who are undocumented; and discrimination, for example, against people with physical or intellectual disabilities, who are assumed by many medical professionals to not be sexually active, or trans men or genderqueer individuals, who frequently experience harassment and other forms of violence in gynecological settings. Certain populations are more likely than others to be encouraged, coerced, or compelled to use contraception. There is a long history of forced sterilization of women with physical and intellectual disabilities, women institutionalized for mental illness, indigenous women, and other racialized women. Around the globe, high rates of forced and coerced sterilization are reported by women living with HIV and by women who are incarcerated. In the United States, many bills have been proposed to either compel or entice women who suffer from drug addiction or who receive welfare benefits to use long-acting contraceptive methods, such as injectable hormonal birth control. Kate Sheese See also Hysterectomy; Pregnancy; Reproductive Rights Movement; Safe Sex; Women’s Health

Further Readings Brown, S. (2015). “They think it’s all up to the girls”: Gender, risk and responsibility for contraception. Culture, Health & Sexuality, 17(3), 312–325. Jacobstein, R., Curtis, C., Spieler, J., & Radloff, S. (2013). Meeting the need for modern contraception: Effective solutions to a pressing global challenge. International Journal of Gynecology and Obstetrics, 121, 9–15. Nappi, R. E., Lobo Abascal, P., Mansour, D., Rabe, T., & Shojai, R. (2014). Use and attitudes towards emergency contraception: A survey of women in five European countries. European Journal of Contraception and Reproductive Health Care, 19(2), 93–101.

Conversion Therapy See Sexual Orientation Change Efforts

Couples Therapy With Heterosexual Couples

Couples Therapy With Heterosexual Couples Couples therapy has existed for more than 80 years, during which time it has developed into multiple methods of practice over time. Couples therapy for heterosexual couples is primarily used to address relationship distress and improve relationship satisfaction. Couples therapy can also be used to help with a wide range of problems that may be considered individual, such as eating disorders, issues of grief and loss, and even smoking cessation, as the support of one’s partner can be instrumental in recovery of mental health. Couples therapists largely look for a variety of patterns that emerge from repetitive interactions between partners, known as dynamics. A common dynamic is the pursuer-distancer pattern, in which one partner (the pursuer) habitually seeks the involvement of the other partner (the distancer), who is repeatedly evasive, physically, emotionally, or both. The pursuer-distancer pattern may follow stereotypical gender roles, with the female more often being the pursuer and the distancer more often being the male. Such gender roles may also be studied in terms of power dynamics, which are frequently addressed in feminist therapy. One major difference between individual and couples therapy is the relationship between the therapist and the client. In individual therapy, the therapist-client relationship is considered to be one that is emotionally corrective and healing. In couples therapy, the relationship between the partners is more important than that of each partner to the therapist. With the help of the therapist, the ­partners in couples therapy must experience and validate the changes that they seek to make. This entry examines theories of couples therapy for heterosexual couples and some of the common factors that lead to couples seeking therapy.

Theories of Couples Therapy for Heterosexual Couples Couples therapy proceeds in varied ways according to the therapist’s chosen theory or philosophy, as well as the nature of the presenting problem. For example, the same couples therapist may treat long-standing relationship dissatisfaction with

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psychoanalytic theory but determine that feminist therapy better treats inequalities created by infidelity. Couples therapy models vary greatly across several dimensions. Some couples therapists, for example, may spend considerable time with each partner in individual sessions to attain better understanding of a partner’s early development, while other couples therapists, believing that all couples problems are contained within the system rather than the individual, see the couple together in every session. Therapy that is behavioral may include homework assignments between office visits, while therapy that is psychoanalytic may never require specific work. Therapy may be long-term, taking place over a year or longer, or short-term and goal oriented, taking place over a matter of 6 to 8 weeks. Models even differ on the matter of love, with some theorists seeing emotion as irrelevant while others regarding it in high esteem. There are mainly seven theories of couples therapy currently practiced: (1) psychoanalytical couples therapy, (2) object relations couples therapy, (3) behavioral couples therapy, (4) cognitive behavioral couples therapy, (5) emotionally focused therapy, (6) feminist couples therapy, and (7) structural-strategic couples therapy. Psychoanalytic Couples Therapy

Psychoanalytic couples therapy studies how unconscious conflicts within each partner play out in their relationship. In the psychoanalytic approach, the task is to understand how events in each partner’s early development contribute to dysfunctional interactions in the present day. The focus is on listening for the symbolic meaning of the couple’s language as they communicate with each other. If a woman states, “I feel like I’m banging my head against the wall,” there would be an examination of earlier times when she felt repeated frustration in her interactions with significant caregivers. Another core feature of psychoanalytic couples therapy is a focus on the process of separation and individuation. As the self may have struggled in early childhood to emerge as a separate person from the primary caregiver, having his or her own needs, wants, thoughts, and opinions, so the self may struggle for individuation from the partner. In

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a healthy adult relationship, each partner can function both separately and interdependently without threat to the security of the relationship, which is the treatment goal.

perpetually embroiled in conflict or patterns of nagging and avoidance. Cognitive Behavioral Couples Therapy

Object relations therapy focuses on the infant’s primary need to be in a relationship with a mothering person (the “object”), a relationship that even under the best of circumstances includes varying amounts of disappointment and frustration. These early experiences of rejection are internalized (as introjects) and repressed (split off) so that the conscious self can operate freely with others, even while struggling with uncomfortable negative feelings. According to object relations therapists, when two people meet, they are each looking for a new mothering person. In a dance of complex unconscious dynamics, both try to protect their own idealized or good version of themselves while defending against the other’s tendency to reject or attack their sense of self. The aim of the therapy is to help each partner recognize these complex dynamics and consciously choose ways to communicate needs, longings, and disappointment in the present moment.

In cognitive therapy, the aim is to make partners aware of how their thoughts, assumptions, and perceptions may disturb the harmony of their relationship. All people characteristically have distortions in their thinking, with some patterns being more rigid and habitual than others. A person may have “all or nothing” thinking, for example, stating to his or her partner, “You never do anything nice for me.” Such thoughts, known as schemas, may not only be false but may also create defensiveness and conflict within the relationship. By developing more realistic thoughts or cognitions, couples may have fewer negative evaluations of their own or their partner’s behaviors. In contemporary cognitive behavioral couples therapy, the couple may also work to understand why they have developed negative thought p ­ atterns, looking to early influences, to develop personal insight as well as empathy for the partner. There is also an emphasis on recognizing positive thoughts and perceptions, such as recognizing the positive social support that a partner may offer in times of crisis.

Behavioral Couples Therapy

Emotionally Focused Therapy

Behavioral couples therapy is based on understanding behavioral techniques based on operant conditioning. In operant conditioning, behavior is shaped through positive or negative reinforcement (also known as reward and punishment). The goal of behavioral couples therapy is to increase positive and decrease negative interactions. By bringing awareness to each partner’s behaviors that reinforce dysfunctional patterns, couples can make conscious choices to behave differently. Basic behavioral interventions may include increasing the number of daily compliments partners give each other and decreasing the number of destructive or critical interactions. Couples may also engage in rehearsal of new behaviors in vivo in the therapist’s office, such as having an exchange of communication that is assertive rather than aggressive or passive. Behavioral couples therapy often is a useful intervention for couples who are

Emotionally focused therapy is described as an integrative therapy that combines an understanding of early human development and attachment theory with experiential, in-the-moment interventions designed to increase empathy and bonding between the members of a couple. Attachment theory concerns the way an infant experiences his or her relationship with the primary caregiver, usually the mother, which for most people is a secure attachment. For others, however, the attachment may be anxious, which can result in dysfunctional, clinging behavior; avoidant, which can result in emotional withdrawal and detachment; or even anxious-avoidant, which can result in chaotic, “come here, go away” messages to one’s partner. In emotionally focused therapy, the therapist listens to each partner’s experience of the other, attending to and correcting faulty attachment patterns when they are reenacted in the present.

Object Relations Couples Therapy

Couples Therapy With Heterosexual Couples

Partners are made aware of how their inner world is expressed in their outer relationship, particularly in terms of emotions. Interventions are designed to help partners validate and soothe each other’s experiences, creating a relationship of emotional safety. Feminist Couples Therapy

Feminist couples therapy focuses on the social construction of gender roles and how these affect couples, as well as inequities of class, gender, power, and even safety among the participants in therapy. Feminist couples therapy examines personal biases, including those of the therapist, and issues of social privilege. The goals of feminist therapy are to increase mutual respect, accountability, and empathy. In the therapy, couples examine how their ­stereotypical heterosexual gender roles are played out in various arenas, such as work, budgeting, parenting, interactions with family members, feelings of self-esteem, and access to power. Feminist couples therapy has been used correctively with intimate partner violence. The intimate justice model in particular looks at the ethics of family violence in terms of three key concepts: (1) equality, (2) fairness, and (3) care. Recent feminist therapy has become more inclusive, assessing and intervening in terms of race and class as well as gender inequities.

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has a diffuse boundary with the children, becoming overly involved with them, while maintaining a rigid boundary with the male partner. This may lead to the male partner voicing complaints, which may only reinforce the female partner’s tendency to be closer to the child subsystem. A couple may also have a diffuse boundary between them, causing feelings of enmeshment and suffocation on the part of one or both partners, or a rigid boundary, which creates a feeling of emotional distance. Interventions are generally strategic in nature, designed to encourage the partners to act in different ways with each other. A couple who habitually fight may be asked to continue fighting but to do so via writing back and forth in a notebook left in an accessible place. This strategy can slow down the partners’ interaction and hopefully make it more meaningful. The strategy also has the effect of creating a healthier boundary, allowing each individual to give voice to concerns without fear of being enveloped or abandoned by the partner.

Common Factors in Couples Therapy Researchers have developed five elements that couples therapy models have in common that ­contribute to their success: (1) changing the perspective (2) changing the dysfunctional behavior, (3) increasing emotional closeness, (4) improving communication, and (5) promoting strengths.

Structural-Strategic Couples Therapy

Structural couples therapy emerged from structural family therapy, which posits that behavioral interactions within a family are not linear (Action A leads to Action B) but circular, wherein Action A leads to Action B, which causes Action A to recur, which causes Action B to recur, and so on. Certain structures contribute to or maintain these circular patterns within a family system. A primary structure is that of boundaries, which are the imaginary demarcations between individuals and/or subsystems, such as between the parents and the offspring or between siblings. Boundaries can be rigid or diffuse, and individuals or subsystems may become disengaged or enmeshed, respectively. The couple is treated as any other subsystem within the family. The way the partners have organized their boundaries may contribute to dysfunction. An example might be that the female partner

Changing the Perspective

Couples therapy helps the couple view their relationship in new ways. A couple may not realize how stressful outside forces may be, such as changes in the economy, and instead blame each other for their difficulties. An objective party can point this out and help the couple unite together and help each other. Another example might be when a wife learns that her husband’s passivity is not a sign that he does not care but that he mainly agrees with her ideas and decisions. Many couples find that their relationship is better than they believed it to be. Changing the Dysfunctional Behavior

In couples therapy, there is emphasis on creating safety both within and outside the therapy office.

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When dysfunctional behavior can cause real physical or emotional harm, therapy can include interventions such as referral to an anger management program or to a psychiatrist for medication. Increasing Emotional Closeness

Couples often come to therapy because they feel they have grown apart. With its emphasis on the expression of positive thoughts and feelings, couples therapy can help partners feel emotionally close again. For partners who avoid emotion, therapy can help them to understand the benefits of expressing their feelings and to explore this dimension within their relationship. Improving Communication

Many couples suffer because they have difficulty verbalizing their thoughts and feelings. Therapy gives them a place to practice new skills and to understand the difference between assertive, aggressive, and passive communication. Promoting Strengths

Couples often focus on what’s wrong with their relationship rather than on what’s working. Cognitive behavioral therapists may help couples see the negative distortions that undermine the social support they could be enjoying from each other. As beneficial as couples therapy may be, it is sometimes faulted for its lack of success. The lack of success is usually attributed to couples waiting too long to reach out, because acknowledging mental health problems is still seen as a stigma. Stephanie Buehler See also Couples Therapy With Same-Sex Couples; Feminist Therapy; Psychodynamic Approaches and Gender; Romantic Relationships in Adulthood; Theories and Therapeutic Approaches: Overview

Further Readings Benson, L. A., McGinn, M. M., & Christensen, A. (2012). Common principles of couple therapy. Behavior Therapy, 43(1), 25–35. doi:10.1016/j.beth.2010 .12.009 Dickson, J., Dattilio, F. M., & Cherrington, L. (2013). Cognitive behavior therapy with couples. In D. K.

Carson & M. Casado-Kehoe (Eds.), Case studies in couples therapy: Theory-based approaches (pp. 93–108). New York, NY: Routledge. Johnson, S. S. (2006). The path to a secure bond: Emotionally focused couple therapy. Journal of Clinical Psychology, 62(5), 597–609. Prouty Lyness, A. M., & Lyness, K. P. (2007). Feminist issues in couple therapy. Journal of Couple & Relationship Therapy, 6(1/2), 181–195. Scharff, J. E. (1997). Object relations couple therapy. American Journal of Psychotherapy, 51(2), 141–173. Simon, G. M. (2015). Structural couple therapy. In A. S. Gurman, J. L. Lebow, & D. K. Snyder (Eds.), Clinical handbook of couple therapy (pp. 358–388). New York, NY: Guilford Press.

Couples Therapy With Same-Sex Couples For much of psychology’s history, sexual minority populations were largely excluded from research, and same-sex desire was considered pathological. There are, however, indications that, as tolerance for and acceptance of lesbian, gay, and bisexual (LGB) populations have increased in society, researchers and practitioners have begun to respect and acknowledge the unique issues that LGB people might face, both as individuals and as couples. Couples therapists, in particular, have demonstrated an increased interest in same-sex couples therapy and have begun incorporating LGB issues into traditional models of couples therapy. For example, there was a 238.8% increase in total LGB content published in the Journal of Marital and Family Therapy from 1995 to 2010. This entry discusses the issues that therapists are advised to take into account when providing couples therapy to same-sex couples and reviews the empirical research on the efficacy of specific therapeutic techniques for same-sex couples.

Similarities and Differences Between Heterosexual and Same-Sex Couples LGB couples are more similar to than different from heterosexual couples, and LGB couples face many of the same relationship challenges as heterosexual couples. Research studies have ­

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concluded that levels of relational functioning, love, trust, intimacy, commitment, and satisfaction do not differ between same-sex and heterosexual couples, and the same four factors ([1] personality variables, [2] conflict resolution styles, [3] psychological adjustment, and [4] social support) predict relationship satisfaction to the same degree in both same-sex and heterosexual couples. Both heterosexual and same-sex couples tend to pass through the same relationship stages (dating, falling in love, living together, and having children). Same-sex couples also view their relationships to be as committed and as serious as those of heterosexual couples, and contemporary LGB adolescents express the desire to get married and raise children. Although the similarities far outnumber the differences, there are key distinctions between samesex and heterosexual couples. Compared with members of heterosexual couples, members of same-sex couples are less likely to be currently raising a child, tend to be better educated, are more likely to be working, and are more likely to embrace a wider variety of sexual practices (e.g., bondage, dominance, submission, masochism, and nonmonogamy). Although same-sex and oppositesex couples primarily argue about many of the same topics, some researchers have theorized that same-sex couples may use more positive conflict resolution strategies and argue more effectively. Because the partners in a same-sex relationship are not automatically assigned a gender role and demonstrate less of a status/power difference, same-sex couples also tend to divide their household labor more equitably than heterosexual couples do.

Sexual Minority Stress Despite the similarities, it is important to note that same-sex couples face prejudice that heterosexual couples do not. They encounter external stressors caused by stigma and discrimination that can lead to significant stress in LGB people’s lives. Minority stress theory describes these forms of prejudice and their effects. Sexual minority stress is a chronic stress felt by LGB people as a result of living in a heterosexist society. According to minority stress theory, sexual minority populations are exposed to the unique stressors of internalized homophobia, stigma, and discrimination, which

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can have negative impacts on their health, wellbeing, and relational functioning. Due to internalized homophobia, LGB couples might feel compelled to hide their same-sex attractions and relationships. Moreover, while attitudes toward the LGB community have become increasingly more positive in recent years, LGB couples still exist in a world where they must fear daily violence and harassment. These constant experiences of stigma can lead to decreased relationship satisfaction and increased conflict, sexual problems, and mental health issues. This stress is compounded when LGB couples fail to experience similar levels of social support from their family members. Although connectedness to a sexual minority community can help counteract the ill effects of minority stress, lack of family support and acceptance can still negatively affect a same-sex relationship.

Similarities and Differences Between Female and Male Same-Sex Couples Different concerns may exist between lesbian couples and gay couples. In many studies, lesbian couples reported having significantly less sex than heterosexual couples and gay couples do; this is a phenomenon colloquially known as “lesbian bed death.” Although some researchers attribute this declining sexual desire to gender socialization or internalized homophobia, sex may have a different meaning for many lesbian women, and low frequency of sex may not be an indication of dissatisfaction. Lesbian women frequently associate more value to nonsexual touching (kissing, hugging) and often use it in place of sex to express intimacy. Another common stereotype that therapists frequently encounter with lesbian relationships is “fusion,” a state in which both partners become so close emotionally that they seem to lose their individual identity and desires. Relationship problems can then emerge from this fusion, as each partner feels that she lacks a sense of autonomy. The ­concept of fusion in lesbian relationships is based on little empirical research. It has been suggested that the emotional closeness in lesbian relationships is not necessarily problematic. Nevertheless, some couples therapists have begun developing ­therapeutic techniques to combat fusion, such as exercises that facilitate differentiation.

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Monogamy Versus Nonmonogamy Gay men report a higher frequency of nonmonogamous relationships, also known as open relationships, than lesbian and heterosexual couples do. Couples might agree to engage in ethical nonmonogamy, which is an agreement that the partners may engage in romantic or sexual relations with other individuals. Such agreements come in many forms, from engaging in loving, romantic relationships with many people at once (polyamory) to loving just one person but engaging in sexual relations with other people. One study on the topic found that 65% of gay couples and 23% of lesbian couples were in some form of a nonmonogamous relationship compared with 15% to 28% of heterosexual couples. Nonmonogamous agreements can take many forms for same-sex couples, but gay couples who establish explicit rules about their nonmonogamy, such as limiting sexual contact with others to certain activities or not using the couple’s bed to have sex with others, tend to have greater relationship satisfaction than those who do not establish such rules. The prevalence of open relationships among gay men may be elevated due to these men subscribing to ideas of traditional masculinity, where frequent casual sex and a high sex drive are ­normalized and encouraged. However, some gay couples choose to be nonmonogamous in part to reject traditional heteronormative relationship schemas. Monogamous and nonmonogamous same-sex relationships appear to be equally satisfying, and there are no differences between the two in terms of sexual satisfaction, communication, or sexual frequency.

Therapists’ Sexual Orientation In the past, many heterosexual therapists received little education about issues specific to LGB clients and instead pathologized sexual orientation to such an extent that they attributed all their clients’ problems to their sexual orientation. To reduce such bias, matching sexual orientation for LGB clients may result in a more positive therapeutic experience for LGB individuals and couples. However, empirical research has demonstrated that matching sexual orientation does not necessarily lead to a more effective therapeutic experience. In one study,

heterosexual female therapists and LGB therapists were rated by LGB clients as equally or more effective than heterosexual male therapists. Recent research has concluded that clinicians’ helpfulness and effectiveness may be more related to how well they convey sensitivity, awareness, and ­appreciation of LGB issues rather than their sexual orientation or gender. Heterosexual therapists, in particular, should educate themselves about LGB culture and issues to avoid situations where LGB clients would feel the need to educate their therapists.

Therapeutic Approaches and Techniques Recently, as support for same-sex couples has increased and research on mental health disparities among LGB individuals has progressed, new affirmative models of psychotherapy have been developed. This is critical since the LGB population is likely to utilize therapy at higher rates than the general population. Affirmative therapies seek to recognize the unique issues that LGB individuals face and enhance a client’s positive LGB identity development. These therapies foster positive LGB identity development, encourage LGB clients to create a support system of other LGB people, help clients gain awareness about how systematic oppression affects them, reduce and eliminate feelings of shame and guilt regarding same-sex attractions, and give clients an opportunity to express anger or other strong emotions surrounding their oppression. Many traditional couples therapy models are integrated with LGB-affirmative techniques to better serve LGB couples. Relationship education for same-sex couples seeks to improve relationship satisfaction and prevent future distress by teaching clients how to develop a relationship, healthy expectations, and specific relationship skills. Although teaching realistic relationship expectations and effective communication is helpful to all couples, LGB partners face specific challenges that necessitate the alteration of traditional relationship education therapy. To address the challenge of lack of support from family and friends, therapists teach the factors that underlie this difficulty, including societal heterosexism, while also discussing the impact of the lack of support on the couple. Therapists are advised to inquire about challenges regarding the disclosure of sexual orientation and relationship status to

Couples Therapy With Same-Sex Couples

others and to facilitate discussion and negotiation of these topics if they are issues. If there are unrealistic relationship expectations due to a lack of traditional gender role schemas to follow, therapists might clarify the partners’ expectations and contextualize these expectations by discussing the benefits and challenges of not having a heteronormative social script to follow. If discrimination is a problem for the couple, therapists should emphasize caregiving and dyadic coping skills. If the therapist suspects that internalized homophobia is underlying the relationship problems, the therapist is advised to discuss its impact. If a couple is in a nonmonogamous relationship, the therapist should explore whether the partners perceive that they are equally benefiting from nonmonogamy and should discuss, negotiate, and emphasize the importance of abiding by rules regarding sex with other people. Overall, teaching communication skills was shown to be especially effective in improving relationship satisfaction among same-sex couples. For gay and lesbian people suffering from alcohol addiction, behavioral couples therapy was found to be more effective than behavioral individual therapy in reducing the percentage of days of heavy drinking in the year after treatment and in fostering greater relationship adjustment. Additionally, cognitive behavioral therapy may also assist couples with strategies for coping with minority stress. The relational-cultural feminist approach is also effective in treating same-sex couples. This therapeutic approach is especially concerned with power dynamics and emphasizes cultural resistance and subversion of sociocultural oppressive forces. Rather than consisting of a set of procedures, this form of therapy is more of a philosophical stance that stresses egalitarian treatment. The therapy explores oppressive social influences, deconstructing negative societal messages about homosexuality, identifying which of these have been problematic for the couple, and challenging these anti-LGB messages. Such an approach is similar to cognitive therapists challenging irrational beliefs and narrative therapists helping couples externalize the problem. Emotion-focused therapy for same-sex couples treats attachment insecurity and recurring separation distress as the two primary sources of relationship dissatisfaction. This model encourages secure bonding between partners by helping them enhance

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their emotional accessibility and responsiveness to attachment needs. Unique to same-sex couples is that the partners will likely experience stress related to their sexual identities, which can hinder healthy sexual identity development and bonding with others of the same sex. This therapeutic approach combats the effects of this stress through a three-step process. The first step is to assess the impact of heterosexist culture on the couple and de-escalate the cycles of emotion regulation strategies used to protect themselves from heterosexism that underlie relationship conflicts. Next, the therapist helps the couple establish healthier cycles of emotional engagement and regulation. Last, the therapist helps the couple focus on positive sexual identity development. This form of therapy effectively promotes open emotional engagement that helps foster long-term, coherent identity development and integration of sexual and attachment needs for a more satisfying relationship.

Research Directions There is a dearth of peer-reviewed research on specific therapeutic techniques for LGB couples ­ relative to therapeutic techniques for couples in general. More scientifically and clinically rigorous research on distinct therapeutic techniques for LGB couples is recommended. Moreover, much of the research at present focuses on White, middleor upper-class, cisgender, same-sex individuals and couples. More research on LGB couples therapy with an intersectional focus is recommended. Factors such as gender identity, race/ethnicity, socioeconomic class, religion, and ability to interact to create unique life experiences and multiple levels of potential oppression may also be addressed in therapy. Michael Murgo, Alexis Adams-Clark, and Jefferson A. Singer See also Romantic Relationships in Adulthood; Sexual Orientation Dynamics in Psychotherapy; Sexual Orientation Identity

Further Readings Brown, J. (2015). Couples therapy for gay men: Exploring sexually open and closed relationships through the lenses of hetero-normative masculinity and attachment

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style. Journal of Family Therapy, 37, 386–402. doi:10.1111/1467-6427.12053 Fals-Stewart, W., O’Farrell, T. J., & Lam, W. K. (2009). Behavioral couple therapy for gay and lesbian couples with alcohol use disorders. Journal of Substance Abuse Treatment, 37, 379–387. doi:10.1016/j.jsat.2009 .05.001 Frost, D. M., Meyer, I. H., & Hammack, P. L. (2014). Health and well-being in emerging adults’ same-sex relationships: Critical questions and directions for research in developmental science. Emerging Adulthood, 3, 3–13. doi:10.1177/2167696814535915 Green, R. J. (2007). Gay and lesbian couples in therapy: A social justice approach. In E. Aldarondo (Ed.), Advancing social justice through clinical practice (pp. 119–149). Mahwah, NJ: Lawrence Erlbaum. Kurdek, L. A. (2005). What do we know about gay and lesbian couples? Current Directions in Psychological Science, 14, 251–254. doi:10.1111/j.0963-7214.2005 .00375.x Pepping, C. A., & Halford, W. K. (2014). Relationship education and therapy for same-sex couples. Australian and New Zealand Journal of Family Therapy, 35, 431–444. doi:10.1002/anzf.1075 Spitalnick, J. S., & McNair, L. D. (2005). Couples therapy with gay and lesbian clients: An analysis of important clinical issues. Journal of Sex & Marital Therapy, 31, 43–56. doi:10.1080/00926230590475260 Zuccarini, D., & Karos, L. (2011). Emotionally focused therapy for gay and lesbian couples: Strong identities, strong bonds. In J. Furrow, B. Bradley, & S. Johnson (Eds.), The emotionally focused casebook (pp. 317–342). New York, NY: Brunner Routledge.

Criminal Justice System and Gender In the United States, the criminal justice (CJ) system is a social institution designed to prevent crime and protect public safety through the use of strategies that focus on controlling individual behaviors. These strategies rest on criminological and psychological knowledge about criminal offending, including personality, cognitive, and environmental factors that influence involvement in unlawful activities. However, until the end of the 20th century, little attention and effort were directed toward understanding how gender shaped criminal trajectories and CJ responses to law-breaking

behaviors. For the most part, the research that guides CJ practices has been conducted on male offenders, who represent the vast majority of correctional populations (between 85% and 89% in 2013). It has produced information that is not generalizable to girls and women’s psychological and treatment needs as well as pathways to crime. Beginning in the 1980s, the dramatic increase of women and girls under some form of correctional supervision in the United States has called for a greater emphasis on gender sensitivity in the CJ system. This entry provides an overview of how gender may influence legal decisions and the management of offenders; it also highlights the principles of gender responsive programming that aims to prevent further involvement in the CJ system and promote positive psychosocial outcomes for women and girls. Gender here is defined as the social structure that organizes interpersonal relations through processes such as the attribution of context-specific meanings to biological sex differences and the enforcement of gender norms and roles. This entry recognizes that gender is not a universal phenomenon; gendered interactions, norms, and roles vary across cultures, local communities, and social classes.

Gender Blindness in the CJ System Until the 1970s, gender was conspicuously absent from theoretical discussions of criminal offending. From the end of the 19th century to the latter part of the 20th century, theories of crime focused on men’s illegal activities, ignored gender differences in law-breaking behaviors, and failed to consider the presence and unique experiences of women in the CJ system. Up to the 1950s, biological determinism was the dominant model used to explain criminal behaviors: Individuals were born with innate characteristics that predisposed them to a criminal lifestyle regardless of gender. Although they were gender blind, biological theories of crime participated in the reproduction of gender biases in the CJ system, in particular the belief that female offending represented irrational acts, which made women nonliable before the law. Other explanations linked female crimes to women’s promiscuity, rebellion against femininity, and deceitful nature and, thus, supported sexist assumptions about

Criminal Justice System and Gender

women’s thoughts and behaviors. In psychology, behavioral, cognitive, and social learning models also failed to describe how gender influenced men’s and women’s offending: They viewed the acquisition of new behaviors as a process of learning and emphasized the role of rewards and ­punishment, the influence of others as behavioral models, and the importance of cognitions and selfefficacy in the development of criminal conduct. These gender-blind psychological models provided a framework for CJ interventions up to the beginning of the 21st century; they also contributed to the limited consideration of social factors that account for the gender differences in juvenile delinquency and adult crime, including disparities in social and economic resources.

Gender-Related Practices in the CJ System Since the 1970s, feminist research has highlighted the unique aspects of women and girls’ involvement in the CJ system, the social and psychological needs associated with female offending, and the processes that perpetuate gender discrimination in correctional settings. In particular, it has brought attention to the harmful consequences of the CJ system’s emphasis on neutrality and equality. Gender neutrality corresponds to the idea that the same laws are appropriate for both men and women; gender equality refers to the belief that men and women should be treated equally or ­similarly for the same crimes. In fact, scientific evidence suggests that the application of criminal laws in policing and sentencing is often gender biased—that is, based on knowledge derived from the study of male offending and informed by individuals’ personal assumptions about men and women. Chivalry, offense relabeling, and bootstrapping are some of the macro- and microlevel processes that result in gender-related discriminatory practices in the CJ system. The term chivalry describes the view that women are childlike and frail and therefore in need of protection. This view translates into a lenient and paternalistic attitude toward women and girls who commit crimes. Indeed, several studies have found that female and male offenders are treated differently depending on the severity of the offense, their marital and parental status, their welfare needs, and their

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duration of involvement in the CJ system. Specifically, women and girls’ conformity to gender roles and norms may result in greater leniency in sentencing. For example, girls are more likely than boys to receive lesser punishment for minor and first-time offenses; however, girls who are repeat offenders and who commit serious crimes tend to serve longer sentences in residential settings. Differential treatment may also result from individuals’ perception that women and girls are a lesser threat to public safety and from the personal belief that it is the responsibility of the CJ system to protect and remove women and girls from risky situations. These preconceived notions could explain why in the absence of gender-specific community-based programs, juvenile courts decide to incarcerate girls with a history of abuse to prevent further victimization and to regulate their conduct and sexuality. Gender bias together with contextual changes in juvenile delinquency, domestic violence, and drug policies are factors that account for the rising number of women and girls involved in the CJ system since the 1970s. After the passage of the Juvenile Justice and Delinquency Prevention Act of 1974, the arrest rate for girls rose at a faster pace than the arrest rate for boys. According to statistics published by the Federal Bureau of Investigation, there was a 24% increase in the number of girls arrested for simple assaults between 1996 and 2005 compared with a 4.1% decrease for boys. By and large, this gender disparity did not reflect a change in girls’ criminal behaviors but was the consequence of offense relabeling, domestic violence mandatory arrest laws, and bootstrapping. Offense relabeling refers to the reclassification of behaviors from status offenses (e.g., incorrigibility, runaway with parent-child dispute) to violent crimes (e.g., simple assault). Bootstrapping describes the commitment to juvenile detention facilities of status offenders who violate court orders (e.g., breaking curfew). Offense relabeling and bootstrapping have amplified girls’ vulnerability to arrests and confinement because girls are three times more likely than boys to display aggressive behaviors toward family members, which call for the application of domestic violence laws, and to run away from home as a self-defense strategy against interpersonal violence, which may violate the conditions of their probation. Similarly,

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at the peak of the war on drugs in the 1980s and 1990s, new drug policies resulted in the criminalization and incarceration of a disproportionate number of women. The number of women sentenced to prison for drug-related, nonviolent offenses increased by more than 800% between 1986 and 1999. Although women played a marginal and minor role in the drug trade compared with men, they were subjected to the same mandatory minimum sentencing laws and were susceptible to arrests for possession, personal use, and street-level sale of illicit substances. Offender assessment constitutes an additional domain of practice where gender discrimination is reproduced. It involves standardized measures originally designed to evaluate men’s risk of recidivism and to identify the specific factors associated with their involvement in criminal activities. When used with women, these instruments produce results that lead to the overclassification of female offenders as higher risk and their placement under greater levels of supervision than necessary. They also contribute to the neglect of women’s unique mental health needs as relates to their history of victimization, trauma, and substance abuse and family and romantic relationships.

Principles of Gender Responsiveness in CJ To minimize gender bias and to maximize the positive impact of CJ interventions on both men and women, Barbara Bloom, Barbara Owen, and Stephanie Covington have identified six evidencebased principles to increase gender responsiveness in CJ practices. These principles emphasize four essential components of CJ programming for women and girls: (1) awareness and knowledge of gender-specific pathways to crime, (2) an environment that provides safety and promotes self-worth, (3) a relational emphasis, and (4) a comprehensive and integrative treatment approach to women and girls’ social, emotional, and psychological needs. Gender sensitivity depends on the acknowledgment that female offending is largely linked to victimization, substance abuse, and mental illness and that it often represents a strategy for survival. It also depends on the recognition that gender differences in social positioning and privilege may interfere with women’s desistance from crime; these differences include family responsibilities,

relational stress, access to educational and vocational training, employment, and housing. Covington has also highlighted how the conditions of supervision (e.g., separation from children, verbal and sexual assault) may replicate the disconnection and violation women experience in their personal lives, thus exacerbating their trauma. She has advocated for a relational approach to the rehabilitation of female offenders, where personal growth is grounded in the formation of healthy bonds with family, partners, and friends. Since the turn of the century, several treatment models have been developed to respond to the unique needs of women offenders. Among them, Seeking Safety, Forever Free, Beyond Trauma, and Helping Women Recover are listed in SAMSHA’s National Registry of Evidence-based Programs and Practices. Forever Free, Beyond Trauma, and Helping Women Recover were specifically created for correctional adult female populations to target substance- and trauma-related symptomatology. They were tested with ethnically diverse samples and were found to produce generally positive effects on substance use, community reentry, employment, and aftercare treatment retention. Future research should investigate whether these programs produce differential outcomes for culturally and sexually diverse groups of women in the CJ system. It should also examine how different intervention components match women’s racial and ethnic experiences. By contrast, gender responsive programs explicitly designed for delinquent girls continue to be scarce. Multidimensional Treatment Foster Care is the only treatment alternative listed for girls in the Model Program Guide of the Office of Juvenile Justice and Delinquency Prevention. As we progress into the 21st century, it is imperative that future program development fills this major gap. It is also crucial that future research examine whether gender responsive programming contributes to desirable changes at broader levels of CJ organizations, including legal decisions and interactions between correctional staff and female offenders. Despite the awareness that gender makes a difference, few CJ interventions address the possibility that masculinity may have an effect on men’s law-breaking behaviors. This parallels the paucity of studies that investigate the link between masculinity and crime. Although male offenders are

Criminal Justice System and Gender

predominantly represented in correctional research, their gender is seldom the subject of inquiry. The work of James Messerschmidt and Christoffer Carlsson, however, has begun to make visible the role of masculinity in men’s criminal trajectories by defining crime as a resource for performing and achieving manhood, power, economic independence, and self-reliance. It has also produced evidence that the family as a gendered social ­ institution can support men’s desistance from a ­ criminal lifestyle by offering opportunities to accomplish masculinity through the roles of provider, protector, and leader. It is critical that future research evaluate the relation between men’s criminal careers and their endorsement of masculine norms and roles and that it identify the factors that mediate and moderate the influence of masculinity on criminal conduct—in particular, men’s family roles and social bonds. The findings of this research may shed new light on the gendered needs of men in the CJ system and support the development of gender-focused programming for male offenders. Last, U.S.-based advocacy organizations such as the Transgender Law Center, Gay and Lesbian Advocates and Defenders, and the Equity Project have brought attention to the discriminatory practices that transgender, queer, and gender nonconforming individuals experience in the CJ system. According to a report published by the Center for Gender and Sexuality Law at Columbia Law School in May 2014, gender minorities are disproportionately represented in all areas of criminal law, from arrest to adjudication and incarceration. They are often the target of profiling, victim blaming, police misconduct, harassment, and physical and sexual violence during detention. Gender, racial, and sexual biases permeate the CJ system in ways that deprive gender minorities of their basic human rights to safety, humane treatment, and equal protection of the law. Psychological research has begun to identify the unique concerns of transgender, queer, and gender nonconforming people who come into contact with the CJ system. These include access to gender affirming health and mental health care, homelessness, unemployment, and victimization in the community as well as by law enforcement and correctional staff. There is a dire need for further scientific and advocacy efforts aimed at (a) identifying best practices for the management of transgender, queer, and gender ­

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nonconforming individuals in the CJ system; (b) increasing justice personnel’s understanding and acceptance of gender variance and nonconformity; and (c) creating gender affirming environments in diverse legal settings through education and legislation that address the legal and social needs of gender minorities, ensure their right to due ­process, and as a result rebuild trust for law enforcement and justice among transgender, queer, and gender nonconforming communities. Corinne Cecile Datchi See also Criminalization of Gender Nonconformity; Female Sex Offenders; Juvenile Justice System and Gender; Legal System and Gender; Violence and Gender: Overview

Further Readings Belknap, J. (2015). The invisible woman: Gender, crime, and justice (4th ed.). Stamford, CT: Cengage Learning. Bloom, B., Owen, B., & Covington, S. (2005, May). Gender-responsive strategies for women offenders: A summary of research, practice, and guiding principles for women offenders. Retrieved from http://static.nicic .gov/Library/020418.pdf Carlsson, C. (2013). Masculinities, persistence and desistance. Criminology, 51(3), 661–693. doi:10.1111/ 1745-9125.12016 Covington, S. (2007). The relational theory of women’s psychological development: Implications for the criminal justice system. In R. Zaplin (Ed.), Female offenders: Critical perspectives and effective interventions (2nd ed., pp. 135–164). Sudbury, MA: Jones & Bartlett. Datchi, C. C., & Ancis, J. R. (2017). Gender, psychology, and justice: The mental health of women and girls in the justice system. New York: New York University Press. Girls Study Group. (2008, May). Violence by teenage girls: Trends and context. Retrieved from https://www .ncjrs.gov/pdffiles1/ojjdp/218905.pdf Gunnison, E. (2013). Psychological theories and research on female criminal behavior. In J. B. Helfgott & J. R. Meloy (Eds.), Criminal psychology: Vol. 1. Theory and research (pp. 261–298). Santa Barbara, CA: Praeger. Javdani, S., Sadeh, N., & Verona, E. (2011). Gendered social forces: A review of the impact of institutionalized factors on women and girls’ criminal justice trajectories. Psychology, Public Policy, and Law, 17(2), 161–211. doi:10.1037/a0021957

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Messerschmidt, J. W. (2005). Men, masculinities, and crime. In M. S. Kimmel, J. Hearn, & R. Connell (Eds.), Handbook of studies on men and masculinities (pp. 196–212). Thousand Oaks, CA: Sage.

Criminal Justice System Sexual Orientation

and

Lesbian, gay, and bisexual (LGB) people interact with the criminal justice system for a variety of reasons, including community-based interactions with law enforcement personnel (LEP), reporting crimes, being incarcerated after perpetrating crimes, and working in the criminal justice system. In light of the historical discord between LEP and LGB people and ongoing societal discrimination, LGB people may have unique needs when interacting with LEP and criminal justice professionals. Community policing and an emphasis on intercultural communication have increased LGB-specific training for LEP. This entry addresses the historical relationship between LEP and LGB people, LGB people’s perceptions of the criminal justice system, LGB people’s interactions with and needs within the criminal justice system, and efforts to create an LGB-affirming criminal justice system.

Historical Context Historically, there have been tensions between the LGB community and LEP. As a marginalized group in a heterosexist society, LGB individuals often gathered in gay bars to connect socially and politically. In addition to prohibiting same-sex sexual behavior, state and local laws restricted the freedom of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people even to socialize with one another. LEP were tasked with enforcing antigay laws, which often resulted in LEP raiding these gatherings and arresting and exposing LGBTQ patrons. This culminated in the 1969 Stonewall riots in New York City, a historical moment when LGBTQ community members at a gay bar resisted arrest and fought back against the LEP responsible. The Stonewall riots represented a turning point in LGBTQ history, often described as the beginning of the gay liberation movement.

Although Stonewall is the most widely recognized example of LGBTQ people’s resistance of oppressive policing, LGBTQ communities have had a long history of resistance. The 1966 Compton’s Cafeteria protest in San Francisco occurred in response to police raids and arrests of trans* people. The Mattachine Society, formed in 1950 to protect the rights of gay men, printed and distributed “What to Do in Case of Arrest” pamphlets. In the 1970s, groups such as the National Coalition of Black Lesbians and Gays and Dykes Against Racism Everywhere were formed, each including an agenda to address issues surrounding policing of LGBTQ people and people of color. Oppressive policing, and resistance to oppressive policing, is central to the histories of LGBTQ people and other marginalized groups in the United States. This context is important to consider when exploring the current relationship between LEP and LGB people.

LGB People’s Interactions With the Criminal Justice System There are a variety of reasons why LGB people may interact with the criminal justice system, most commonly receiving citations for traffic violations (as well as being a crime victim or witness), being incarcerated for committing crimes, interacting with LEP in public spaces and community events, and working in the criminal justice system. LGB people can be victimized by crimes that may or may not be related to sexual orientation, and they interact with LEP if they report the crime. It has been widely documented that sexual minorities in the United States are victimized by anti-LGB verbal and physical assaults. Within LGBT communities, people of color, undocumented immigrants, transgender people, and gay men are at a disproportionate risk for more severe violence. LGBTQ youth are at a higher risk for school victimization as compared with heterosexual peers. LGB people do not always report experiences of victimization to LEP. In fact, LGB people are often particularly reluctant to contact LEP when victimized by bias crimes. Factors preventing LGB people from reporting crimes include mistrust of LEP; fears that reported crimes will not be taken seriously; concerns that LEP will be dismissive of bias motives; fears that LEP will be hostile, abusive, or

Criminal Justice System and Sexual Orientation

discriminatory; feeling unprotected by LEP; and feeling that the victim had a role in their own victimization. LGB people may also report crimes unrelated to sexual orientation to LEP, such as theft or domestic violence. When reporting crimes unrelated to sexual orientation, there can be factors that uniquely affect LGB people. For example, victims of samesex domestic violence may be reluctant to make a police report due to fears of being outed, not being taken seriously by law enforcement, or confirming heterosexist societal beliefs that same-sex relationships are inherently unhealthy. Although one study found no difference in law enforcement officers’ treatment of domestic violence in same- and mixed-sex couples, the perception of risk combined with societal heterosexism contributes to a climate where same-sex domestic violence remains underreported. LGB people may also interact with LEP in public spaces and at community events, such as LGBTQ Pride celebrations and political gatherings. LGB people’s observations of LEP in public settings may affect their perceptions of LEP. LEP being actively engaged in public can increase positive perceptions and feelings of safety among LGBTQ participants attending the event. LEP intervening in anti-LGBTQ harassment also aids the development of more positive perceptions of LEP. On the other hand, observing mistreatment of LGBTQ people or other marginalized communities in public settings can contribute to negative perceptions of LEP, even if LEP were not on duty. LGB people also may come into contact with LEP and/or the criminal justice system as perpetrators of traffic violations or other crimes. In some cases, LGB perpetrators of crimes are incarcerated. LGB youth are at a disproportionate risk for homelessness due to factors such as family rejection, which can heighten the possibility of interacting with LEP. LGB youth are also more likely than their heterosexual peers to receive school or criminal justice system sanctions for legal transgressions, and sanctions are disproportionately severe for LGB youth. The problem of overrepresentation of LGB youth in the juvenile justice system is particularly evident for girls. In contrast, in one study, adult gay and bisexual men were approximately half as likely as heterosexual men to have an arrest history.

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Incarcerated LGB people may face heterosexism, institutional bias, discrimination, and harassment while in prison. Research shows that sexual minorities are at increased risk for sexual victimization perpetrated by another inmate and sexual abuse by prison staff. Some correctional facilities offer protective custody to prisoners who identify as LGB and feel unsafe in the general population. However, protective custody is often only available in larger, more resourced correctional facilities. Furthermore, gay and bisexual men incarcerated in protective custody face ongoing challenges, such as feeling less supported by jail personnel and heterosexual incarcerated peers. Incarcerating LGB offenders in isolation can also be experienced as a problematic approach to working with LGBTQ people in the criminal justice system, oftentimes leading to increased psychological distress. In general, there is limited empirical knowledge of LGB people’s experiences in the criminal justice system, driven by the infrequency of including sexual orientation when collecting demographic information from arrestees. LGB People’s Perceptions of Law Enforcement

LGB people report variable perceptions of law enforcement. Historical and current problematic relationships between LEP and LGB people can influence LGB people’s negative perceptions of LEP and the criminal justice system. LGBTQ ­people may perceive behavior intended by LEP to be neutral or professional as stern, cold, or indifferent, and lacking safety cues in the context of historical and ongoing discrimination. To offset these negative perceptions and create feelings of safety, LEP may need to particularly demonstrate a warm demeanor and present clear cues that they are nonthreatening when working with LGB community members. LGB people’s experiences with the criminal justice system also affect their perceptions. A recent survey showed that LGBTQ people reported positive experiences when LEP were perceived as warm, professional, and respectful and reported negative experiences when LEP were perceived as rude, demeaning, or judgmental. Perceiving that LEP did their job effectively or efficiently fostered positive perceptions. Negative experiences with LEP were often shaped by perceptions that the

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police abused their power, using excessive force, threats, or harassment. Factors related to sexual orientation or gender identity also affected LGBTQ people’s perceptions and experiences of LEP. Perceptions that LEP treated LGBTQ people differently than non-LGBTQ people or that LEP were uncomfortable with LGBTQ people contributed to negative experiences with LEP. When reporting anti-LGBTQ crimes, LEP downplaying bias motives or blaming the victim contribute to negative experiences, whereas showing concern for LGBTQ people’s safety, attending to the antiLGBTQ aspects of crimes, and demonstrating sensitivity and knowledge about LGB people contribute to positive experiences with LEP. LGB people’s direct or media observations of the experiences of other LGBTQ people and members of other marginalized groups with the criminal justice system may further affect perceptions. Although police raids of LGBTQ gatherings do not occur as frequently or overtly today as they did prior to Stonewall, there are recent examples of police raids and use of excessive force that contribute to LGB people’s negative perceptions of LEP. More than two thirds of transgender Latinas in the Los Angeles area report having been assaulted verbally, physically, and/or sexually by LEP. Observations of or connections with victims of police crimes may negatively affect LGB people’s perceptions of LEP. Learning of the criminal justice system’s mistreatment or abuse of LGBTQ people and other marginalized groups may also affect perceptions. There are many stereotypes of LEP in the United States. Most research on “police culture” is based on the perspectives of predominately White, heterosexual men, showing that LEP are expected to maintain a masculine, authoritative, aggressive, tactically competent, heterosexual, and sexist presentation. However, recent research including a more diverse police force suggests that aspiring LEP are motivated to work in the criminal justice system to perform a civic duty and obtain a secure job. Field training officers describe conscientious and empathic entry-level LEP as highest performing and high-neuroticism LEP as lowest performing. These findings capture a different image of LEP than is traditionally described in accounts of police culture; however, LGB community members’ perceptions of LEP may be based on stereotypes that may be outdated.

Efforts to Improve Relations Between LGB People and the Criminal Justice System Since the early 1990s, LEP have increasingly been trained in multicultural issues to ameliorate the historical tensions between law enforcement and racial, ethnic, sexual, and gender minority communities. This coincides with a shift toward a ­community policing model, prioritizing the development of trusting, collaborative relationships between LEP and community members, particularly communities historically underserved or ­mistreated by LEP. Using this model, police departments have designated LGBTQ liaisons, developed gay and lesbian liaison units, and created mandatory LGBTQ sensitivity training programs. One study showed that a brief training workshop resulted in LEP reporting increased self-efficacy in working with LGBTQ community members and greater objective knowledge of LGBTQ issues. Further evaluation showed that the LEP were able to generate LGBTQ-affirming policing tactics in hypothetical situations. Additional evaluation is needed to determine whether each of these efforts to create an LGBTQ-affirming police force is effective in creating positive behavioral change in LEP. Training in LGBTQ issues is also needed in the broader criminal justice education system. Research has shown minimal coverage of LGBTQ issues in criminal justice textbooks and curricula, and few criminal justice education programs offer specialized coursework in hate crimes. This is important to note given the findings that criminal justice students reported more negative, homophobic attitudes and being more disapproving of lesbian and gay communities than non–criminal justice majors. Possibilities for improving relations between LGB communities and criminal justice professionals through the criminal justice education system include partnering with LGBTQ studies programs, offering specialized coursework in LGBTQ issues and hate crimes, and integrating LGBTQ issues into required courses. The criminal justice system may also improve relations with LGB people through the process of hiring and retaining LGB employees, which has been an increased priority of police departments in recent decades. For example, a study of the San Diego Police Department found that increased

Criminal Justice System and Transgender People

hiring of self-identified gay and lesbian LEP did not result in their harassment or discrimination, or difficulties in the work environment. At the same time, research has identified ongoing challenges for gay and lesbian LEP, such as subtle discrimination and exposure to anti-LGB behaviors, difficulty gaining promotions and receiving fair evaluations, social isolation, heightened risk for disciplinary action, and ongoing fears of a negative response after coming out in the law enforcement w ­ orkplace. Researchers continue to call for law enforcement to address these structural barriers to including and retaining LGB LEP.

Future Directions LGB people interact with the criminal justice system for a variety of reasons. Although relations between LGB people and LEP are improving, there are continued possibilities for bolstering a more trusting relationship, particularly given their historically tenuous relationship. Further research is needed to determine the effectiveness of existing and future strategies for strengthening the relationship between LEP and LGB communities. Tania Israel and Audrey Harkness See also Criminal Justice System and Gender; Criminal Justice System and Transgender People; Criminalization of Gender Nonconformity; Criminalization of Transgender People; Hate Crimes Toward LGBTQ People; Juvenile Justice System and Gender; Legal System and Gender; Sodomy Laws

Further Readings Belkin, A., & McNichol, J. (2002). Pink and blue: Outcomes associated with the integration of open gay and lesbian personnel in the San Diego Police Department. Police Quarterly, 5(1), 63–95. doi:10.1177/109861102129198020 Gillespie, W. (2008). Thirty-five years after Stonewall: An exploratory study of satisfaction with police among gay, lesbian, and bisexual persons at the 34th Annual Atlanta Pride Festival. Journal of Homosexuality, 55(4), 619–647. Goodman, J. A., Israel, T., Avellar, T. R., Ledbetter, J. N., Harkness, A., & Delucio, K. (2013, August). Capturing LGBTQ positive and negative experiences with and perceptions of law enforcement. Poster

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presented at the American Psychological Association Annual Convention, Honolulu, HI. Guadalupe-Diaz, X. (2013). An exploration of differences in the help-seeking of LGBQ victims of violence by race, economic class and gender. Gay and Lesbian Issues and Psychology, 9(1), 15–33. Israel, T., Harkness, A., Avellar, T. R., Delucio, K., Bettergarcia, J. N., & Goodman, J. A. (2016). LGBTQaffirming policing: Tactics generated by law enforcement personnel. Journal of Police and Criminal Psychology, 31(3), 173–181. Israel, T., Harkness, A., Delucio, K., Ledbetter, J. N., & Avellar, T. R. (2013). Evaluation of police training on LGBTQ issues: Knowledge, interpersonal apprehension, and self efficacy. Journal of Police and Criminal Psychology, 29(2), 57–67. doi:10.1007/ s11896-013-9132-z Mallory, C., Hasenbush, A., & Sears, B. (2015). Discrimination and harassment by law enforcement officers in the LGBT community. Los Angeles: University of California, Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/ uploads/LGBT-Discrimination-and-Harassment-inLaw-Enforcement-March-2015.pdf Wolff, K., & Cokely, C. (2007). “To protect and to serve?” An exploration of police conduct in relation to the gay, lesbian, bisexual, and transgender community. Sexuality & Culture, 11(2), 1–23. doi:10.1007/ s12119-007-9000-z

Criminal Justice System Transgender People

and

Transgender people experience a constellation of criminal justice issues in the United States. Transgender has been conceptualized as an umbrella term to describe a range of gendered identities and experiences for people who do not identify with the gender that they were assigned at birth. With regard to the criminal justice system, transgender people experience substantial incarceration and violence-related criminalization rates. A number of legal barriers have an impact on criminal justice issues for transgender people in the United States, such as identification and inadequate access to health care. Socio-structural barriers, as situated in intersectional oppression, also influence the experience of the criminal justice system, including

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criminalization, for transgender people. This entry explores the role that the criminal justice system plays in the lives of transgender people in the United States.

Incarceration Rates for Transgender People There are limited government data that document incarceration rates for transgender people. However, recent national surveys have examined the incarceration-related experiences of transgender people. According to the U.S. Department of Justice, more than 2 million people are incarcerated in federal, state, and local jurisdictions in the United States, while 0.91% of the general U.S. population have a reported history of incarceration. Recent data from Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, a national survey of 6,436 transgender people in the United States, observed that approximately 16% of, or 1 in 6, transgender people have experienced incarceration during the course of their lifetime. The report also noted that transgender people of color are disproportionately affected by high incarceration rates as compared with the overall transgender community. For example, rates of lifetime incarceration history were 47.0% for Blacks and 25.0% for Latino/as. In addition, the report noted greater lengths of incarceration periods among Black transgender people, as compared with the overall transgender community, based on the following time points: 6 months to 1 year, 1 to 3 years, 3 to 5 years, 5 to 10 years, and 10 or more years. At the same time, the report noted significant disparities related to the length of time of incarceration of less than 6 months, in that the rate for Black transgender people was 81.0% compared with 47.0% for the overall transgender community.

Violence-Related Criminalization Rates for Transgender People The Injustice at Every Turn report surveyed respondents with respect to police-related harassment, physical violence while in jail or prison, and sexual violence while in jail or prison. The rate for police harassment for the overall transgender community was 22.0%; the police harassment rate was 38.0%

for Black transgender people and 23.0% for Latino/a transgender people. Sixteen percent of the overall transgender community reported physical violence while in jail or prison, while 33.0% of Black and 21.0% of Latino/a respondents reported this occurrence. Fifteen percent of the overall transgender community indicated experiencing an act of sexual violence while in jail or prison, as compared with 34.0% of Blacks and 24.0% of Latino/a respondents. Furthermore, Black (47.0%) and Latino/a (47.0%) transgender people reported elevated rates of disrespectful treatment by the police as compared with the overall transgender community. In particular, Black transgender people reported the highest rates (41.0%) of arrest or incarceration due to bias as compared with the overall transgender community. Fifty-three percent of transgender people reported verbal harassment or disrespect within the context of public accommodations. With respect to criminal justice issues, transgender people reported being harassed or disrespected by police officers (29.0%) and the judge or court officials (12.0%); 20.0% reported being denied equal treatment by police officers, and 12.0% indicated being denied equal treatment by the judge or court officials. Transgender communities have often been targeted through ­ hypersurveillance and profiling by law enforcement agencies based on the intersection of socioeconomic, racial, and gender identity indicators (i.e., low income, non-White, and gender identity/ expression, respectively).

Legal Barriers for Transgender People A multitude of legal barriers have an impact on criminal justice issues for transgender people. Legal status affects many facets of the lives of transgender people, such as identification. The Injustice at Every Turn report indicated that only 21.0% (approximately one fifth) of those respondents who had transitioned were able to change their identification documents based on their new gender identity. Identification in the form of government documents, such as birth certificates, may influence relevant criminal justice issues for transgender people. Transgender people who are incarcerated often have been placed in correctional facilities based on their birth sex or biological genitalia rather than their gender identity or ­

Criminal Justice System and Transgender People

expression. For example, the New York State Department of Correctional Services maintains that incarcerated individuals be identified by their birth name rather than their chosen name, which may be commensurate with their gender identity. Male-to-female transgender people (i.e., transgender women) typically will be placed in men’s ­correctional facilities, while female-to-male transgender people (i.e., transgender men) often will be assigned to women’s correctional facilities. ­Transgender people have often been subjected to emotional, physical, and sexual violence in these correctional facilities from inmates and correctional staff because of these mis-gendered placements. People who experience gender transition, the process of shifting or moving from one gender to another gender, during the period of incarceration have complex challenges related to correctional placement and subsequent harassment and abuse. As such, human rights violations are commonplace in correctional facilities, although the Matthew Shepard Act, passed by Congress and signed by President Barack Obama into law in 2009, broadened the scope of hate crimes to be inclusive of gender, sexual orientation, gender identity, and disability. Another major legal barrier that influences criminal justice issues for transgender people involves access to health care during the period of arrest or incarceration. Transgender people have inadequate access to hormonal therapy and care (e.g., physical and mental health care) while under arrest or incarceration. Delays in or acute ­termination of hormonal treatment may have an adverse impact on the health status of transgender people. Transgender people have been denied access to treatment and care by correctional staff due to gender bias and stigma. Transgender people who experience complex health care problems often may have their conditions worsened due to inadequate health care access. Transgender people who have histories of trauma (e.g., due to sexual violence/rape), incarceration, commercial sex work, and drug abuse are at a higher risk of acquiring or transmitting sexually transmitted infections such as HIV. HIV-related care for transgender people may be suboptimal while under arrest or incarceration. Before arrest or incarceration, transgender people may have been administered nonprescribed hormones by non–health care providers, which

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may place them at higher risk for HIV. The Injustice at Every Turn report observed that Black and Native American (30.0% and 36.0%, respectively) transgender people are more likely to be denied hormone treatments during arrest or incarceration than the overall transgender community.

Socio-Structural Barriers and Criminal Justice Issues for Transgender People Intersectional oppression has been conceptualized by Kimberlé Crenshaw as overlapping inequalities based on power differentials in society vis-à-vis race, gender, social class, and so on. Intersectional oppression has had an impact on the experience of the criminal justice system for transgender people. Intersectional oppression reinforces stigma, marginalization, and structural inequalities for transgender people (e.g., the intersection of institutional forms of racism, misogyny, transphobia, and homophobia). The Injustice at Every Turn report contended that these intersectional domains serve as core socio-structural barriers for transgender people, which corresponds to their experience of the criminal justice system. First, discrimination based on anti-transgender bias, particularly for transgender people of color, often intersects with poverty (e.g., inequities based on income, education, and employment). The Injustice at Every Turn report noted that transgender people are approximately four times (15.0%) more likely to experience extreme poverty (i.e., household income less than $10,000 per year) than the general U.S. population (7.0%). In particular, Black transgender people showed elevated poverty (i.e., 38.0% earning less than $10,000 per year). In relation to employment status, while 14.0% of the overall transgender community were unemployed, 28.0% of Black transgender people and 18.0% of Latino/a transgender people were unemployed. Based on housing status, 19.0% of the overall transgender community reported being homeless, compared with 41.0% for Black transgender people and 29.0% for Latino/a transgender people; the overall rate of homelessness for the general U.S. population was 7.4%. These socio-structural findings from the Injustice at Every Turn report illuminate the multifaceted role that structural oppression in social, economic, legal, political, and educational

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Criminalization of Gender Nonconformity

systems plays in the lives of transgender people, which provides a relevant context for understanding the complexities of the criminal justice system.

Implications for Policy Policy initiatives are urgently needed to address the problems embedded in the criminal justice system for transgender people. The fundamental task of addressing macrolevel legal barriers to health ­outcomes for transgender people needs to be considered (e.g., access to health care, including ­prevention). Prevention specialists need to design, implement, and evaluate structural-level interventions that focus on strengthening treatment and care, access to health care and health care utilization, and access to health insurance. The development and implementation of federal legislation are fundamental to addressing human rights violations in the criminal justice system, in addition to advancing the enforcement of legislation such as the Matthew Shepard Act. Policies need to incorporate socio-structural domains (e.g., poverty, racism) in addressing criminal justice issues, in ­ addition to the development of programs for criminal justice personnel that address bias and profiling and promote gender-based inclusion. ­Furthermore, there is a need to develop systems to track the number of transgender people who experience arrest and incarceration in federal, state, and local jurisdictions as a basis for strengthening community outreach services. Empirical investigations are needed to assess the social, mental health, physical health, education, employment, and legal needs of transgender people. Leo Wilton See also Coming Out Processes for Transgender People; Criminal Justice System and Transgender People; Gender Nonconformity and Transgender Issues: Overview; Trans*; Transgender People; Transgender People and Violence

Further Readings American Psychological Association. (2006). Incarcerated transgender people. Retrieved from http://www.apa .org/monitor/mar06/jn.aspx Crenshaw, K. (2014). The structural and political dimensions of intersectional oppression. In P. R.

Grzanka (Ed.), Intersectionality: A foundations and frontiers reader (pp. 16–21). Boulder, CO: Westview Press. Currah, P., Juang, R. M., & Minter, S. P. (2006). Transgender rights. Minneapolis: University of Minnesota Press. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, H., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

Criminalization of Gender Nonconformity The criminalization of gender nonconformity refers to the policing of adherence to expected gender norms at individual, interpersonal, and institutional levels and the association of violating those norms or identifying as genderqueer or nonbinary with criminal misconduct. Although the reason why gender nonconforming individuals are criminalized for their gender identities and presentations has not yet been explored by research, it can be assumed that the ambiguity and the tendency for humans to categorize people into in- and outgroup dyads may be one mechanism through which this discrimination operates. A tendency to criminalize or pathologize that which is unknown is characteristic of heteronormative cultures. This entry briefly discusses the association between gender nonconformity and criminal behavior, the intersectional nature of criminalizing gender nonconformity, and the cycle of discrimination and criminalization.

Discrimination and the Criminalization of Gender Nonconforming Bodies While research on the mechanisms through which stereotypes emerge and criminalize gender nonconforming bodies is limited, some researchers and scholars in sociology, psychology, and law offer both evidence and implications for this ­phenomenon. The vast majority of the discussion has been in the context of lesbian, gay, bisexual, transgender, queer (LGBTQ), and gender

Criminalization of Gender Nonconformity

nonconforming youth, as they face high rates of homelessness compared with their heterosexual/ cisgender peers due to family rejection and bullying and violence from family, peers, and law enforcement. Recent research suggests that ­gender nonconforming youth receive disproportionately harsh punishments in schools and the criminal legal system that is not accounted for by higher rates of participation in illegal activity. This has led scholars to propose a schoolto-prison pipeline that perpetuates poor psychosocial functioning and quality-of-life outcomes later in life. Those in the transgender and gender nonconforming communities have coined the phrase “walking while trans,” a variant of “driving while Black,” which reflects the frequency with which gender presentation is the sole reason why individuals are stopped by law enforcement officers. In fact, prior to June 2013, in New York City, law enforcement officers were able to use possession of condoms as evidence of prostitution—a policy that was disproportionately applied to transgender and gender nonconforming individuals who were wrongly arrested for engaging in sex work. There are also stereotypes of individuals with a more masculine gender presentation as violent, and those who present as more androgynous or nonbinary as deceptive or guileful. Some gender nonconforming individuals have been required to register as sex offenders or engage in treatment for sex offending even if their crime was not a sex offense. In addition to discrimination by law enforcement, including discrimination within the court system that may lead to sex offender status or increased sentences, gender nonconforming individuals face harsh measures within the U.S. prison system. First, sex assigned at birth is most often the criterion for determining prison placement. For individuals whose gender identity or gender presentation is not aligned with the sex they were assigned at birth, being placed in a prison that is incongruent with their identity can be traumatic and even life threatening, as violence and rape are more common experiences for LGBTQ inmates. Furthermore, gender nonconforming inmates may be placed in solitary as a “solution” to the problem of violence, which may have significant mental health consequences.

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Intersectionality It is important to note that gender nonconformity does not exist in a vacuum, and intersections between gender presentation and other identities significantly affect the likelihood of being targeted. Those who do not subscribe to the gender binary are more likely to be viewed or assumed to be criminal if their gender nonconforming identity intersects with being a person of color or a person of low socioeconomic status. In particular, transgender women of color and nonbinary people of color whose gender presentation is more feminine are subjected to street harassment, are stereotyped as sex workers, and experience disproportionate rates of violence even in comparison with other LGBTQ groups. It is likely that those who identify as both gender nonconforming and as a person of color are more prone to experiencing discrimination in the form of criminalizing normal behavior or having assumptions made regarding their criminal status.

The School-to-Prison Pipeline and the Cycle of Criminalization For gender nonconforming youth, experiences of discrimination based on their gender presentation or rejection of the gender binary can have consequences that affect vital aspects of their lives. The discrimination they face may be from peers or instructors at school, their families, or police officers, among others. Gender nonconforming youth are more likely to miss school, to leave or be forced to leave their home of origin, and to be homeless for some period of time. As a result, they may incur higher rates of truancy charges, loitering, or noise violations and are noted to be cited more often for consensual, age-appropriate sexual encounters. Scholars have proposed the existence of a schoolto-prison pipeline for gender nonconforming and LGBTQ youth, characterized primarily by the lack of safety nets and social services equipped to deal with the unique needs of this population, higher rates of suspension and expulsion of LGBTQ students, and zero-tolerance policies. Restricted access to employment, competent and gender affirming health care, housing, and education as a by-product of discrimination leads some gender nonconforming individuals to engage

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Criminalization of Men of Color

in survival behavior, which is often seen as a last resort. Survival behavior borne of desperation, such as sex work, selling illegal drugs, theft, or other criminal acts, may lead to incarceration, which in turn further impedes access to the very services associated with reduced options in the first place (e.g., health care and education). Reacting with punitive measures to criminal behavior ­conducted in the context of institutional, interpersonal, and systemic discrimination may not fit the needs of this population and may have the ­counterproductive impact of increasing recidivism and hindering successful community reintegration following incarceration. Kristin C. Davidoff See also Criminal Justice System and Transgender People; Gender Expression; Gender Nonconforming Behaviors; Gender Nonconforming People; Heteronormativity

Further Readings Hunt, J., & Moodie-Mills, A. C. (2012, June 29). The unfair criminalization of gay and transgender youth. Washington, DC: Center for American Progress. Retrieved from https://www.americanprogress.org/ issues/lgbt/ report/2012/06/29/11730/the-unfaircriminalization-of-gay-and-transgender-youth/ Johnson, J. R. (2013). Cisgender privilege, intersectionality, and the criminalization of CeCe McDonald: Why intercultural communication needs transgender studies. Journal of International and Intercultural Communication, 6, 135–144. doi:10.108 0/17513057.2013.776094 Mogul, J. L., Ritchie, A. J., & Whitlock, K. (2011). Queer (in)justice: The criminalization of LGBT people in the United States. Boston, MA: Beacon Press.

Criminalization

of

Men

of

Color

The criminalization of men of color in the United States is connected to multilayered, systemic f­ actors involving marginalization and structural inequalities. Paying specific attention to the contemporary incarceration for men of color in the United States, this entry explores the public discourse about criminalization, inequities in incarceration rates,

and the structural contexts of incarceration for men of color.

Public Discourse About Criminalization of Men of Color There has been extensive public discourse about the pervasive criminalization of men of color in the United States. In 2015, The New Yorker featured the case of Kalief Browder, a 22-year-old African American male who had been falsely imprisoned and subjected to solitary confinement, violence, and abuse during his teenage years at the Rikers Island Correctional Facility in New York City. Browder reported that he experienced multiple instances of traumatic abuse and dehumanization, such as starvation, physical violence from correctional staff, and mice infestations in his solitary confinement quarters. Browder was arrested for allegedly taking a backpack and was held at Rikers Island for 3 years without a trial. Following a number of suicide attempts in the midst of recovering from this ongoing trauma after his release, Browder subsequently committed suicide by hanging at his home. The Browder case reflects one of the most egregious recent illustrative accounts of the criminalization of men of color and racialized inequities in the criminal justice system in the United States. Importantly, the Browder case has been reflective of the culmination of a multitude of recent cases of criminalization involving males of color in the United States. For example, in 2015, Ahmed Mohamed, a 14-year-old Sudanese Muslim high school male student in Texas, experienced racial profiling and Islamophobia when he was arrested for bringing an assembled clock to school; he was accused of constructing a bomb. In 2014, the City of New York reached a settlement of $41 million to a group of five African American and Latino men who were criminalized in a case that later became known in the media as the Central Park jogger case. In 1988, the young men were charged with the sexual assault of a White woman, an investment banker, who was jogging in Central Park. The men established a legal case against the city of New York based on malevolent legal actions, racial discrimination, and emotional trauma. In 2012, the case of Trayvon Martin spurred a national outcry and advanced the Black Lives

Criminalization of Men of Color

Matter movement. This movement has been conceptualized as a human rights grassroots response to the experience of state-sanctioned structural violence by Black communities. Trayvon Martin, an African American male high school student, was racially profiled and murdered in Florida while he was walking home from the store. Shortly thereafter, multiple well-publicized occurrences of the criminalization and murders of Black boys and men, including Eric Garner, Michael Brown, Tamir Rice, and Freddie Gray Jr., occurred in cities across the United States. The New York City Police arrested Eric Garner in Staten Island for allegedly selling loose cigarettes, whereby he was placed in an illegal choke hold, causing him to experience severe difficulties in breathing; Garner died as a result of the choke hold procedure. Michael Brown, a young African American man, was killed by White police officers for allegedly taking store merchandise in Ferguson, Missouri. Baltimore police officers arrested Freddie Gray Jr., a 25-year-old African American man, for allegedly concealing a switchblade; he died as a result of ambiguous spinal cord injuries in a police van. Tamir Rice, a 12-year-old African American male, was shot and killed by two White police officers while playing with a toy pistol in a park in Cleveland, Ohio; the police officers were not indicted. In 2016, there were two high-profile cases of the police killing Black men, which occurred within a 2-day span; this resulted in further outrage across the country. One main difference with these cases was that two videos of the incidents were shared instantaneously through social media and the Internet. In Baton Rouge, Mississippi, Alton Sterling was killed by police officers after he was accused of selling CDs outside a local market. The police officers shot Sterling multiple times, from just a few inches away from his body, while Sterling was already face down on the ground. The event was caught on videotape by a bystander and went viral in a few hours. The next day, in Falcon Heights, Minnesota, Philando Castile was killed by a police officer after being stopped for a broken taillight. Though he informed the officer that there was a gun in his glove compartment, the officer shot him. Diamond Reynolds, a female passenger in the car, posted a live video on Facebook immediately, describing to the world what had transpired; this video also reached thousands of people

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immediately. The occurrence of both these cases within a short span of time resulted in national news attention and protests across the United States. These recent cases can be linked to key sociohistorical and political contexts of the criminalization of men of color in the United States. For example, during the 1930s, the case of the Scottsboro Boys involved nine African American youth who were accused of raping White women on a train in ­Alabama. The racialized nature of this case, including the violation of legal rights (e.g., racially ­homogeneous White juries, legal irregularities in protocol, hostile and obtrusive mobs of White people), has been cited as a heinous illustration of the criminalization of African American male youth and the problematic racialized injustices that have been indicative of the U.S. legal system. Another well-cited case was that of Emmett Till, a 14-year-old African American male who was murdered by White men for allegedly flirting with a White woman in Mississippi in 1955. These historical cases provide a relevant milieu for understanding the complexities of the criminalization of men of color within the context of macro- and microlevel inequalities in the United States.

Incarceration Rates for Men of Color The United States has the highest incarceration rate in the world, at 716 per 100,000 of the U.S. population. According to the U.S. Department of Justice, in 2013, approximately 1,574,000 people were in state and federal prisons, which reflected an increase of about 4,300 prisoners from the previous year. Based on these data, Black men (37.0%) represented the highest imprisonment rate for male inmates in state and federal prisons, as compared with Latinos (22.0%) and White men (32.0%). In 2013, about 3% of Black males in the United States, irrespective of age, were incarcerated, as compared with 0.5% of White men. In 2014, according to the U.S. Department of Justice, approximately 3% of Black males and 1% of Latinos had been sentenced to at least 1 year in prison, in comparison with 0.5% of White males. Drugsentencing disparities based, in part, on mandatory minimum sentencing have also been noted for Black men, although substance use rates have been lower among this population. In 2013, a study

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conducted by the Pew Research Center indicated that Black men were about six times more likely to have been incarcerated in federal, state, and local jurisdictions. Incarceration rates for Asian American/Pacific Islander men have been underestimated due to limited research design and methodological approaches, such as measurement and sampling procedures, misclassifying racial/ethnic groups, and not disaggregating data on Asian Americans/ Pacific Islanders with the collection and reporting of within-group data among this population. In 2015, a report by the Southeast Asia Resource Action Center, AAPIs Behind Bars: Exposing the School to Prison to Deportation Pipeline, observed that incarceration rates for Asian American/Pacific Islanders increased fourfold during the period from 2000 to 2010, with Southeast Asians and Pacific Islanders experiencing higher rates of incarceration. Furthermore, in relation to sexual orientation, racial disparities in incarceration rates have also been observed for Black men who have sex with men (MSM) in the United States. MSM refers to gay, bisexually, or heterosexually identified men who engage in male-to-male sexual behavior. In 2014, as reported in the American Journal of ­Public Health, researchers from the HIV Prevention Trials Network 061 study of Black MSM in six U.S. cities (n = 1,521) indicated that 60.0% (n = 914) of the sample reported a history of incarceration.

Structural Disenfranchisement and Criminalization Men of color have experienced criminalization based on a system of mass incarceration in the United States. This system of mass incarceration has involved structural disenfranchisement or hierarchical systems of oppression (e.g., legal, political, education structures at the macrolevel) that have produced racialized inequalities in the criminal justice system. Building on this framework, Angela Davis contends that the prison-industrial complex has been formulated based on the premise that there are common interests of government and private industry. These common interests involve imprisonment (i.e., the privatization of punishment) as a basis to remedy social problems in society (e.g., homelessness, unemployment, poverty).

The prison-industrial complex has been reinforced based on an ideological framework that negatively constructs marginalized or disenfranchised communities. Davis asserts that one of the core racialized images for men of color, for example, has been based on the idea of criminality and deviance. These racialized images of men of color as lazy, negligent, violent criminals have been fortified by mass media. Parallel to the prison-industrial complex, research has shown the emergence of the school-toprison pipeline. The school-to-prison pipeline has been conceptualized as the interface between the criminal justice system and the educational system. The intersection of these two systems has been contingent on educational practices such as zerotolerance policies (e.g., rigid discipline–based educational policies), policing in schools (e.g., arrests), racial profiling, discriminatory school discipline policies, and out-of-school suspensions. Research has indicated that males of color experience disparate rates of criminalization in educational contexts. For example, studies have found that Black male preschool students have higher suspension and expulsion rates than male students from other racial/ethnic backgrounds. Research has also demonstrated that Southeast Asian male students have been subjected to ongoing criminalization in educational contexts. One study found that Cambodian and Laotian youth had higher incarceration rates. Another study showed that Southeast Asian male students were more likely to experience deportation based on criminalization practices. Leo Wilton See also Criminal Justice System and Gender; Criminal Justice System and Sexual Orientation; Criminal Justice System and Transgender People; Criminalization of Gender Nonconformity

Further Readings Black Lives Matter. (n.d.). Black Lives Matter: Not a moment, a movement. Retrieved from http:// blacklivesmatter.com/ Davis, A. Y. (2012). The meaning of freedom: And other difficult dialogues. San Francisco, CA: City Light Books. Gonnerman, J. (2015, June 7). Kalief Browder, 1993–2015. The New Yorker. Retrieved from http://

Criminalization of Transgender People www.newyorker.com/news/news-desk/kalief-browder1993-2015 Miller, J. A. (2009). Remembering Scottsboro: The legacy of an infamous trial. Princeton, NJ: Princeton University Press.

Criminalization People

of

Transgender

The criminalization of transgender people can be defined as the process or context in which the actions, behaviors, and characteristics of people who appear transgender or gender nonconforming (TGNC) are classified as criminal. This often occurs through discriminatory interpretation and enforcement of the law. A certain behavior may be classified as criminal or illegal for all people; however, through discriminatory policing and ­ application of legal statutes, TGNC citizens are disproportionately arrested, prosecuted, and incarcerated for such crimes. In addition, because of other types of discrimination against transgender people, TGNC individuals are more likely to come into contact with the police and the criminal justice system. The following entry addresses how the discriminatory enforcement of laws and administrative policies as well as the behaviors of actors in the justice system contribute to the criminalization of transgender people. This includes the criminalization of public gender nonconformity, the legal and social consequences of nonaffirming identity documents, and the economic factors associated with a TGNC identity.

Social Elements of the Criminalization of Transgender People In a predominantly cisgender society, individuals are expected to pass as a classic representation of a single binary gender category in order to avoid harassment and discrimination. When they do not pass as a single gender, transgender people encounter resistance from societal and legal forces, which increases the likelihood that their actions and presence will be policed and criminalized. The criminalization of transgender people is important to

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gender and psychology because it exemplifies how culture polices the expectations and rules for enacting gender in public spaces. Transgender people are not bound by the common notions of gender identity and instead demonstrate individualized embodiment of their gendered traits. Social acceptance of the alienation of transgender people indicates to other members of society that there is no punishment for expressing disapproval, showing disgust, or committing acts of public humiliation against transgender people. The type of social outrage that has typically provoked social change and demands for equality for other minority groups has been absent for individuals who identify as TGNC. This communicates a message that transgender people are less than human and, in some senses, less deserving of civil rights than cisgender people. Other social elements that contribute to the criminalization of transgender people include ignorance about aspects of trans life such as culture, personality, mental health, and other lifestyle factors. Citizens who have very little contact with a trans identified person may be unaware of the physical, mental, social, and economic needs or lives of TGNC people. This gap in public information prevents active social opposition to the criminalization of transgender people.

Civil Elements of the Criminalization of Transgender People Laws that prohibit discrimination against minority groups have helped communicate to citizens and agencies that the specific groups of minorities are in need and worthy of protection and equal treatment. The civil structure, including laws and guidelines, of many societies has, however, provided limited protection from discrimination and the subsequent criminalization of transgender people. This lack of protection and equal treatment has been identified for other minority groups and has resulted in some changes that provide a better chance of equality for the members of those minority groups. Civil structures have shifted throughout history to provide better protections for minority groups. However, with some groups, previous civil structures that contained discriminatory laws leave artifacts such as pervasive poverty and criminalization of members of those groups. These systems slowly change, but criminalization

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is one element of inequality that takes longer to repair than other elements.

Criminalizing Public Gender Nonconformity The legal aspects of discriminatory social and civil structures leave transgender people vulnerable to misconduct by law enforcement officers. The police misconduct has taken many forms, including disparate enforcement of misdemeanor crimes such as loitering, public urination, disturbing the peace, and health code violations. These crimes are usually the result of profiling transgender people as criminal. As a result of profiling, officers write tickets, which in turn require transgender people to go to court or to pay fines through administrative offices. Police also profile TGNC people for crimes, such as prostitution, that have more serious legal consequences than misdemeanor crimes. For example, many trans women have described what amounts to systematic harassment by police officers; this is also known as “walking while trans.” Law enforcement officers will often state that they are responding to public reports of “a suspicious person” or that they suspect the trans woman of prostitution. Other elements of “walking while trans” involve reports of transgender people being stopped by police officers while walking in their own neighborhood, traveling to and from medical or social appointments, and even standing at bus stops waiting for public transportation. Police profiling is known to produce higher levels of anxiety, fear, and even anger within individuals belonging to the profiled group. Transgender people who have not experienced police profiling, but are aware of the pattern of profiling of transgender people, may still experience negative mental health consequences. Profiling of transgender people also increases the likelihood that passersby will believe that individuals who are gender nonconforming should be suspected of criminal activity. Even transgender children experience policing of their public gender nonconformity, albeit in noncriminal ways, by school administrators. Schools may have administrative policies that prohibit TGNC children from appearing gender ­ nonconforming on school property and at organized events. School administrators have also forbidden TGNC children from using appropriate

gender-segregated restrooms that match their ­gender identity. These TGNC children are characterized as breaking the rules and are sometimes punished through administrative means (i.e., ­suspended from school or prevented from participating in social events like prom). Thus, trans ­children experience a nonlegal form of criminalization by living as the gender with which they ­identify or by presenting in a gender nonconforming manner at school. Many transgender people have expressed the distress associated with using gender-segregated public restrooms. Again, if they are not passing as a single sex, cisgender people in their vicinity may complain to management or the police about their use of the wrong restroom. This can lead to involvement of legal authorities and to police requests for government-issued identification from the TGNC person to confirm that they are in fact the gender for whom the restroom has been designated. Transgender persons who are accused of using the wrong restrooms have been charged with misdemeanor crimes such as disturbing the peace and trespassing. These misdemeanor charges are typically dismissed when the TGNC person arrives at court; however, the arrest and the interaction with police officers still serve to criminalize the transgender person.

Criminalization Associated With Identity Documents Typically, when police officers profile and subsequently stop people, they will request a form of legal identification. If the name, gender, or gendered appearance on the identification does not match that of the transgender citizens, the officer will question them about the legitimacy of their presence or intentions in the location where they were stopped. Affirming identity documents ­provide a form of security for trans people, who can then offer valid identification on request in public settings. The legal processes and medical requirements for obtaining affirming identity documents prevent many transgender people from obtaining the standard federal or state-managed forms of identification. U.S. states vary in their requirements for name and gender changes on birth certificates, social security records, and driver’s licenses. Transgender individuals who are

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financially secure may not have trouble affording access to physicians who can provide the gender dysphoria diagnosis and treatment and evidence of “real-life experience” that must precede legal changes in identity documents. However, the existence of this process, and the existence of obstacles during the completion of this process, creates a dynamic where, initially, the transgender citizen’s gender identity is not legally recognized. This lack of legal recognition creates another situation where transgender identity and gender nonconforming appearance are in conflict with the law. The value of these identity documents for legal legitimacy extends beyond criminal profiling by law enforcement. The absence of affirming identity documents can complicate many common life events. In that sense, administrative policies within social and public infrastructure have contributed to the criminalization of transgender people. Transgender people often encounter problems when trying to get access to legal identification (i.e., driver’s license, social security number, and birth certificate) that corresponds with their gender identity. In addition to everyday use, these government-issued documents are required to obtain important things that provide financial stability, like housing, bank accounts, and employment. Having incompatible identification can pose problems in casual interactions with salespersons and servers when using a credit card or providing identification for agerestricted activities like purchasing cigarettes or alcohol. In these situations, transgender persons may have their identification, method of payment, or themselves physically detained until they can provide information to explain the discrepancies between their gender presentation and their legal identification documents.

sleeping or loitering is prohibited. Homelessness often leads to interactions with the police and citations or arrests for infractions related to what public policies describe as “quality-of-life” crimes. Quality-of-life crimes such as loitering, disorderly conduct, and disturbing the peace can be vaguely interpreted and leave room for police officers to use their discretion in enforcing the law. Police officers disparately enforce the laws governing quality-of-life crimes, such that cisgender individuals may receive a warning, without a formal citation, but transgender and gender nonconforming people who come into contact with the police under identical circumstances may not receive the same type of leniency. The criminalization of transgender people is also closely related to their financial health and economic limitations associated with their TGNC identity. Sometimes, it may be their gender nonconforming appearance and, at other times, it could be the lack of affirming identity documents that negatively affect a trans person’s ability to obtain and keep legal employment with an abovepoverty-level income. To maintain a livable wage, some transgender people may commit what some sociologists have classified as survival crimes. Survival crimes like drug dealing and sex working allow people to obtain money, shelter, or physical protection in lieu of legal, self-supporting employment opportunities. Thus, when options are l­ imited by the social and legal climate, illegal employment is the most expedient way of gaining access to food, shelter, clothing, and other benefits of financial independence. Survival crimes may provide inconsistent and unreliable forms of income, which can involve periods of homelessness or unsafe ­living situations for transgender people.

Criminalization Associated With Economic Limitations

Other Circumstances Associated With Criminalization

The criminalization of transgender persons also occurs because of other types of discrimination that they experience. Employment and housing discrimination has affected the trans community tremendously as many have lost jobs and housing because of their transgender identity or their gender nonconforming appearance. Housing discrimination leads to homelessness, which can in turn lead to sleeping in public or private spaces where

There are many other circumstances related to the criminalization of transgender people. For example, limited access to health care and discrimination on the part of health providers or insurance companies can lead some transgender people who seek hormonal methods of gender affirmation to purchase these drugs from illegal sources, thus breaking the law to get one form of medical care that is integral to their mental health and well-being.

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Critical Race Feminism

Another example relates to how transgender women housed in prisons with cisgender men are at risk for victimization in the form of verbal, physical, and sexual assault. To prevent contact between transgender women and cisgender men housed in a men’s prison, these correctional facilities place transgender women in administrative segregation “for their own protection.” Administrative segregation is a form of solitary confinement and serves to indirectly punish the transgender prisoners. The impact of the criminalization of transgender people is evident in the consequences associated with being arrested, serving time in jail or prison, and having a criminal record because of profiling. Many public and government-subsidized housing developments are critical of new applicants who have criminal records, especially applicants with a history of arrests or convictions for drug-related crimes. This further limits access to a stable housing environment for transgender people who have experienced both employment and housing discrimination. Second, transgender people who are concerned about police officers profiling them for and arresting them under the suspicion of sex work have reported carrying fewer or no condoms to prevent harassment from law enforcement. This entry has reviewed a few of the many ways in which transgender people are criminalized, including through administrative polices and infrastructure, social discrimination, and discriminatory policing. These social and civil factors increase the likelihood that transgender people will come into contact with law enforcement or be perceived as criminals by other, non-TGNC citizens. Societal policing of gender nonconformity and gender identity is compounded by limited financial options, all of which contribute to the criminalization of transgender people beginning as early as childhood and through adulthood. Alexis Forbes See also Cisgender; Gender Identity; Gender Nonconforming People; Transgender People

Further Readings Davis, M., & Wertz, K. (2012). When laws are not enough: A study of the economic health of transgender people and the need for a multidisciplinary approach to economic justice. Seattle Journal for Social Justice, 8, 467–495.

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Taylor, J. K. (2007). Transgender identities and public policy in the United States: The relevance for public administration. Administration & Society, 39, 833–856. doi:10.177/0095399707305548

Critical Race Feminism Critical race feminism (CRF) refers to a multidisciplinary theory developed to highlight and address the legal concerns of women of color (i.e., women of African, Asian, Latin, Middle Eastern, and Native American descent). CRF takes into consideration the intersections of race, class, and gender in understanding the experiences of women of color, thus attending to the unique needs of this population. This theory has contributed to an increased attention in certain fields, including education, psychology, criminology, and law, to the plight of women of color. This entry defines CRF, briefly describes the theories from which CRF originates, emphasizes Black feminism as key to the development of CRF, and finally provides a summary of CRF’s tenets.

CRF Defined Women of color, whether in the United States, Europe, or developing countries, are disproportionally represented at the lower end of most social, political, and economical spectrums. As such, critical race feminism, a term first introduced by Richard Delgado, seeks to acknowledge and identify issues pertaining to women of color around the world. CRF, using a multidisciplinary approach and pulling from fields such as law, education, sociology, history, and psychology, also seeks to develop appropriate solutions to the issues concerning women of color. To define CRF, it is important to acknowledge the theories from which CRF was developed, including critical legal studies, critical race theory, and feminist jurisprudence.

Critical Race Feminism

Theories Critical Legal Studies

Critical legal studies, which was developed in the late 1970s, emphasizes a progressive approach to understanding of the law by critiquing both conservative conventions and liberal ideals. ­Critical legal studies posits that the law has been developed and continues to be implemented in a manner that benefits the wealthy while subordinating the poor. Additionally, critical legal studies rejects the idea that individuals are autonomous, possessing full agency over their choices and the environment. Rather, critical legal studies explains that the constraints associated with the varied statuses held in society due to class, race, and gender identities (among others) influence the opportunities that individuals are provided and the choices that individuals make. Thus, the lives of members of society are determined by their circumstances and the social and political forces that shape those circumstances. Critical legal studies employs a deconstruction methodology utilized by postmodernists, such as Michel Foucault, to uncover how the law propagates and maintains race, gender, and class inequalities. CRF seeks to challenge the notion that the law is neutral, objective, and determinate and moves beyond some of critical legal studies’ tenets to particularly focus on the perspectives and experiences of women of color. Critical Race Theory

Critical race theory emerged as a challenge to traditional legal strategies that sought to provide adequate social and economic justice to marginalized individuals. Some of critical race theory’s original tenets can be traced to the work of D ­ errick Bell, a Harvard law professor, in the mid-1970s. Critical race theory stresses a social construction approach to race, which posits that although biological races do not exist, race and race relations are socially constructed and enforced by the legal system, thereby creating a societal hierarchy that elevates some racial groups while devaluing others. Critical race theory posits that racism is core to U.S. society. Thus, in critiquing the U.S. legal system, critical race theory emphasizes how the law can perpetuate White supremacy and in the p ­ rocess subordinate people of color. Acknowledging that

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class plays an important role within society and presents with its own unique set of concerns for impoverished communities, critical race theory recognizes the additional concerns underprivileged communities of color face due to the combination of their race and class. To promote societal change, critical race theory rejects the notion of colorblindness and advocates for a racially conscious approach to social and political change. In addition, critical race theory highlights a multidisciplinary approach to creating solutions for society’s racial problems, by drawing from fields such as political science, history, economics, women’s studies, and anthropology. Consequently, critical race theory engages with issues of hate speech, voting rights, affirmative action, and immigration law. Critical race theory appears to adopt an essentialist ideology, referring to the commonality of experiences among all oppressed groups. On the other hand, critical race theory distinguishes between these experiences of oppression, highlighting that the concerns of individuals sharing the same identity marker (e.g., gender, race, class) may vary, warranting different solutions targeting the unique needs of each population. Critical race theory also utilizes a narrative or storytelling to expose differing perspectives on oppression in order to connect with individuals who may not understand technical legal terminology. This type of methodology draws its roots from the historical oral tradition of communication associated with some racial minorities, where important societal notions are communicated and passed down from generation to generation. Similar to critical race theory, CRF also denounces color blindness within the law and promotes color consciousness. CRF may utilize the narrative methodology often found in critical race theory. Furthermore, CRF endorses critical race theory as key for conceptualizing racism and ultimately promoting racial justice. Critical race feminists believe in developing and applying concrete solutions to the problems of disenfranchised communities.

Black Feminism CRF draws on feminism as a way of highlighting the experiences of women of color, when these experiences may be assumed by some CRT literature to be similar to those of men of color. CRF

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mirrors feminism’s emphasis on gender oppression in a patriarchal system, while simultaneously employing a racial lens to women’s experiences and feminist discourse. As such, CRF draws from Black feminism and womanism, as exemplified in the work of Audre Lorde, Patricia Hill Collins, bell hooks, and Alice Walker, for instance. Black feminism represents an important component of CRF theory and practice. Black feminism contends that Black women are discriminated against based on their race, gender, sexuality, and class. Because of the interaction between and among each of these identity markers, Black feminism highlights the position Black women hold within society. This position relegates Black women to a lower status compared with many of their White counterparts. The Combahee River Collective, representing a group of Black lesbian f­ eminists, issued a groundbreaking document stemming from their meetings from 1974 to 1980. This document, the Combahee River Collective Statement, became a defining manuscript in shaping contemporary Black feminism. The Combahee River Collective Statement sought to define and declare what Black feminists believed and provided a description of their political work. In their collaborative work in developing this key document, Black feminists emphasized the varied types of oppression Black women encounter that mainstream feminism overlooked. CRF advocates denounce mainstream feminism’s lack of emphasis on White supremacy and its role in perpetuating oppression toward women of color. CRF distances itself from mainstream feminism due to its essentialization of all women, which effectively erases the unique experiences of women of color. Mainstream feminism has been guilty of universalizing the experiences of middleclass White women. In rejecting the mainstream feminist notion that an essential female voice exists (meaning that there are specific fundamental attributes that represent the “essence” of all women), CRF adopts the concept of anti-essentialism, asserting that the experiences of women of color do not fit into an essentialist norm. Because of the varied and diverse lived experiences of women of color, CRF proponents advocate for a more intersectional approach from which to understand and conceptualize the experiences and needs of women of color.

Kimberlé Crenshaw popularized the term intersectionality, an anti-essentialist concept that serves to promote a critical consideration of the plight of women of color by looking at the complex intersection of their multiple identities. Intersectionality highlights the idea that one’s race cannot be isolated from one’s gender, class, nationality, sexuality, and other identity markers. Rather, it is important to consider all identities to better understand one’s experiences. Particularly, the experiences of Black women and other women of color are inextricably tied to the other identities they hold. Therefore, intersectionality presents as an essential tool for CRF to highlight differing perspectives and deepen understanding. Similarly, Adrien Katherine Wing, a CRF scholar, utilizes the term multiplicative identity, explaining that when multiplied together, the different identities of women of colors come together to create a “holistic One.” This multiplicative identity, then, allows for better understanding of the discrimination perpetuated against women of color. Thus, Black feminism provides a lens through which to witness the unique racialized, gendered experiences of Black women in U.S. society.

Tenets CRF’s tenets draw on critical legal studies, critical race theory, and Black feminist theory to identify issues specific to women of color and articulate appropriate solutions. CRF concerns itself with the experiences of women of color and emphasizes how such experiences differ from the experiences of White women, men of color, and White men. With a focus on anti-essentialism, CRF highlights the multiple identities of women of color, identities that must be considered when addressing their distinctive concerns. Using an intersectional lens, CRF seeks to address the varying types of oppression that women of color experience due to their race, class, and gender. Furthermore, while utilizing a multidisciplinary approach and drawing from various fields, CRF emphasizes both theory and practice working to dismantle the racial and gendered oppression that women of color face. Suzette L. Speight and Myriam Kadeba See also Black Americans and Gender; Feminism: Overview; Feminist Psychology; Intersectional Theories; Race and Gender

Cross-Cultural Differences in Gender

Further Readings Collins, P. H. (2000). Gender, Black feminism, and Black political economy. Annals of the American Academy of Political and Social Science, 568, 41–53. Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299. doi:10.2307/1229039 Delgado, R., & Stefancic, J. (2012). Critical race theory: An introduction. New York: New York University Press. Evans-Winter, V. E., & Esposito, J. (2010). Other people’s daughters: Critical race feminism and Black girls’ education. Educational Foundations, 24(1), 11–14. Wing, A. K. (Ed.). (2003). Critical race feminism: A reader. New York: New York University Press. Wing, A. K. (2015). Critical race feminism. In K. Murji & J. Solomos (Eds.), Theories of race and ethnicity: Contemporary debates and perspectives (pp. 162–179). Cambridge, England: Cambridge University Press.

Cross-Cultural Differences in Gender In discussing gender classification across various cultures, it is important to pay particular attention to the socially and culturally constructed nature of gender. Gender classification is intertwined with other constructs such as sex assigned at birth, ­gender identity, and gender roles. Without understanding the cultural backdrop, it is difficult to understand how gender is defined, shaped, and experienced by the members of a specific society. Gender has served as a category in basing behavioral expectations on individuals within a cultural system. Certain cultures believe in gender binary, with two gender categorizations, whereas others may believe in gender plurality, where there are more than two gender categories in a particular society. Various constructs such as an individual’s sex assigned at birth, one’s self-identification (gender identity), gender roles and expectations, and cultural, societal, and legal contexts/parameters constitute gender within a particular culture. Subsequently, gender categorization defines the ­ allocation of power, rights, and resources to members of a society.

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Most cultures currently construct their societies based on the understanding of gender binary—the two gender categorizations (male and female). Such societies divide their population based on biological sex assigned to individuals at birth to begin the process of gender socialization. While this process is rather universal, there are some cultures and societies that consider gender from a nonbinary perspective, and they have more than two gender categories. Such a perspective is called gender pluralism. This entry examines genderbinary societies and societies where gender plurality is accepted and encouraged, as well as the impactions these concepts have on the understandings and applications of human rights.

Gender Binary A gender binary exists in most Western cultures, where people are identified male or female at birth and gender socialization along with self-­ identification and adherence to the assigned sex shape one’s gender identity as either male or female. Western cultures only started closely examining the idea of a third gender in the 1970s, acknowledging that there are individuals who may not self-identify as either male or female. Gender binary societies have gone through some changes in the past few decades in understanding individuals who may not identify themselves with the sex given to them at birth, do not identify as either male or female, or identify as asexual or third ­gender, genderqueer, or gender nonconforming. Gender binary societies range widely in the extent to which third gender, transgender, and gender nonconforming individuals are accepted, acknowledged, and supported by their respective societies and their law. The term third gender refers to individuals who may identify themselves with neither or both genders or are independent of both gender groups that exist in a gender binary society. There are other terminologies, such as pangender, bi-gender, genderqueer, androgyny, intergender, and X-gender. Distinctions of these terminologies from one another are often culturally and context dependent. For example, in Japan, a distinction has been made between transgender and X-gender. The term transgender was at first used to refer to any individuals who felt discomfort in identifying with a gender identity associated with the sex assigned

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to them at birth. However, the introduction of X-­gender allowed for individuals who identify as neither men nor women to be separately identified from transgender individuals, who often identified with a gender identity opposite to the sex assigned at birth. While this distinction may be made within the subculture of gender nonconforming people in Japan, the larger Japanese society still continues to operate under a gender binary system. While these terminologies have been coined in an attempt to reference individuals’ gender identity appropriately, and in turn their lived experience, discrimination against gender nonconforming individuals continues to exist in gender binary ­ societies. Moreover, while there are countries that guarantee basic equal rights for men and women, sexism and wage gaps between men and women remain. They are examples of gender disparities between male and female as well as the reluctance to accept gender nonconforming individuals.

Examples of Gender Binary Societies Gender binary societies range from countries and cultures that are striving toward acceptance of a third gender both culturally and legally to those that have resisted gender equality between men and women. In Argentina, the Gender Identity and Health Comprehensive Care for Transgender People Act in 2012 provided transgender individuals the rights that many such individuals are not able to have anywhere else. For example, individuals can now request their recorded sex, first name, and image to match their self-perceived gender identity without having to undergo any surgeries or mental health diagnoses, to live continuously for any length of time in a gender role matching their gender identity, or to end their marriage as a ­ precondition for legal gender recognition. These ­ conditions still exist in many countries if transgender individuals were to go through a procedure to change legal documentations to match their gender identity. In other countries, such as Afghanistan and Saudi Arabia, due to both cultural and religious reasons, women are not provided with equal rights in comparison with men. While religion certainly has an influence on this matter, the strictness of gender roles and inequality against women in these two cultures are not fully due to the teaching of the

Koran. It has been noted that the teachings of the Koran acknowledge and value the different roles men and women play in the society; however, the restriction of rights for women seems to be supported more by cultural values. Furthermore, as modernization influences both these cultures, some changes have been noted. In 2011, Lynn L. Manganaro and Nicholas O. Alozie conducted research using a national probability sample of 6,593 adult Afghans and found that Afghan women are more liberal than Afghan men and that they are interested in securing basic rights. Education has played an important role in women’s attitudes regarding gender roles. As women become more educated and exposed to various perspectives, it is likely that attitudes toward advocating for their rights will change.

Gender Plurality Some non-Western cultures have traditionally ­supported the existence of third gender individuals and regarded them as a sacred gender. Such ­individuals were recognized and revered for their ability to communicate with a higher power and function as mediators between humans and the gods. They fulfilled critical roles in courts and ­religious ceremonies. While their gender identity and gender expressions varied, many of them were often believed to be intersex or male bodied. ­During precolonialism, third gender individuals’ position in the society seemed to be quite secure, without any legal rights, due to their prominent role in the religious and spiritual aspects of everyone’s life. Michael G. Peletz, Nora Alarifi ­ Pharaon, and Saskia E. Wieringa, to name a few researchers, believe that colonization affected these gender ­ pluralistic societies, causing third gender individuals to lose their spiritual roles and positions of prestige.

Examples of Gender Plural Societies The Bugis in Indonesia have five gender categories in their society: (1) male, (2) female, (3) calabai, (4) calalai, and (5) bissu. Bissu are known as the keepers of the sacred royal ornaments, and one becomes a bissu through a supernatural calling. Unlike calabai and calalai, bissu have ­ ambiguous gender and sexual statuses. Calabai are

Cross-Cultural Differences in Gender

male-bodied individuals who dress as females and fulfill female roles. Their relationship partners are often males. They are highly visible in their society and perform marriage ceremonies. Unlike calabai, calalai are less visible in the society, and they do not perform ceremonies. They are female-bodied individuals who fulfill male roles. Their relationship partners are often females. While traditional ceremonies were on the decline post-colonialism era, the regional autonomy of Indonesia has allowed for a revival of such ceremonies, where bissu and their sacred roles have been more protected than those of the calabai. Bissu’s ambiguous genders and sexual statuses allow them to navigate with the other genders (particularly as holders of the sacred ornaments). Because these ornaments are necessary for communion, their roles are highly appreciated. In Samoa, there are three gender categories: (1) male, (2) female, and (3) fa’afafine. A literal translation of fa’afafine being “in the manner of a woman,” they are identified as male at birth, and their gender expression ranges from extremely feminine to masculine. However, it is more typical for fa’afafine to be more effeminate in their appearance and mannerisms. Fa’afafine are highly accepted by their families and Samoan society. They are traditionally known for taking a more female gender role, participating more in household chores and child rearing. Thus, it has been believed that fa’afafine may hold unique transgender role expectations for themselves and also live with such expectations as are placed on them. However, research results have been mixed regarding such expectations. Western cultural values have influenced Samoan society and how they view fa’afafine, and discrimination against them does exist in their society.

Human Rights Movement As societies, both gender binary and gender plural, shifted their perspectives in defining and understanding gender, laws and regulations were not providing legal rights or protections to gender nonconforming individuals. Gender binary societies have had rigid gender structures that accommodate only men, or men and women. Gender plural societies have not had a formal structure to specifically protect gender groups that are not

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male or female, and as their society became more Westernized, gender nonconforming individuals ­ started to suffer. To ensure rights for transgender, third gender, and gender nonconforming people, there are two conditions that need to be met. One is individuals’ ability to obtain and/or change their legal documents without difficulty to match their gender. The other is for them to be able to change their gender status by their self-identification of gender, without the need for documentations, medical procedures, mental disorder diagnoses, or an undertaking that their current gender identification will be permanent. This last point is of particular importance since as a social and cultural construct, gender as a construct/identity is fluid in nature and requiring an assurance that their gender identity is permanent seems unreasonable. The Yogyakarta Principles on the Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity, developed in 2006, provide guidance to countries on related human rights issues and legal standards. The Yogyakarta Principles have since functioned as ­ guidelines as various countries strove to make changes in human rights laws in relation to sexual orientation and gender identity. As mentioned previously, Argentina, with the Gender Identity and Health Comprehensive Care for Transgender People Act in 2012, has been considered exemplary in advocating for equal rights for gender nonconforming people. This has largely to do with the fact that many other countries, while they are continuing to make changes, still require transgender individuals to obtain medical documents and/or ­ mental disorder diagnoses, dissolve their marriages, live continuously in their self-identified gender, and go through medical procedures to have their legal documents changed. All of these requirements may get in the way of gender nonconforming individuals obtaining legal documents that match their gender. Moreover, without legal documents that represent them fully and accurately, transgender individuals may not have access to certain rights, such as marriage, health care, voting, employment, and enrollment to the education system. While obtaining legal rights is separate from gaining social power or respect within their communities, not having documentations or encountering difficulties in changing legal documentations

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can strip individuals of access to rights, care, and resources that have been guaranteed to all people in most cultures. As various countries make changes in their human rights laws related to sexual orientation and gender identity, human rights activists, sexual orientation activists, and gender identity activists are working collaboratively to advocate for equal rights for gender and sexual orientation minority individuals. Yuki Okubo See also Cross-Cultural Models or Approaches to Gender; Cultural Competence; Cultural Gender Role Norms

Further Readings Manganaro, L. L., & Alozie, N. O. (2011). Gender role attitudes: Who supports expanded rights for women in Afghanistan? Sex Roles, 63, 516–529. Open Society Foundations. (2014). License to be yourself: Laws and advocacy for legal gender recognition of trans people. New York, NY: Author. Peletz, M. G. (2006). Transgenderisms and gender pluralism in Southeast Asia since early modern times. Current Anthropology, 47, 309–340. Peletz, M. G. (2011). Gender pluralism: Muslim Southeast Asia since early modern times. Social Research, 78, 659–686. Peletz, M. G. (2012). Gender, sexuality, and the state in Southeast Asia. Journal of Asian Studies, 71, 895–917. Pharaon, N. A. (2004). Saudi women and the Muslim state in the twenty-first century. Sex Roles, 51, 349–366. VanderLaan, D. P., Petterson, L. J., Mallard, R. W., & Vasey, P. L. (2015). (Trans)gender role expectations and child care in Samoa. Journal of Sex Research, 52, 710–720. Wieringa, S. E. (2010). Gender variance in Asia: Discursive contestations and legal implications. Gender Technology and Development, 14, 143–172.

Cross-Cultural Models Approaches to Gender

or

Inherent in the concept of gender is its sociocultural construction. Where a person is born may be the most important question in discerning who they will become, including how they will

conceive, express, and socialize others into a gender. Basically, culture matters. Socialization of gender starts at birth and continues throughout the life span. While variations in approaches to and forms of gender are found across cultures, socialization for gender roles is ubiquitous—so much so that learned roles are often seen as natural and expected. However, decades of psychological and anthropological research has helped us understand different approaches to gender crossculturally, with patterns both across and within cultures becoming better understood. This entry highlights the theory that directs views of gender and culture and gender stereotypes; reviews some of the larger cultural influences, including religion, social structure, and broad psychological variables, that affect and predict gender outcomes; and summarizes the more intimate cultural influences on gender, including family, peers, and schools. This entry concludes with an example of how gender is affected by the organization of a culture.

Theoretical Positions on Gender and Culture One assumption about gender shared by many cultures is that only two genders exist: male and female. Ethnographic research has debated this dichotomy. Among the Lakota Native American Indians, the term berdache is widely used to describe third and fourth genders. The male berdache is biologically male but takes on the characteristics of both women and men in appearance and manner. Historically, the berdache preferred to care for children and make clothing instead of becoming warriors. They were respected and held sacred positions in communities, maintaining the highest status among all of the genders. In Southeast Asia, gender fluidity has been an integral part of culture and history. In January 2015, Thailand added a third gender (kathoey) to their constitution in efforts to provide equal rights and protection for all genders. Other examples exist in the Balkans, India and Pakistan (hijras), Indonesia (kuta), and Mexico. The roles of both biology (nature) and socialization (nurture) have been established in the research on gender. Gender development theories fall broadly into these two categories, biology or the environment, or a merger of both.

Cross-Cultural Models or Approaches to Gender

Biological Perspectives

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Biological and physiological differences exist in males and females (chromosomes, hormone production, reproductive capacity, brain structure and function), and scholars endorsing a biological perspective believe that these are directly and indirectly linked to observed differences in cognition, behavior, and even gender roles. Twin and adoption studies conclude that genes are contributors to differences in cognition and social behavior as well as to gender-related behavior, but there is still much variability to be accounted for. The strongest evidence for links of sex hormones to cognition has shown that prenatal exposure to male hormones (androgens) is associated with enhanced special skills and male gender role behavior in women. Critics of the biological theory of gender differences point to the correlational nature of most findings and how results can often be used to justify the inferior status of women cross-culturally.

sex differences in behavior. In fact, their findings have been among the most convincing in displaying the importance of culture on gender development. In the Six Cultures Study (India, Kenya, Mexico, Okinawa, the Philippines, and the United States), different settings, social agents, task assignments, and interactions with parents, peers, ­siblings, and unrelated others affected the genderrelated behaviors. Several consistent gender ­differences were found. Boys demonstrated more aggression and dominance, and girls demonstrated more nurturance. At first read, this might appear to contribute to the universalistic view of gender; however, it was the task assignment in different cultures—girls assigned to domestic tasks and ­sibling caregiving, which elicited nurturance, and boys assigned to tasks like herding with same-age peers, which elicited egotistical dominance—that predicted these gender differences. The differential treatment of boys and girls was most markedly observed in societies where men and women did not share equal status.

Socialization and Learning Perspectives

Cultural Psychology

From before birth, individuals are socialized into their particular culture and taught values, beliefs, and behaviors that will help them reach adulthood and function successfully in the given context. In this process, gender is socialized, and children learn to conform to roles that the cultures deem consistent with their biological sex. Girls are rewarded for displaying behaviors that are desirable for a woman in the culture and discouraged from gender-inappropriate behavior. A parallel process exists for boys. In addition to direct reinforcement and punishment, children are observing adult role models and imitating same-sex peers toward gender-appropriate behavior. For example, social role theory posits that the differences in gendered behavior between men and women is a function of the different roles that each hold in the society. It focuses on social conditions (i.e., division of labor) more than on the specific ways in which individuals behave. Culture becomes increasingly important in understanding how gender functions. Seminal work by John and Beatrice Whiting and Carolyn Edwards examined childhood across cultures, hypothesizing that the differing environments of men and women contribute to

Cultural psychology is an interdisciplinary field that offers an understanding of how culture and psyche make up each other. Delineated by Richard Shweder, cultural psychology holds the position that few characteristics of our psyche are h ­ ardwired and fundamental such that their developmental pathway is fixed and not amended by culture. Gender can be viewed as edited by culture. Differences in our world derive from the material, social, and cultural conditions in development. Each culture has its own ideas of the world that combine beliefs and morals that give meaning to gender. Departing from the question of universal human nature, cultural psychology focuses on a way of life, value sets, and what makes work and life meaningful.

Gender Roles and Stereotypes Research into gender stereotypes has been conducted in more than 30 countries with more than 3,000 individuals. When people were asked to identify a list of adjectives associated with men or women, high levels of consensus existed both within and across cultures. Examples of adjectives

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associated with men included adventurous, determined, assertive, and stern; adjectives associated with women included emotional, gentle, kind, and anxious. In fact, scholars were so struck by the consensus that some believed that the results suggested that there may be a psychological universal when it comes to gender stereotypes. Other domains like favorability, strength, and activity of the traits have been investigated. There was a congruence where the traits associated with men were classified as stronger and more active. Alternatively, cultural differences in favorability were found. For example, in Japan and South Africa, male characteristics were deemed more favorable, but in Italy and Peru, female characteristics were viewed more favorably. Self-concept was explored by asking the respondents to rate the adjectives as descriptors of themselves as they are or as their ideal self. Men and women in all countries rated the ideal self as more masculine than their actual self. In essence, they were saying that they wanted to have more traits traditionally associated with males. In summary, there is considerable, perhaps even universal, consensus among cultures in terms of what kinds of psychological characteristics best define males and females. But despite these ­similarities, there are also considerable cultural differences in the degree to which each culture believes in these differences as a mark of what is favorable.

Macroenvironmental Influences Macrolevel cultural factors make up the learning environment of any child and affect how gender is thus socialized and internalized. Macrolevel factors have not always received due attention from psychologists. Urie Bronfenbrennor helped the field visualize how culture might matter at each level of development. Macrolevel factors include how societies are structured physically as well as socially and psychologically. A macrolevel psychological variable like individualism and collectivism shapes gender. Individualistic cultures are characterized by practices and customs that encourage people to prioritize their own goals ahead of ­collective goals and emphasize ways in which the individual is distinct from others. Collectivistic cultures promote practices, institutions, and customs that encourage

people to place relatively more emphasis on collective goals than on individual ones. Prior research has suggested that regardless of the culture women have more ­ collectivistic identities and men have more individualistic identities. In more nuanced research that compared collectivism, agency, assertiveness, and relatedness, only relatedness seemed to be found in women cross-culturally, whereas agency and assertiveness were found more in Western cultures regardless of gender and collectivism was found more in Eastern cultures regardless of gender. Social structure affects gender differences and sex role choices. When comparing patricentric societies, which center on the father (families live next to the husband’s family, and descent is through the father) with nonpatricentric societies (families live next to either family, and descent is through both mother and father), patricentric societies show more salient gender differentiation. While children in patricentric societies mostly choose same-sex roles and culturally specific, ­gender-based tasks, the Newar of Nepal, although patricentric, decrease the preference for same-sex roles with age. Newar women have a somewhat higher status than is typically found in patricentric societies (e.g., they control money, can divorce and remarry), which provides evidence for how a shifting social structure affects gender development. Status and economic resources affect gender development. Research suggests that as a country’s gross domestic product decreases, patriarchal values increase quickly. Across cultures, as women engage in the economy, more equitable gender norms arise. Other factors have also been correlated with egalitarianism. One variable that has a large impact on gender perception is the percentage of people in a region who embrace a particular religion. Countries with large populations of ­Protestants are related to egalitarianism, whereas countries with large populations of Muslims are related to more traditional gender views. Location has also been linked to egalitarianism. More northern hemisphere countries express higher levels of egalitarianism, and more southern hemisphere countries express lower levels of egalitarianism. Similarly, the more urbanized the country, the higher the level of egalitarianism. For immigrant communities who straddle the invisible line between culture of origin and culture of

Cross-Cultural Models or Approaches to Gender

habitation, the egalitarian values of the dominant culture pertaining to career opportunities, traditional gender roles, and decision making may seem negligent. However, in the Somali immigrant community in the United States, women within the community often describe themselves as much more empowered than their male counterparts. A religious cultural adage follows: “If you seek advice, first ask your mother. If you don’t understand, ask your mother again. For further instruction, ask your mother for the third time. If you still don’t understand, ask your father.” The mother holds three times as much wisdom and power as the father within the household. Women are typically expected to raise the children and maintain the home, but outside employment is also supported. These nuances of power within a marginalized status often go unrecognized.

Microenvironmental Influences While macrolevel cultural variables influence gender development, it is the family and home that significantly socialize the younger child. Thus, parenting styles are culturally specific and shape gender development. Reinforcement, role models, and approval and disapproval by significant adults encourage a gender identity that is congruent with the larger society and culture. These microlevel influences interact with factors like social structure to create variant gender differentiation. For example, in complex, stratified societies like China and India, a strong preference for sons exists. More expensive sweets are eaten at the birth celebrations of sons than of daughters, and although both births are occasions to celebrate, it is a practice that begins a pattern of gender privilege. Research has found that in the United States, in families where at least one son is present in the family, fathers invest increased time in leisure activities. Siblings are also active socialization agents in the development of gender identity. One study published in 2000 found that the presence of an older brother was related to both masculinization and de-feminization of both girls and boys. The presence of an older sister, however, was related to feminization but not de-masculinization in boys, but not feminization in girls. Thus, the presence of a same-sex older sibling creates more sex-typed

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behaviors in the younger sibling compared with single children. With whom children spend their days also affects gender socialization and is a function of cultural norms. The degree of peer influence is variable across cultures, genders, and types of societies. In traditional societies, children are usually around children of multiple ages. In industrialized societies with mandatory schooling, children spend their days with same-age and sometimes same-sex peers. Referred to as the “social dosage affect” (influence of peers), children who spend more time with same-sex peers are more affected by peer influence. Peers affect gender socialization by both reinforcing and undoing stereotypes. Cross-­cultural research with preschool children shows that peers reprimand, tease, and taunt other children for using gender-inappropriate language more than mothers do. In more religiously conservative societies, where religious leaders and/or spiritual text dictate behavior, peer influence may never be as strong as it would be in an individualistic, critical thinking– based culture. For example, Somali adolescents experience the universal sexual maturation and angst of the teenage years, but their daily routines and choices are less variable. The Somali mother focuses on instilling physical health, obedience, resourcefulness, helpfulness, and hard work. The fear of becoming an outsider in a collectivist culture is greater than the pressure a friend could impose. Peer pressure occurs less frequently in general because of a hierarchical power structure in the home; yet when it does occur, it often involves high school males, who have fewer familial or domestic duties and more free time since employment is not yet required. This has been an increasingly salient concern among Somali immigrants in the United States. Young teen males are more susceptible to gang membership. Schools are important contexts for gender socialization and the reinforcement of a hegemonic culture. School settings have been characterized as creating “two cultures” that fragment boys and girls and segregate play. Research from urban India documents a hidden curriculum that brings out the gender code found in the larger society. Boys and girls are segregated for assemblies, homework has a girl side and a boy side to be done only by the appropriate gender, roll call is taken

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separately, and girls clean and dust the school and boys run errands and carry furniture.

Essentialized Gender Scholars have also been interested in people’s perceptions of how “essential” each gender is considered. An essentialized gender reflects an underlying unchangeable essence—one that has less flexibility in expression and less social approval if deviation occurs. The essentialized gender is also correlated with more power within the culture. The United States provides a good example. Most Americans do not find it disturbing if females present more masculine traits (wearing pants, having short hair) or participate in stereotypically male activities (playing with boy’s toys or typically male sports like basketball or hockey). The female role is more flexible, which suggests that the male role in the United States is essentialized. Many people living in the United States do find it unusual and more deviant if a male is wearing female clothes and makeup or engaging in female activities (boys playing with dolls or taking dance lessons). Conversely, in South Korea, women are the essentialized gender. Men can wear various kinds of garb: preppy, businessman, hipster, or sporty, while women are expected to maintain a universal look including 5-inch stilettos, short skirts, high-neck blouses, and perfect makeup. Seoul is the world’s plastic surgery capital. Photographs are required to be submitted with résumés. Due to the high rates of education and densely populated cities, competition for jobs is so fierce that plastic surgery is a common graduation gift. The idea is that if everyone applying is equally qualified, at least a woman may be preferred because of her good looks. Aegyo is a phenomena in South Korea that refers to a display of affection often expressed through a cute baby voice, infantile facial expressions, and gestures. It is displayed by behaving in a coquettish manner, and female idols are generally expected to behave in this way.

A Cultural Example Traditional Band Societies

Humans inhabit an enormous range of ecologies, but most of our evolutionary past was spent

in traditional band societies hunting and gathering for food. Material conditions affect the allocation of roles performed by men and women, with the roles entailed in economic production crucial to gender development. It is believed that farming communities began to exist only 10,000 years ago, absorbing foragers or pushing them into harsher conditions. That leaves us with 50,000 or more years of living by foraging. By looking at traditional band societies founded on collecting resources from their local environment, the conditions that led to the establishment and maintenance of gender roles as a species can be better understood. Because foragers in traditional band societies depend totally on the natural environment for their subsistence, they are, more than any other people, influenced by environmental constraints. Furthermore, as these societies change economically, one is able to see how gender constructs are transformed. The Ju/’hoansi of Botswana and Namibia are a traditional band society. In general, foragers live in small settlements, dispersed over a large territory. They tend to be nomadic and shift location as vegetation, water, and animal migration shift seasonally. The Ju/’hoansi live together in bilateral kinship systems that provide the most flexibility as people have the greatest choice of whom to reside with. This is useful as resources are scarce at times. People mostly live in monogamous, nuclear households with limited family size. As a general pattern, women are responsible for gathering wild vegetation and hunting small game. Men provide meat through hunting larger game. While subsistence activities do align with gender, they are flexible. Leadership among the Ju/’hoansi is fluid. Individuals gain respect due to their cooperative nature and their abilities. Success in the skills of subsistence contributes to one’s prestige, but complex rituals exist that keep people’s ego in check and create equality. Men and women participate in group discussion and decision making. Men often contribute more frequently and are more likely to be the leaders, but it is not unknown to see women in these roles. Men are older (18–25 years) than women (12–16 years) when they marry, and the age difference bestows some initial authority to men. This is due to the fact that many years of experience and training are needed for

Cultural Competence

boys to become hunters, and men cannot marry until they can hunt well. Although this age difference may lead to differential status, newlyweds live with the wife’s natal family after marriage, which leads to greater emotional support. Later, couples may switch to the husband’s family. Gender equality is seen in attitudes toward sexuality before, during, and outside marriage. Premarital sexual experiences are seen as the norm, and no stigma exists even if it leads to pregnancy. In marriage, sexual intercourse depends on the full willingness of both wife and husband, and extramarital affairs are common. The Ju/’hoansi provide an example of how a culture, constrained and afforded resources from the environment, creates a unique pattern of gendered roles and norms that stress egalitarianism. Jill Brown and Robyn Kelly See also Biculturalism and Gender; Cross-Cultural Differences in Gender; Cultural Competence; TwoSpirited People

Further Readings Bonvillain, N. (1998). Women and men: Cultural constructs of gender. Upper Saddle River, NJ: Pearson Prentice Hall. Bronfenbrenner, U. (1979). The ecology of human development: Experiments in nature and design. Cambridge, MA: Harvard University Press. Monroe, R. L. (2004). Social structure and sex-role choices among children in four cultures. CrossCultural Research, 38(4), 387–406. Rust, J., Golombok, S., Hines, M., Johnston, K., Golding, J., & the ALSPAC Study Team. (2000). The role of brothers and sisters in the gender development of preschool children. Journal of Experimental Child Psychology, 77(4), 292–303. Shweder, R. A. (1999). Why cultural psychology? Ethos, 27, 62–73. Whiting, B. B., & Edwards, C. P. (1988). Children of different worlds: The formation of social behavior. Cambridge, MA: Harvard University Press. Whiting, B. B., & Whiting, J. W. M. (1975). Children of six cultures: A psycho-cultural analysis. Cambridge, MA: Harvard University Press. Williams, J., & Best, D. (1990). Measuring sex stereotypes: A multination study. Newbury Park, CA: Sage.

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Cultural Competence Culture may be defined as a set of beliefs, values, behaviors, and way of life that informs individuals in their being and their relationships with others. Cultural competence for mental health professionals refers to the ability to have awareness, understanding, and knowledge of themselves and their clients as cultural beings and the skills to provide effective, culturally appropriate interventions. As communities become increasingly diverse, there is a greater demand and need for mental health ­professionals who can understand and work effectively with an ever-growing population with ­varying worldviews (i.e., personal attitudes, beliefs, values, and behaviors that may influence and affect interactions with others). This entry presents and discusses the development, significance, and dimensions of cultural competence and provides examples of cultural competency when working with lesbian, gay, bisexual, transgender, and queer (LGBTQ) clients in clinical practice.

Relevant Background Psychology has been shaped predominantly by Western, Eurocentric views and assumptions, which conflict with the worldviews of racial and ethnic minority groups. The movement for and promotion of cultural competency was due to the recognition of this difference in worldviews among different cultural groups and to the realization that racial and ethnic minority populations were being underserved in the mental health system. Studies indicated high dropout rates for racial and ethnic minorities due to inadequate culturally sensitive services. Studies further found that the cultural differences between mental health professionals and their clients affected the process and outcome of treatment. As a result, the American Psychological Association established guidelines for working with ethnically and culturally diverse populations and later included those related to age, gender, social class, religion, and sexual orientation. The American Psychological Association further included guidelines on multicultural education, training, research, and ­ practice, and organizational change to promote cultural competency.

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Cultural Competence

Dimensions of Cultural Competence Although there is no agreement on conceptualizing cultural competence, there is consensus on its need, importance, and impact on the process and outcome of therapy. The three main broad dimensions of cultural competence that theorists agree on are (1) therapists’ awareness of their own cultural ­values, beliefs, and biases; (2) therapists’ knowledge of their clients’ worldviews; and (3) therapists’ skills to implement and provide culturally appropriate interventions. Cultural competence entails the awareness, knowledge, and skills that enable therapists to understand, respect, appreciate, and effectively work with culturally diverse clients. Therapists’ awareness involves the understanding of themselves as cultural beings with worldviews that may differ from their clients’ experiences, through open and honest ongoing self-reflection and examination of their worldviews and various social identities (e.g., gender, race, ethnicity, religion, ­ socioeconomic status, age, sexual orientation). With therapists’ awareness come the realization and acceptance that we all hold biases, and the understanding that the various social identities that they hold influence and affect their interactions and relationships with their clients and others in their lives. Therapists recognize that their various social identities and those of their clients may affect the way they perceive and understand their clients and their clients’ presenting concerns and, ultimately, their interventions and the therapeutic outcome. The knowledge of their clients as cultural beings helps therapists understand how cultural, historical, and sociopolitical contexts shape their clients’ worldviews and behaviors. With knowledge come understanding, sensitivity, respect, empathy, and awareness of clients’ contextual issues and how clients’ values, beliefs, and biases may be similar to or different from the therapists’ and may affect and influence the therapeutic process. In addition, with this knowledge, therapists may have a greater awareness and understanding of how clients’ worldviews affect their relationships and their understanding of themselves and others around them, as well as their presenting concerns. Therapists’ skill involves being able to effectively provide culturally sensitive services for their clients and advocating for social

justice. Competent skills require that therapists have culturally appropriate understandings of their clients and their presenting concerns and effectively communicate and adapt their clinical work to the cultural contexts of their clients. Becoming culturally competent is a developmental process and a lifelong journey of increasing awareness, gaining knowledge, and developing skills to effectively engage and work with c­ ulturally diverse individuals. To provide a better understanding of the dimensions of cultural competency, working with LGBTQ clients as a culturally competent therapist will be discussed.

Cultural Competency With LGBTQ Clients in Clinical Practice Therapists play an integral role in challenging gender biases that are more harmful than helpful when providing care to LGBTQ individuals, couples, and families. Despite increased social acceptance, there is a long history of anti-LGBTQ bias within mental health training and practice, which has created barriers to accessing and receiving quality mental health services for LGBTQ individuals. As institutions and educational programs transition to more culturally competent training, effective frameworks for assessment and treatment of LGBTQ clients are emerging. As a culturally competent practitioner, one should not only respect other cultural groups but also be able to work effectively with them. To provide culturally competent services for LGBTQ clients, therapists will need to become aware of and challenge their own biases and beliefs regarding the LGBTQ population, as well as expand their knowledge about LGBTQ issues. Awareness of Self

One significant dimension of cultural competency is therapists’ efforts to self-reflect on their own values and biases that they have developed. To increase this awareness, a practitioner may participate in what is sometimes described as “self-ofthe-therapist” work. Self-of-the-therapist work can be defined as a practitioner’s willingness to examine and confront “family-of-origin” issues that may influence the therapist’s ability to engage fully in the therapeutic process. Family-of-origin issues

Cultural Competence

are those messages and biases that therapists have internalized from the family they were raised in. Within the LGBTQ context, developing therapeutic self-awareness requires an exploration of the therapist’s values and biases and how those issues interconnect with the client’s differing worldview. Mental health professionals who come from families where heterosexuality is promoted as the ­preferred sexual orientation may struggle to empathize with LGBTQ clients who have experienced discrimination and invalidation because of their sexual orientation. It may be helpful to those willing to engage in self-of-the-therapist work to begin by reflecting on their historical beliefs surrounding sexual orientation, gender roles, and gender identity. While LGBTQ therapists may have greater knowledge of and sensitivity to LGBTQ issues than heterosexual therapists, they are also at risk of internalizing the same messages of homophobia and gender discrimination that dominate much of our culture. This disparity is important to note because LBGTQ individuals are more likely to go to an LGBTQ therapist than a heterosexual therapist. As a result, LGBTQ therapists must be willing to explore their own values and internalized biases. There are many useful tools that therapists can seek out to help facilitate the self-of-the-therapist process. Activities such as reflective journaling with prompts and questions related to diversity issues can lead therapists to identify their thoughts and feelings, and how their family and culture may influence their reactions, and become more ­self-aware. Similarly, therapists can increase selfawareness by writing out process notes that allow reflection on the thoughts, reactions, and assumptions that occurred during a session with a diverse client. In addition, therapists may consult with their professional colleagues and be open to processing and receiving feedback from their clients regarding their work with them. Furthermore, there are many cultural competency training workshops and programs that incorporate self-reflection activities through assignments and small-group discussions. Similarly, there are public and private agencies that offer some form of individual and/or group supervision focused on cultural competency and self-of-the-therapist work. Training within universities may offer the most thorough self-of-the-therapist work for new

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therapists. In the classroom, therapists in training are challenged through discussions, readings, and papers that expect self-reflection on one’s dimensions of culture. Once students begin their therapy internship, they will have an opportunity to present client cases in the presence of their peers and supervisors and reflect on their work with and understandings of their diverse clients. In response to the presentation, the supervisor and the other students ask questions, offer reflections, and suggest challenges to facilitate growth in theoretical skills and cultural competency, and self-of-the-therapist work. This time can provide insight and increased awareness of themselves as cultural beings and their impact on the therapeutic r­elationship with their clients. It may also be an opportunity to learn, develop, and refine their intervention strategies in working with diverse clients. Knowledge of Issues Within the LGBTQ Community

Self-of-the-therapist work is only one aspect of becoming a more culturally aware therapist. Knowing the historical and sociopolitical contexts and issues affecting LGBTQ individuals is critical to understanding the client and providing appropriate interventions. This understanding can be gained by inviting LGBTQ clients to speak about who they are and the experiences they have had. However, the knowledge gap that exists for therapists cannot be filled solely by clients. Practitioners must acknowledge the gaps in their own knowledge base and search out answers in books, workshops, and trainings and by participating in LGBTQ events and interacting with LGBTQ community members. While cultural competency is improving in the mental health field, LGBTQ concerns are often invalidated or ignored by practitioners. Research shows that many LBGTQ clients fear discrimination, making them less likely to seek appropriate health care. At the same time, LGBTQ individuals are nearly three times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. Evidence suggests that the experiences of harassment and bigotry have led to increased levels of posttraumatic stress disorder, thoughts of suicide, and substance abuse.

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Cultural Competence

LGBTQ individuals occupy a minority status, and from an early age, many LGBTQ youth recognize that they are different and they may not be given the same opportunities as their heterosexual counterparts. School and peers are often cited as sources of harassment and discrimination. In addition, a child’s family can also be a source of homophobia and harassment. Family pressure to conform to a heterosexual ideal can instill high levels of internal homophobia within LBTQ individuals themselves. Some experts suggest that LGBTQ individuals experience only internalized homophobia, but they also actually display symptoms of posttraumatic stress disorder because of the immense pressure to conform within the family of origin. These experiences can lead to high levels of isolation and feelings of loss characterized by a lack of connection to the community and the home. According to a study in 2007, students who identified as lesbian, gay, bisexual, or transgender were nearly 10 times as likely to have experienced bullying and victimization at school. Furthermore, this harassment led to increased risk for suicidal thoughts and self-harm. LGBTQ students are more than twice as likely to have considered suicide than their heterosexual, nontransgender classmates. Isolation from community and family and the fear of institutional stigmas can also create challenges in an LGBTQ individual’s decision and process of coming out. Coming out is a lifelong process of negotiating when and to whom to disclose. Therefore, it can be a continual source of anxiety for LGBTQ individuals. While coming out is generally seen as healthy for the individual, therapists must be aware that beginning phases of coming out can actually decrease self-esteem and happiness while increasing feelings of loneliness and isolation. Consequently, it is crucial to identify what stage the client is at in the coming out ­process because this will help determine which therapeutic tools will be most helpful. Culturally Appropriate Interventions

Providing culturally appropriate interventions is an integral aspect of cultural competency. Interventions do not exist solely in the therapy room; there are many ways in which a therapist can intervene to provide a positive experience for the client to

feel accepted and understood. When therapists meet with LGBTQ clients for the first time, it is important to adopt an affirming language and tone that validate the client. Intake forms that incorporate inclusive language and avoid the use of labels are a good first step. This can help in creating a flexible and welcoming environment to begin establishing the therapeutic alliance. The therapeutic alliance can be understood as a practitioner’s ability to build and cultivate an emotionally positive relationship with clients. Intakes are also a good resource in gathering general information about the client’s sources of family and relational support, spirituality, past violence or abuse, level of internalized homophobia, gender/sexual identity, and substance abuse history. This base knowledge can be helpful as the sessions progress. Clinical work with LGBTQ individuals’ families presents its own challenges and should be approached with the same level of empathy and compassion in seeking to understand both the experience of the LGBTQ individual and that of the family. Historically, few adolescents came out to their families. Most would wait until adulthood to reveal their gender and sexual identities, if they came out at all. With greater social acceptance and access to resources, this is quickly changing, and practitioners are facing new challenges from families. If an adolescent has not come out and wishes to do so, therapeutic strategies such as role-plays or writing a coming out letter can help the adolescent prepare for the conversation with family and friends. If an individual has already come out to the family and family members are willing to participate in therapy, practitioners can provide psychoeducation to both the client and the client’s family. Therapists can normalize the LGBTQ individual’s experience as well as challenge potential cultural, religious, and family beliefs. In addition, providing families with resources such as books or research articles helps dispel some of the more common myths surrounding sexual orientation and gender identity. Furthermore, facilitating conversations between the individual and the individual’s family can provide opportunities to discuss solutions for how best to support the LBGTQ individual’s coming out process. These conversations can also reveal ways for the family to manage other larger systems like the extended family, work, and school.

Cultural Competence

However, many LBGTQ individuals are not embraced by their families, and without that support, they are at risk of developing increased levels of anxiety, depression, and a poor self-image. With the development of a strong therapeutic relationship, the therapy room can become a safe and secure place for clients to share their pain. Therapists can assist clients in developing coping strategies that are helpful in managing the challenges within their family of origin as well as the societal discrimination that exists in our culture. Therapists should be careful not to treat individuals without understanding them as interactive members of their familial and social groups. A client’s sexual and gender identities are not isolated. Culturally competent therapists assist their clients in the examination of the many aspects of their cultural identity, such as race, ethnicity, age, economic status, ability, and spiritual beliefs. These cultural dimensions always intersect with the individual’s sexual orientation and gender identity/expression, but they can do so in very different ways. A middle-aged Christian lesbian with two kids will have very different therapeutic needs from a 15-year-old African American boy struggling to come out to his parents. The differences in LGBTQ experiences often originate in clients’ family of origin. A useful tool for both therapists and clients in visualizing the family values and beliefs is a cultural genogram. As in creating a family tree genogram, use symbols to represent family members, relationships, and the cultural characteristics of that family. Genograms help both therapists and clients visualize the connections, rules, and expectations that govern the family. Interventions are not only important in the therapy room. Culturally competent therapists advocate for change at the institutional and community levels as well. Therapists can stand with LGBTQ individuals, couples, and families as allies by helping train new therapists in cultural competency skills, presenting at professional workshops, or engaging in research that advocates for the needs of the LGBTQ community. Therapists can also get involved by becoming familiar with the relevant issues and striving for social justice and social change. Becoming culturally competent is a lifelong journey and a process of examining, learning, interacting, advocating, and understanding the self

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and others who differ from the self. It is imperative as therapists serving diverse, underserved, and marginalized populations to work toward continual examination of their worldviews and how these may affect their work with their clients and assess ways to provide culturally appropriate interventions with understanding and respect for their clients’ worldviews. Angela B. Kim and John Patrick Devine See also Cross-Cultural Models or Approaches to Gender; LGBTQ Community, Gender Dynamics in; LGBTQ People of Color and Discrimination; Multiculturalism and Gender: Overview; Worldviews and Gender Research

Further Readings American Psychological Association. (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Washington, DC: Author. Retrieved from http://www .apa.org/pi/oema/resources/policy/multiculturalguidelines.aspx Bassey, S., & Melluish, S. (2013). Cultural competence for mental health practitioners: A selective narrative review. Counselling Psychology Quarterly, 26(2), 151–173. doi:10.1080/09515070.2013.792995 Berardo, K., Deardorff, D. K., & Trompenaars, F. (2012). Building cultural competence: Innovative activities and models. Sterling, VA: Stylus. Fassinger, R. E., & Richie. B. S. (1996). Sex matters: Gender and sexual orientation in training for multicultural counseling competency. In D. B. PopeDavis & H. L. K. Coleman (Eds.), Multicultural counseling competencies: Assessment, education and training, and supervision (pp. 83–110). Thousand Oaks, CA: Sage. Gilbert, L. A., & Scher, M. (2009). Gender and sex in counseling and psychotherapy. Eugene, OR: Wipf and Stock. La Roche, M. J., & Maxie, A. (2003). Ten considerations in addressing cultural differences in psychotherapy. Professional Psychology: Research and Practice, 34(2), 180–186. doi:10.1037/0735-7028.34.2.180 National Alliance on Mental Illness. (n.d.). LGBTQ. Arlington, VA: Author. Retrieved from https://www .nami.org/Find-Support/LGBTQ Owen, J., Wong, J. Y., & Rodolfa, E. (2009). Empirical search for psychotherapists’ gender competence in psychotherapy. Psychotherapy Theory, Research,

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Practice, Training, 46(4), 448–458. doi:10.1037/ a0017958 Perosa, L., Perosa, S., & Queener, J. (2008). Assessing competencies for counseling lesbian, gay, bisexual, and transgender individuals, couples, and families. Journal of LGBT Issues in Counseling, 2(2), 159–169. doi:10.1080/15538600802125613 Ryan, C. (2010). Helping families support their lesbian, gay, bisexual, and transgender (LGBT) children. Retrieved from http://docplayer.net/117280-Helpingfamilies-support-their-lesbian-gay-bisexual-andtransgender-lgbt-children.html Shires, D., & Jaffee, K. (2015). Factors associated with health care discrimination experiences among a national sample of female-to-male transgender individuals. Health & Social Work, 40(2), 134–141. doi:10.1093/hsw/hlv025 Timm, T., & Blow, A. (1999). Self-of-the-therapist work: A balance between removing restraints and identifying resources. Contemporary Family Therapy, 21(3), 331–351. doi:10.1023/A:1021960315503

Cultural Gender Role Norms In cultures across the world, men and women often espouse different roles professionally and personally. Oftentimes, these roles are dictated by social norms that force individuals to take on specific, socially acceptable positions due to their gender. Social norms are unwritten standards and rules that drive social behavior through different forms of social reinforcement or punishment. Gender role norms are derived from social norms. They are shaped by the particular time period experienced, as well as a society’s culture and its specific needs. Gender norms are often defined as culturally bound expectations of each gender’s proper characteristics and behaviors, and they provide more specific directions and restrictions with regard to how men and women should act and perform in society. Gender norms function when individuals, especially younger children, view how well-regarded men and women behave in society, are told what behavior is acceptable or unacceptable, and learn how they are supposed to act in response. This process utilizes values, ideologies, and norms to instill the ways in which men and women are expected to conduct themselves in

society. It is a culturally based form of socialization that dictates how one should act based on one’s gender. This entry examines both male and female gender role norms, their biological origins, how they are enforced through social learning, and how they differ across cultures.

Male Gender Role Norms Male gender role norms are particularly rigid in most cultures, and from a very young age, boys learn the importance of masculinity and the unacceptability of exhibiting any feminine traits. The gender role norms typically ascribed to men include characteristics of being active, decisive, and driven. Boys and men are expected to be assertive, dominant, stoic, and aggressive. Men are expected to be the household breadwinners, and norms dictate that they care financially for their wife and children. Consequently, many men value themselves by their ability to make money and financially provide for their families. Men are expected to be strong, masculine beings, who do not show signs of weakness. Signs of weakness include expressing emotions, so these gender role norms often cause men to search for other outlets for their feelings. Men are socialized to give the appearance of always being in control, with favorable traits including being competitive and intimidating. There is also the notion that men are highly sexualized, which is instilled at an early age. Having a high sexual drive is of great importance to many men, and it often goes hand in hand with masculinity. When a man’s actions do not match a culture’s masculinity standard, others often ridicule him and question his sexuality. Due to the rigidity of male gender role norms and the high expectations placed on masculinity, the male gender role is much more vulnerable and fragile than the female gender role. With ­masculinity so easily threatened, oftentimes men, particularly in adolescence, find themselves constantly trying to establish their masculinity by strictly adhering to male gender role norms. This can include trying to distance themselves from traits associated with femininity, proving their heterosexuality through homophobia, avoiding vulnerabilities, restricting emotions, and being highly sexual with women.

Cultural Gender Role Norms

Female Gender Role Norms Women are often ascribed more communal, caring, and emotional characteristics and are expected to be warm, sensitive, and nurturing. They are often taught as children to be more passive and submissive, and in most professional settings, they are viewed as having positions of less power or authority than men. Due to their communal nature, women are expected to take on caretaking or domestic roles within a household. In contrast to professional settings, women usually exert more influence in the household and over their children than men. It is very common across cultures for females to gain most of their power from within the home through gendered caretaking responsibilities (e.g., child rearing, elder care). Indeed, women often assume control over domestic responsibilities in the home. In some cultures, women have the expectation of being thin, small, and elegant, with the purpose of looking pretty and attracting men. Much of a woman’s worth is derived from her ability to attract men and the perception that men have of her. Sexually, women are thought of as being much more chaste than men. While men face greater repercussions in general when they do not conform to gender role norms, women also come under scrutiny. Women are under pressure to remain feminine and nurturing, while also trying to excel in a world where they have to prove themselves against more aggressive men. When women do not conform, they can be chastised and ridiculed to the same degree as men.

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be more cautious physically in order to have healthy children and continue growing the population. There are several important differences in brain function between men and women that lead to a greater understanding of the root of gender role norms. In abstract thinking or concrete tasks, men are more likely to hyperfocus on a task, so much so that they may not show empathy or compassion to others in their surroundings. Men excel at focusing on one task at a time and cannot easily multitask. Women, on the other hand, are much more able to transition between tasks than men. Their brains’ chemical makeup differs as well. Men exhibit higher levels of testosterone than females, which can cause them to be more aggressive and physically impulsive. Women are often found with higher levels of oxytocin, which helps with emotional bonding and relationship building, than men. Structurally, women commonly have a larger hippocampus, which plays a large role in emotional regulation and memory. This helps women take in more sensory data, often makes them more aware of others’ nonverbal emotional communication, and enhances their intuitiveness. The female brain makeup allows women to be much more emotional. Men’s brains are designed to analyze a situation, come to a conclusion, and move on to the next task, usually without feeling a need to revisit the event. This ability enables men to perform certain duties much more proficiently than women, who due to their biological compositions will often keep returning to completed tasks.

Biological Origins

Social Learning Theory

Many researchers contend that gender roles originated due in large part to biological predispositions. Historically, men and women survived based on their abilities and strengths. Several aspects of the physical makeup of males and females can explain how gender role norms arose. Males, on average, display stronger muscular structures than women. Accordingly, men are usually naturally physically stronger than women. Historically, this led females to rely on males to complete more strenuous, physically taxing activities. In addition, because only women can give birth to children, they were viewed as child bearers, who needed to

Although there may be a biological origin to the development of gender role norms, social and cultural standards also largely influence and reinforce their development. Albert Bandura’s social learning theory describes how individuals learn from one another through observation, modeling, and imitation. They learn to navigate their surroundings through observing people’s attitudes and behaviors and the outcomes of those behaviors. This approach is largely how children learn which traits they should display based on their particular sex. Bandura explained that human behavior is shaped in terms of continuous, reciprocal

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interaction between behavioral, cognitive, and environmental influences. He posited that the following processes are essential for observational learning: (a) attention, (b) retention, (c) reproduction, and (d) motivation. With social learning theory in mind, we can begin to see how culture and society shape males’ and females’ differently gendered behaviors. As children, boys and girls learn how they are to behave through their observation and modeling of parents, siblings, and peers. This shaping begins as infants, with parents often dressing boys and girls in blue and pink, respectively. As they continue to grow, they are frequently expected to interact and play with others of the same sex, with certain gendered toys and activities. Social learning is able to take place through overt or subtle behaviors of others and slowly shapes the views and attitudes of males and females.

Cultural Differences Across Gender Norms Gender roles are generally similar across cultures, and most cultures have similar expectations of what qualities males and females should possess. Universally, men and women agree about the different descriptions that are used to encompass the characteristics of males and females. Gender stereotypes are often found to be stable across countries and cultures. Although there is stability in gender norms across cultures, there are different expectations for how these roles are displayed. Gender differences can be either subtle or overt depending on the cultural context and societal norms. Many different cultures value the strength of males and their ability to accumulate wealth; however, Asian cultures scorn the discussion of financial affluence and making gestures of sexual prowess. Thus, Asian males generally display their strength and wealth much more subtly than males socialized in other cultures. Conversely, American culture expects men to flaunt their wealth and abilities and values men who overtly wield their power.

Shift in Gender Norms Many individuals, particularly females, are ­beginning to challenge traditional gender norms, both domestically and professionally. Many contemporary women are establishing themselves

professionally. The average age for women to begin having children has steadily increased as women are taking more time to create an identity outside the home and family. While women have been making great strides, there have also been notable changes in male gender role norms. Fathers are spending more time within their households and are taking on additional child-rearing duties. Men have begun to assume more responsibility for their children, and many are seeking greater worklife balance. Both sexes are becoming more accepting of males and females eluding traditional gender roles. However, with this shift comes a difficult period of adjustment for both sexes. Professionally, females often feel less powerful than men with the same titles. Moreover, when females hold more powerful positions, they can often face greater scrutiny than men. Women are expected to continue embodying feminine traits, even when they are in environments where more aggressive characteristics are valued. Concurrently, a man’s shift in gender role may be ridiculed, and men often find it necessary to keep their masculine traits ever ­present for fear of a backlash. Even though much progress has been made, resistance remains due to the gender role norms that modern-day society continues to deem important.

Gender Role Conflict Gender includes a range of characteristics, including physical attributes, such as genitalia; internal perceptions, like self-concept of gender; or an external viewpoint, such as gender stereotypes. Gender is often viewed as a binary concept due to sex; however, many face internal conflicts about their gender and attached expectations. Gender role conflict is often viewed as a psychological state where the rigid and constraining definitions of a person’s sex limit his or her well-being, opportunities, and potential. It takes place when socialized gender roles have a negative impact on a particular person or other individuals. Gender role conflict is much more prevalent in males than in females, as male gender role norms are much more restrictive and are enforced with harsher repercussions. An example of men facing gender role ­conflict would be when they feel a need to restrict their emotions. The male gender role often requires men to remain strong and composed during

Cyberbullying

stressful events, and any emotionality is viewed as a weakness. Restricting emotions can have positive results in society, as such reticence is viewed as a sign of strength and masculinity. However, it can also have negative consequences, such as impeding the formation of an emotional connection in a romantic relationship. Gender role conflict can also lead to many serious psychological problems such as anxiety and depression. A reduction in these negative consequences is seen in individuals who have experienced more flexible attitudes toward gender norms. The topic of gender role conflict warrants further attention, as its influence is broad and widespread across cultures. Chelsea Manchester and Sara Cho Kim See also Gender Conformity; Gender Identity; Gender Role Socialization; Gender Stereotypes; Social Role Theory

Further Readings Archer, J., & Lloyd, B. (2002). Sex and gender. Cambridge, MA: Cambridge University Press. Lee, J. (2005). Gender roles. New York, NY: Nova Biomedical Books. Lindsey, L. (2011). Gender roles: A sociological perspective (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. O’Neil, J. M. (2015). Men’s gender role conflict: Psychological costs, consequences, and an agenda for change. Washington, DC: American Psychological Association.

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conducted via personal computers, cellular phones, or other electronic technology. Cyberbullies convey harmful messages through name-calling, rumor spreading, and abusive comments. While cyberbullying takes place outside school, it often has reverberations within the school climate. This entry offers an overview of cyberbullying research and further explores its impacts on children and teens.

Overview of Cyberbullying Research The impact of bullying has been studied across a number of disciplines, while the impact of cyberbullying is less understood. Since bullying has largely occurred within the context of school, most bullying research presumes a physical, or face-toface, context. Research is needed that focuses on bullying beyond school as the number of young people using the Internet expands and cyberbullying victimization increases concomitantly. Cyberbullying research is currently conceptualized in varied ways, creating inconsistencies. One popular approach has been to define it broadly as bullying that occurs though electronic media, but this does not account for the differences between various electronic platforms. Other researchers have relied on the work of Olweus in establishing the three main tenets of bullying, and some have used these three tenets but expanded the meaning of “cyberbullying” to include the potential for one or multiple bullies. Victims, Offenders, Prevalence, and Forms

Cyberbullying Persons, particularly young persons, are more reliant on technology to provide social connections than ever before. This focus on social media for interpersonal connectivity creates the potential for victimization via online bullying. Cyberbullying refers to aggressive, intentional, and harmful behavior that is willfully conducted by a group or individual toward a specific victim through the use of electronic messaging. When defining cyberbullying, many researchers begin with Dan Olweus’s tenets of traditional bullying, which include intent to inflict harm, a power differential, and repetition. These aspects are present in cyberbullying, but it is

As Internet access has grown, so have the number of potential cyberbullying offenders and victims. It is estimated that more than 77% of teens between the ages of 12 and 17 years own a cell phone, allowing users to text message, e-mail, and access social networking sites. A survey in 2011 estimated that approximately 93% of children and adolescents use the Internet at least weekly and 60% use it daily. There have been large variations in findings regarding cyberbullying victimization, with reported rates ranging from 11% to 72% but often hovering between 20% and 40% of middle and high school students. Cyberbullying can take many forms. Young people use an array of online media with messaging capabilities. Since teenagers have limited

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options where they can socialize outside school, these social technologies have become integral avenues through which social connectivity can stretch beyond school hours and borders. Teens often have constant access to social network technologies. In addition to using these sites to ­ maximize social status, young people can use the messaging forums to bully other individuals. Given the nature of online communication, cyberbullying perpetuates verbal bullying, and traditional forms of intimidation are supplanted by humiliation, slander, and gossip. Unique Nature of Cyberbullying

While traditional bullying and cyberbullying share similarities, they also differ, especially in terms of the Internet’s ability to provide increased anonymity. Cyber offenders feel an added sense of security because they are behind a computer screen or cell phone, which makes them less likely to follow societal pressures to act in a normative manner. Researchers have noted that cyberbullying is particularly malicious when offenders take steps to remain anonymous. Also, traditional bullying tends to be characterized by the presence of a victim and a bully, with few onlookers, while ­ cyberbullying often features a large audience, with ridicule that materializes quickly.

Cyberbullying Implications: Policy, Legislation, and Future Research Implications and Ramifications for Victims

Youth victims are treated in ways that negatively affect their physical, social, emotional, and cognitive functioning, development, and wellbeing. While victims of traditional bullying v­ ictims are able to seek refuge after school, cyberbullying does not allow for this reprieve as bullies, possessing access to the Internet, are able to reach victims at all times and everywhere. Research has found links between cyberbullying victimization and school difficulties (tardiness and truancy), suicidal ideation, eating disorders, chronic illness, depression, social anxiety, and reduced selfesteem. In extreme cases, victims have used violence against bullies, and the risk of violence, and/ or retaliatory behavior, may place school safety in jeopardy.

Prevention and Intervention

Since teachers connect with students daily, they can play a central role in combating cyberbullying. Researchers report varied support for school bullying prevention programs. Other researchers have highlighted the importance of parents educating their children regarding proper Internet activity. Schools can partner with law enforcement for information exchange purposes to help bring about formal charges against cyberbullies. Research supports school-level comprehensive programs to address bullying while carefully supervising students, establishing rules and punishments for ­ violations, and being strict about inappropriate behavior. Legal Issues

Cyberbullying is difficult to monitor and regulate since most speech is protected by the First Amendment to the U.S. Constitution until the offender’s behavior becomes harassment. School administrators can sanction traditional bullies since their actions usually occur at school. Since cyberbullying often occurs outside school, the investigation and interdiction of cyberbullying are less straightforward. Schools must develop clear policies regarding student online behavior and introduce learning exercises that enhance empathy and connect students with parents, school officials, and law enforcement. These efforts will reduce cyberbullying victimization and minimize the risk of reciprocal behavior, which could escalate to violence. Steven T. Keener and William V. Pelfrey See also Bullying, Gender-Based; Bullying in Adolescence; Bullying in Childhood; Emotional Abuse; Identity Construction; Peer Pressure in Adolescence; Psychological Abuse

Further Readings Hinduja, S., & Patchin, J. W. (2012). Cyberbullying: An exploratory analysis of factors related to offending and victimization. Deviant Behavior, 29(2), 129–156. Pelfrey, W. V., & Weber, N. (2013). Keyboard gangsters: Analysis of incidence and correlates of cyberbullying in a large urban student population. Deviant Behavior, 34(1), 68–84.

Cycles of Abuse Vollink, T., Bolman, C. A. W., Dehue, F., & Jacobs, N. C. L. (2013). Coping with cyberbullying: Differences between victims, bully-victims and children not involved in bullying. Journal of Community & Applied Social Psychology, 23, 7–24.

Cycles

of

Abuse

Cycles of abuse is a term used to explain the experience of abuse in intimate partner violence. This entry describes cycles of abuse in intimate partner violence and offers critiques of the framework, as well as adaptations of the model. This entry pays specific attention to the ongoing evolution of this foundational framework for understanding abuse.

Cycles of Abuse in Intimate Partner Violence The term battering cycle was utilized by researcher Lenore Walker in 1979 to describe a pattern of abusive behaviors she found in her seminal quantitative study documenting the experiences of battered women in Denver, Colorado. Since that time, researchers and practitioners have utilized her framework to build knowledge about behavioral patterns commonly seen in relationships with violence, which generally include three phases: (1) the tension-building phase, (2) the explosion of acute battering, and (3) the calm, loving respite. In the tension phase, tension is rising in the relationship as the perpetrator displays passive/aggressive gestures and other behaviors to express feelings of anger and frustration. At this time, the victim may walk on “egg shells” to avoid conflict. Eventually, the tension erupts in an episode of violence. During the “explosion of acute battering” phase, the perpetrator may use various forms of violence against the victim. In response, the victim may use any means necessary to protect himself/herself/themselves until the episode has passed and the perpetrator decides to stop. The last phase in Walker’s model is the calm, loving phase or, as it has come to be called, the “honeymoon” phase, in which the perpetrator desperately attempts to get the victim back (e.g., by asking for forgiveness; engaging others to support him/her/them, including in-laws, friends, and other family members; and playing on

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the survivor’s feelings of guilt and nurturance to win him/her/them back). In this phase, the victim forgives the perpetrator and ignores the recent incident to enter a state of calm in their relationship. Another adaptation of this framework includes a fourth stage, splitting up Walker’s “calm, loving respite” phase into (3) reconciliation/honeymoon and then (4) calm. Both versions are common and are used interchangeably. In addition, over several decades, the name has changed from “battering cycle” to “cycles of abuse.” Since the development and utilization of this original framework, it has been noted that the cycles do not have to occur in the exact order in which they are listed. For example, one can skip the “calm” phase altogether and return to the tension phase rather quickly, eliminating the reprieve from the violence. In addition, the cycles can repeat many times within the relationship. Each phase can be completed rapidly, or it can take months and years to move from one phase to the next. However, practitioners have documented that as the cycles repeat, the duration between explosions lessens. This framework has been utilized in the field by practitioners as an educational and practical tool to support survivors’ efforts to understand and make decisions regarding their experiences of violence. Researchers who study batterers have used this framework to conceptualize what they might be going through when they use violence and abuse their partners. Donald G. Dutton has used the cycles of violence combined with clinical theories to expand an understanding of how attachment issues in early childhood contribute to a perpetrator’s use of violence. This work has also been used in batterer intervention programs to help interventionists to understand the use of violence by batterers in order to intervene. For instance, the knowledge of the cycles-of-abuse framework coupled with the understanding that tactics of violence are utilized by batterers to dominate, intimidate, and control their partners has significantly influenced the field of intimate partner violence for work with both survivors and batterers alike.

Critiques The cycles-of-abuse framework was an important contribution to the field on its inception as it

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offered a look into the dynamics within an abusive relationship, which many had not previously understood. However, as the framework began to be used in practice and gained more attention throughout the field, practitioners found that it had notable limitations. One notable critique is that the framework was developed in response to a study based on the experiences of a group of heterosexual White women in Colorado. Little work has been done to examine whether the same cycles of abuse are relevant for and present in the relationships of women of color and sexual and gender minorities from other parts of the country. Another critique is that using the term cycles infers a predictive pattern, which many practitioners have said is not the reality in many abusive relationships, where violence can be unpredictable. In other words, the framework is too simplistic, leaving out other dynamics that could potentially occur leading up to, during, and after the violence. The framework is limited in that it only focuses on the perpetrators’ dynamics, which takes away from focusing on the victims and their own empowerment process. In addition, the framework is too focused, taking the relationship out of a larger context of oppression and marginalization that can influence the dynamics of violence as well as serve as a barrier to support for the survivor. For instance, a Latina immigrant who identifies as lesbian and is in a relationship with a partner who is also experiencing discrimination because of class and ethnicity might have different barriers to accessing resources then a heterosexual White woman, including the possibility of experiencing more isolation from her family and/or experiencing discrimination when seeking services due to her sexual orientation.

Updates to the Framework In response to critiques of the original three-phase cycles-of-abuse framework, adaptations have been made by various theorists and practitioners in an attempt to be more inclusive of a broader range of victims. One adaptation of the framework was developed by Scott Allen Johnson, who was most interested in what occurs before, during, and after intimate partner violence. Johnson agreed with the three foundational elements of the cycles-of-abuse framework; however, he expanded each phase into

more detail, offering a 14-phase-cycle framework. On the other hand, Ann Carrington’s adaptation transformed the two-dimensional cycles into a three-dimensional vortex, showing how the cycles repeat and what victims may experience as they reexperience the cycles numerous times. Carrington’s model allows for a more comprehensive view of the victim’s experience and allows chances for the victim to identify opportunities for transformation. Nathaly Hill adapted the framework to include the intersectional perspective of violence, in an effort to better reflect the realities of individuals facing multiple forms of oppression, trauma, and adversity (e.g., trans individuals, genderqueer individuals, people of color, low­ income individuals, people with disabilities). Her adaptation is based on the experiences of African ­American lesbians (e.g., the experience of racialized sexism or sexist, racialized classism) and data that show that African American lesbians represent a high-risk subpopulation for intimate partner violence. In Hill’s adaptation, experiences of societal oppression such as sexism, heterosexism, classism, and racism surround the cycles to reflect the external pressures that are often experienced by both members of the relationship. For example, Hill notes that African Americans are disproportionately affected by poverty and experiences of multiple forms of trauma and oppression, which makes it likely that a lesbian African American couple is coping with significant stressors in the relationship. In addition, the intersectional image includes a victim’s internal risk factors, such as traumatic experiences, mental health symptoms, poverty, and intersecting and internalized oppression (e.g., internalized homophobia and/or racism). Thus, one African American lesbian couple can experience tremendous external adversity, which when coupled with mental health issues and other oppressive factors can put the couple at risk for intimate partner violence. The intersectional adaptation also includes the behaviors of the abuser, such as isolation, verbal abuse, threats, suicidal gestures, and physical violence. The intersectional cycles of abuse still include four-phase cycles: (1) the tension phase, (2) the abusive e­pisode, (3) the reconciliation phase, and (4) the period of calm; however, they also include the other dynamics noted above, which reflects the reality that many victims of violence, especially those

Cycles of Abuse

disproportionately affected by multiple forms of adversity and oppression, still experience trauma even in periods of relative “calm.” These adaptations, especially the intersectional perspective, have followed a trend in the field of intimate partner violence to understand the nuances of violence among diverse communities, answering the critiques that the original cycles-ofabuse framework was too simplistic and based on the experiences of a select few. Josephine Serrata See also Gender-Based Violence; Intimate Partner Violence; Intimate Partner Violence in Same-Sex Couples; Violence and Gender: Overview

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Further Readings Carrington, A. M. (2014). The vortex of violence: Moving beyond the cycle and engaging clients in change. British Journal of Social Work, 44, 451–568. Dutton, D. G. (2007). The abusive personality: Violence and control in intimate relationships (2nd ed.). New York, NY: Guilford Press. Hill, N. A., Woodson, K. M., Ferguson, A. D., & Carlton, W. P. J. (2012). Intimate partner abuse among African American lesbians: Prevalence, risk factors, theory, and resilience. Journal of Family Violence, 27, 401–413. Johnson, S. A. (2007). Physical abusers and sexual offenders: Forensic and clinical strategies. Boca Raton, FL: CRC Press. Walker, L. E. (1979). The battered woman. New York, NY: Harper & Row.

D assault. However, not all rapes perpetrated in a dating relationship are facilitated by drugs, and not all rapes facilitated by drugs are perpetrated by dating partners. Therefore, the term date rape drug may cloud people’s understanding of what date rape is.

Date Rape This entry discusses the challenges in defining the term date rape and includes a history of the term, current prevalence estimates, and the influence of rape myths on victim blaming and reporting of date rape. Both colloquially and in research, the term date rape is used to label a range of phenomena. Indeed, both the terms date and rape are defined in varying ways. In legal and research definitions, rape is often defined as nonconsensual sexual intercourse that is achieved through physical force or incapacitation, such as from drugs or alcohol. Thus, one frequently used definition of “date rape” is nonconsensual sex perpetrated by someone with whom an individual is in a dating relationship (i.e., a sexual and/or romantic relationship). Another common definition is nonconsensual sex that occurs in the context of a date (i.e., a planned romantic engagement). Notably, for both of these definitions, the perpetrator could be a long-term intimate partner or a mere acquaintance with whom the victim is on a first date. Definitions of date rape typically exclude rape perpetrated by spouses, which often is categorized separately as “spousal rape.” To further confuse matters, drugs that are sometimes given to women without their knowledge to facilitate sexual assault, like Rohypnol, ketamine, and gamma hydroxybutyrate, have been labeled “date rape drugs.” Therefore, the term date rape also has been used to label drug-facilitated sexual

History of the Term As early as the 1950s, researchers had begun investigating the phenomenon of forced sex in the context of intimate and dating relationships, but the term date rape did not appear in the empirical literature until the early 1980s. The term was widely used throughout the 1990s and early 2000s. Although the term is still used by some researchers, its use has declined somewhat in recent years, with the broader designation of “acquaintance rape” being used more frequently. This is likely because it is unclear what relationships and situations are categorized as dates. Furthermore, research has demonstrated that, over time, college students are increasingly more likely to characterize their sexual interactions as occurring in the context of “hooking up” rather than “dating.” Hooking up involves sexual interaction between partners who often know each other but are not in romantic or dating relationships. Furthermore, hooking up generally occurs in group social settings (e.g., at parties) rather than in the context of preplanned, one-on-one dates. Therefore, the term acquaintance rape encompasses rape that occurs in a hookup setting, whereas the term date rape does not. Indeed, recent research suggests that among 423

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college students rape occurs far more often at parties or while “hanging out” with friends or acquaintances than on dates.

Prevalence of Date Rape Because different researchers define and measure date rape in different ways, prevalence rates differ widely across studies. Summarizing across largescale U.S. studies, it seems accurate to say that approximately 15% to 18% of women have experienced rape in their lifetime and approximately 90% of female rape victims are raped by someone they know. Research also suggests that about 25% to 45% of all rapes experienced by women are perpetrated by boyfriends or intimate partners and thus would qualify as date rapes by some definitions. This means that as many as 9% of women will experience rape perpetrated by a boyfriend or an intimate partner in their lifetime. Fewer studies have addressed men as victims of date rape, but some studies suggest that between 0.3% and 1.5% of men have been raped by an intimate partner.

Date Rape and the Influence of Rape Myths Although research reveals that rape is most often perpetrated by someone an individual knows, research also suggests that many people hold misperceptions about rape—sometimes called rape myths—which include beliefs that women are rarely raped by their boyfriends and that rapists are mostly deviant strangers. Myths such as these have been shown to influence the allocation of blame after incidents of rape, such that individuals who endorse these myths blame victims more when the victims knew their perpetrator—as in the case of date rape—than when the victims did not know their perpetrator. Thus, victims of date rape may experience more victim blame than victims of stranger rape. Rape myths also influence how individuals label their own experiences of rape. For example, if a woman believes the myth that most rapists are deviant strangers and she experiences date rape perpetrated by her popular, successful, middleclass boyfriend, then she may be unlikely to label her own experience as rape. Indeed, research

suggests that individuals who experience date rape are less likely to label their experiences as rape than individuals who experience stranger rape. Rape myths that deny the existence of date rape may also contribute to the fact that rape victims are very unlikely to report their rape to the police. It has been estimated that between 65% and 95% of rapes go unreported, and research has demonstrated that women who are raped by a romantic partner are less likely to report their experience to the police or seek crisis services than women who are raped by a stranger. If an individual does not label the date rape experience as rape because the individual believes that most rapists are strangers, the individual is unlikely to report the event to the police or to seek crisis services. Furthermore, even if an individual does label the date rape experience as rape, the individual may fear reporting the experience to the police out of concerns of being blamed or disbelieved because the rapist was a date or intimate partner rather than a stranger. Sara G. Kern and Zoë D. Peterson See also Acquaintance Rape; Campus Rape; Rape; Rape Culture; Sexual Assault; Spousal Rape; Victim Blaming

Further Readings Abrams, D., Viki, G. T., Masser, B., & Bohner, G. (2003). Perceptions of stranger and acquaintance rape: The role of benevolent and hostile sexism in victim blame and rape proclivity. Journal of Personality and Social Psychology, 84, 111–125. doi:10.1037/ 0022-3514.84.1.111 Cranney, S. (2015). The relationship between sexual victimization and year in school in U.S. colleges: Investigating the parameters of the “Red Zone.” Journal of Interpersonal Violence, 30, 3133–3145. doi:10.1177/0886260514554425 Muehlenhard, C. L., & Linton, M. A. (1987). Date rape and sexual aggression in dating situations: Incidence and risk factors. Journal of Counseling Psychology, 34, 186–196. doi:10.1037/0022-0167.34.2.186 Tjaden, P., & Thoennes, N. (2000). Prevalence and consequences of male-to-female and female-to-male intimate partner violence as measured by the National Violence Against Women Survey. Violence Against Women, 6, 142–161. doi:10.1177/ 10778010022181769

Delusional Disorder and Gender

Delusional Disorder  and Gender Delusional disorders are a category of mental disorders in which individuals experience delusions for at least 1 month but have never had a diagnosis of schizophrenia. There are several subtypes of delusional disorder, including persecutory, grandiose, jealous, somatic, and erotomanic. Although individuals diagnosed with delusional disorder experience delusions that may negatively affect their home, work, and social lives, the impact of the disorder on their lives is less severe than in other psychotic illnesses, such as schizophrenia. For each of the subtypes of delusional disorder, except the jealous subtype, there is no gender difference in prevalence, onset, or outcome. The jealous subtype occurs as much as three times more frequently in males than in females. Guided by an evolutionary psychological perspective, this entry addresses this gender difference.

An Evolutionary Perspective An understanding of cognitive mechanisms requires examining why the mechanisms evolved and what function the mechanisms have been selected to perform. Modern humans possess mechanisms that were adaptive in the environments of ancestral humans, but these same mechanisms may not be adaptive in modern environments. Examining the evolved function of mechanisms may provide insight into the causes of psychological disorders. Jerome Wakefield has proposed that disorders be considered “harmful dysfunctions.” These include failures of mechanisms to perform their selected function in the environments for which they were selected. For example, depression can be conceptualized as a malfunction of the mechanisms for sadness. Sadness usually occurs when individuals experience losses associated with reproductive resources, such as the loss of a romantic partner. The loss of resources may be an indication that maladaptive behaviors are occurring, and the accompanying sadness may function to alter future behaviors in order to avoid further losses. A parallel argument is applicable to the jealous subtype of delusional disorder. Better understanding of the disorder, and therefore more successful treatment,

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is likely to be facilitated by understanding the normal functioning of jealousy mechanisms.

Delusional Disorder, Jealous Type The functioning of regulatory mechanisms, such as jealousy, varies among individuals. As is the case with delusional disorder, jealousy mechanisms may be hypersensitive to perceived threats. Individuals with hypersensitive jealousy mechanisms may be more likely to misperceive innocent cues as threats of partner infidelity, or perhaps they may be more aware of potential infidelities than individuals with normally functioning jealousy mechanisms. Because these individuals might be less likely to experience the costs associated with partner infidelity, this might be a beneficial malfunction and, therefore, might propagate through future generations. There are, however, costs associated with hypersensitive jealousy mechanisms. Individuals who constantly accuse their partners of infidelity might risk their partners leaving the relationship. These individuals may be so focused on potential partner infidelity that their daily functioning suffers. Both of these costs are present in individuals with delusional disorder, jealous type, more commonly referred to as morbid or pathological jealousy. Individuals with this type of delusional disorder constantly monitor their partner’s behaviors, by phoning them incessantly, following them, questioning them about their whereabouts, or not allowing them to leave the house. They also misinterpret everyday actions and objects as cues to their partner’s infidelity. Examples of these misinterpretations include letters from strangers perceived to be love letters, cars driving by perceived to be lovers checking the partner’s availability, and sexual frigidity of the partner perceived to indicate the partner receives sexual satisfaction from someone else. To better understand the gender differences associated with this disorder, it is important to appreciate the gender differences associated with normally functioning jealousy mechanisms.

Jealousy and Types of Infidelity Jealousy is a normal emotional reaction to perceived or actual partner infidelity. Because both

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men and women invest heavily in long-term romantic relationships and have much to lose if their partner is unfaithful, jealousy serves the adaptive regulatory purpose of attempting to prevent the costly act of partner infidelity. Decades of research has demonstrated a sex difference in jealousy, such that men are more upset by a partner’s sexual infidelity and women are more upset by a partner’s emotional infidelity. Sexual infidelity involves having sexual intercourse with someone other than a romantic partner. Ancestral men and women may have benefited from engaging in sexual intercourse with an extrapair partner. Men had the potential of producing another genetic offspring in which minimum investment would be required on their part, and women could have benefited by obtaining high-quality genes for their offspring. Emotional infidelity involves spending time and resources on someone other than a romantic partner. As with sexual infidelity, both ancestral men and women may have benefited from an emotional relationship with an extrapair partner. Men would have benefited by providing resources to increase the likelihood of survival for any offspring produced with the extrapair partner, and women would have benefited by obtaining immediate resources for themselves and any current offspring. Although men and women obtain benefits from both types of infidelity, the potential costs accrued by their romantic partners differ as a function of the gender of the unfaithful individual. Female sexual infidelity is more costly to a romantic partner than female emotional infidelity. If a man’s partner engages in sexual intercourse with another man when she is fertile (and therefore may become pregnant), he risks unwittingly investing in offspring to whom he is genetically unrelated. Conversely, male emotional infidelity is more costly to a romantic partner than male sexual infidelity. The woman risks the loss of her partner’s resources, which could reduce the survival chances of her offspring. Because of the gender differences in infidelity costs, jealousy may function to attune men to threats of their partner’s sexual infidelity and women to threats of their partner’s emotional infidelity.

Jealousy and Sexual Rivals Men and women also differ in the qualities of potential romantic rivals that produce jealousy.

This gender difference can be explained by the different characteristics that men and women prefer in potential romantic partners. Robert Trivers’s theory of parental investment suggests that the sex that has the higher minimum required investment will prefer partners who will be able to provide for any potential offspring, and the sex with the lower minimum required investment will prefer partners who are fertile and able to produce offspring. In humans, men have a lower minimum required parental investment; at a minimum, their investment is a few moments of time and the costs of a single ejaculate. Women’s minimum required investment is 9 months of gestation and approximately 2 years of lactation. Therefore, women prefer romantic partners who demonstrate a willingness to invest, either directly through parental care or indirectly through financial support and resources. Men prefer romantic partners who demonstrate health and fertility (as indexed by physical attractiveness and youth) because over ancestral history, health and fertility traits would have indicated a greater likelihood of becoming pregnant and producing offspring. Because of these differences in preferences for a romantic partner, men and women feel threatened by romantic rivals who embody these particular characteristics. Men are more likely to experience jealousy when a potential rival has more resources to invest, because a woman is more likely to want a partner with the best capabilities for investment. A woman may be able to determine a potential romantic partner’s ability to invest by his occupation, salary, and social status or by the amount of money he spends on her. Therefore, men tend to be more upset by potential romantic rivals who have better jobs, make more money, have a higher social status, or are willing to spend more money on the partner. Women are likely to be more upset by potential romantic rivals who display characteristics that index health and fertility as these are the traits preferred in a romantic partner by men. Health in women may be advertised as physical attractiveness, and fertility may be advertised as youth. Younger women are more likely to be able to successfully produce offspring. Therefore, women tend to be more upset by potential rivals who are younger and more physically attractive. In sum, the normal function of jealousy is to thwart the costly act of partner infidelity. There is a gender difference in what causes jealousy

Delusional Disorder and Gender

feelings. Men are more likely to experience jealousy when there is a threat of sexual infidelity with a rival who has more resources, and women are more likely to experience jealousy when there is a threat of emotional infidelity with a rival who is younger and more physically attractive. These gender differences should also be evident in ­individuals diagnosed with the jealous subtype of delusional disorder as their jealousy mechanisms are not atypical but, instead, are hypersensitive.

Gender Differences in Delusional Disorder, Jealous Type Delusional disorder is one of the rarer disorders categorized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The prevalence rate is less than 1% of the population. These low rates make studying this disorder difficult. Much about this disorder remains to be explained, for example, how an individual’s race or sexual orientation may influence the onset, severity, and outcome of the disorder. Of the subtypes of the disorder, the jealous subtype is, on average, the third most common type of the disorder. One group of researchers compiled a database of published case histories, which resulted in a total of 398 case histories published from 1940 to 2002. Case histories came from several countries, including England, Norway, the United States, and Sri Lanka. To date, this remains the largest compilation of case histories on the jealous subtype of delusional disorder. Of the 398 cases, 298 were men and 100 were women. The gender difference was not influenced by country of origin. In 2010, a smaller case history investigation presented similar findings: 57% of its cases were men. Examining the content of the case histories indicates a gender difference parallel to what is seen in normal jealousy. Men with this disorder have delusions that focus on their partner’s sexual infidelity, and women with this disorder have delusions that focus on their partner’s emotional infidelity. In addition, men with this disorder tend to focus more on rival characteristics indicating resources and investment, whereas women tend to focus more on rival characteristics indicating youth and physical attractiveness. Further analysis of the case histories indicates a strong emphasis on perceived sexual infidelities

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of partners, not perceived emotional infidelities. This may explain the reported gender difference in prevalence rates. If clinicians believe that ­jealousy only occurs after a sexual threat to a ­relationship, they may be underreporting or misdiagnosing the number of women afflicted with the jealous subtype of delusional disorder. Using an evolutionary psychological perspective to understand that individuals with the jealous subtype of delusional disorder may have hypersensitive jealousy mechanisms suggests that clinicians should attend to cues of not only sexual infidelity but also emotional infidelity. Doing so could help explain what appears to be an anomaly within the subtypes of delusional disorder—a gender difference only in one subtype—and could help in treating what is typically a difficult disorder to treat. Judith A. Easton and Todd K. Shackelford See also Biological Sex Differences: Overview; Evolutionary Sex Differences; Mental Health and Gender: Overview; Obsessive-Compulsive Disorder and Gender; Romantic Relationships in Adulthood; Schizophrenia and Gender

Further Readings Buss, D. M. (2013). Sexual jealousy. Psychological Topics, 22, 155–182. de Portugal, E., González, N., Vilaplana, M., Haro, J. M., Usall, J., & Cervilla, J. A. (2010). Gender differences in delusional disorder: Evidence from an outpatient sample. Psychiatry Research, 177, 235–239. doi:10.1016/j.psychres .2010.02.017 de Silva, P. (2004). Jealousy in couple relationships. Behavior Change, 21, 1–13. Easton, J. A., Schipper, L. D., & Shackelford, T. K. (2007). Morbid jealousy from an evolutionary psychological perspective. Evolution and Human Behavior, 28, 399–402. Kingham, M., & Gordon, H. (2004). Aspects of morbid jealousy. Advances in Psychiatric Treatment, 10, 207–215. Nesse, R. M., & Williams, G. C. (1994). Why we get sick: The new science of Darwinian medicine. New York, NY: Vintage Books. Sagarin, B. J., Martin, A. L., Coutinho, S. A., Edlund, J. E., Patel, L., Skowronski, J. J., & Zengel, B. (2012). Sex differences in jealousy: A meta-analytic examination. Evolution and Human Behavior, 33, 595–614.

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Dependent Personality Disorder and Gender

Demasculation See Masculinity Threats

Dependent Personality Disorder  and Gender Dependent personality disorder (PD) refers to a long-standing, maladaptive pattern of overreliance on interpersonal support, lack of confidence, passivity, and fears of abandonment that causes significant suffering at school, at work, or in relationships. Notions of normal versus abnormal dependency can be traced back to the early-20thcentury psychoanalytic texts. Most developmental models even today fundamentally deal with the transition from normal, obligatory dependence in infancy to mature independence or interdependence in adulthood. Excessive dependency was largely considered a feature of other personality dysfunctions until the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), in 1980, introduced dependent PD as an (theoretically) independent diagnosis. Controversies surrounding dependent PD include ­potential gender bias and lack of diagnostic distinctiveness from other PDs (which remains an issue for most PDs). Researchers have not always taken into account that the expression of dependency and its impact on occupational, relational, or day-to-day functioning may vary by gender and culture.

Current Definitions and Brief History Dependent PD is defined in the DSM-5, which was published in 2013, as a pervasive and relatively stable tendency to behave in ways that are clingy and submissive in order to satisfy an excessive need to be taken care of by others. Similarly, the International Classification of Diseases, 10th revision (ICD-10), refers to dependent PD as a pervasive pattern that involves excessive fear of abandonment, an image of oneself as helpless and incompetent, extreme reliance on others for important as well as minor decisions, passive

submission to the wishes of others, and insufficient effort to meet the demands of daily living. A  less elaborate conceptualization of unhealthy dependency was present in the first DSM under the “passive-dependent type” of passive-­aggressive PD. The DSM-II removed the passive-dependent type and referred to excessive dependency as a feature of both hysterical/histrionic and passiveaggressive PDs, before the DSM-III established dependent PD as a separate disorder. The DSM-III situated dependent PD in the newly formed Cluster C (the “anxious/avoidant” cluster) along with avoidant and obsessive-compulsive PDs. The greatest revision of the diagnosis occurred in the DSM-III-R (revised), which increased its criteria from three to nine symptoms. The DSM-5 work group considered major revisions to personality diagnosis and almost deleted dependent PD; however, its final decision was to retain all DSM-IV PDs. For a diagnosis of dependent PD, the DSM-5 requires five out of the following eight signs or symptoms to be present: (1) requiring others to give excessive levels of advice and reassurance to make everyday decisions, (2) needing others to be responsible for major areas in the person’s life, (3) having difficulty asserting oneself (because of fear of disapproval or losing support), (4) avoiding independent or new projects (because of low self-confidence or self-efficacy), (5) making excessive efforts and sacrifices to secure nurturance and support from others (to the point of agreeing to do things against one’s wishes or self-interest), (6) unrealistically fearing that one would not be able to take care of oneself if left alone, (7) frantically seeking a new relationship to restore nurturance and support when a previous relationship ends, and (8) cognitive preoccupation with unrealistic fears that one would be abandoned and unable to manage independently. The pattern must have started no later than early adulthood and should not be attributable to other mental or general health problems. The degree of dependency should exceed one’s actual needs due to another physical, psychological, or intellectual condition. Cultural considerations are important in that submissive behavior may be expected and situationally appropriate in certain cultures, even as it may be viewed negatively in the individualistic Western society.

Dependent Personality Disorder and Gender

The ICD-10 includes similar criteria, with a somewhat greater emphasis on sacrificing one’s own needs for others’ and a general inability to make sensible requests of the person on whom the patient primarily relies. The ICD-10 also includes the following subtypes of dependent PD: asthenic (meaning weak or enfeebled), inadequate, passive, and self-defeating. The DSM-5 asserts that dependent PD is more prevalent among women than among men, at least in clinical settings. However, of all PDs, the debate about gender bias is most prominent and controversial regarding dependent PD. Marcie Kaplan’s 1983 seminal critique of gender bias in DSM-III PDs remains influential. Kaplan claimed that various DSM-III diagnoses (including dependent PD) aligned with stereotypically feminine characteristics, whereas stereotypically masculine characteristics were deemed normal. Robert Bornstein’s 1995 meta-analysis confirmed that women score higher than men on self-report and interview-based dependent PD measures. In 2002, E. David Klonsky and collaborators found that peer-rated dependent PD traits were linked to peer-rated femininity in men and women. Self-reported dependent PD traits were also linked to self-reported femininity across genders. The most robust correlation, however, across methods of assessment, was the association between femininity and dependency in women. When evaluating specific criteria, Leslie Morey and collaborators found that most dependent PD criteria show similar correlations with a dependent PD diagnosis in both men and women. One exception was the symptom pertaining to feeling helplessness or discomfort when alone, which was associated slightly more with a dependent PD diagnosis in men than it was in women.

Epidemiology and Course According to a review by Mark Lenzenweger and collaborators, dependent PD affects between 0.1% and 0.8% of the U.S. general adult population. The DSM-5 estimates its prevalence at 0.5% to 0.6% and notes its being more commonly diagnosed in women than in men. In clinical populations, dependent PD is more common in inpatient settings, with up to 25% of patients meeting the criteria. Estimates of dependent PD among

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outpatients vary from 0% to 10%, making it less common than PDs such as borderline and avoidant PD. The higher prevalence in women in clinical settings may be because women are more likely to seek treatment, though this interpretation may be insufficient to explain completely the gender ratio. The real sex ratio of dependent PD is not known as research has yielded conflicting findings. In one review, women in clinical settings were 40% more likely to meet the dependent PD criteria, but they were almost twice as likely to receive the diagnosis. In 1996, preeminent dependent PD researcher Robert Bornstein concluded that the sex differences in diagnosis were most likely due to gender differences in the willingness to admit dependency needs and behaviors. This conclusion was consistent with several studies showing that when the same clinical vignette was given a male or a female identity, clinicians tended to diagnose dependent PD at similar rates regardless of gender. Thus, gender differences in self-report of dependency may have implications for clinical assessment. Research on transgender identity and PDs is scant and suffers from sampling difficulties. In one study, transgender individuals (both male-tofemale and female-to-male) were at increased risk for other PDs relative to a nonclinical, heterosexual, cisgender sample, but not for dependent PD. Caution is important in interpreting this research because of the difficulties of recruiting a representative sample. Dependent PD typically begins in late childhood or early adolescence. Some theorists have proposed that separation anxiety disorder may precede some cases of dependent PD, but this hypothesis has not been sufficiently studied to date. As some individuals mature, they may no longer meet the criteria, but interpersonal problems may continue to negatively affect functioning.

Genetic and Early Environmental Factors Genetic and environmental factors both play a role in dependent PD. In a twin study by Line Gjerde’s team from Norway, dependent PD’s heritability was high at .66 overall. In other words, genetic differences explained more than 65% of the variation in dependent PD symptoms among Norwegians. The genetic influences were stronger than nonshared environmental factors (those specific to the

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individual and not shared with siblings). Environmental factors shared with the siblings seemed to play no significant role; no sex-specific heritability patterns emerged. Dependent PD may involve heritable traits that are specific (e.g., submissiveness to authority) or much broader (e.g., soothability, anxiety proneness, or a more general tendency to experience negative emotions across situations). In personality trait research, dependent PD is most consistently linked to high scores on neuroticism (which correlates with many other disorders) and, sometimes, high agreeableness and low conscientiousness and openness to experience. Early environmental factors may also influence the development of dependent PD. Parenting style theory attributes dependent PD to overprotective and/or authoritarian parenting. The correlational evidence in support of this link does not establish causality and tends to rely on retrospective reports about parenting, which may be susceptible to memory biases. Attachment theory is also often cited with regard to the development of dependent PD, and research links dependent PD to insecure attachment, particularly high attachment anxiety and preoccupied attachment style. From a behavioral perspective, dependent behavior is often reinforced by close others who provide caregiving and support.

Comorbidities PDs are highly comorbid with one another, and dependent PD falls in line with this pattern, though careful differential diagnosis may reduce some apparent comorbidity. In the National Comorbidity Study Replication data, dependent PD symptoms positively correlated most strongly with symptoms of borderline and avoidant PDs. Dependent PD also frequently co-occurs with anxiety disorders. One 2005 meta-analysis found modest comorbidities with panic disorder (with and without agoraphobia), social phobia, and obsessive-compulsive disorder. In a 1995 review, Bornstein concluded that dependent PD displayed less overlap, though, with depressive and substance use disorders than many other PDs. Some evidence links dependent PD to increased risk for intimate partner violence, as well as occasionally perpetrating such violence (although not at the rates associated with Cluster B PDs).

Assessment Like all PD assessment, assessing dependent PD is complex and involves self-report measures, clinician ratings, informant report, and important decisions about each method’s advantages and downsides. Relying solely on self-report is problematic because individuals with PDs may lack sufficient insight to report accurately. Some standardized self-report questionnaires, nonetheless, have shown adequate psychometric properties (e.g., the Personality Diagnostic Questionnaire for DSM-IV). Other instruments, such as the Millon Multiaxial Clinical Inventory, may exaggerate gender differences. The preferred assessment method is using structured interviews (e.g., the Structured Clinical Interview for DSM-IV Axis II Personality Disorders and the Structured Interview for DSM-IV Personality). They are the standard for PD assessment because they systematically measure multiple diagnostic criteria, which promotes reliable measurement and may mitigate the risk of gender bias. Narrative-based interviews (e.g., Drew Westen’s Clinical Diagnostic Interview) may aid in case conceptualization and treatment planning, but they are less structured and often insufficiently assess each diagnostic criterion. Dependent PD in particular, though, may lend itself to less direct, more projective, inferential, or narrative-based types of assessment, as they may uncover dependency in people, such as men, who are unlikely to endorse it. Unlike PD symptoms that individuals tend to admit more willingly (e.g., avoidant symptoms), evidence suggests that men may underreport dependent PD symptoms. Thus, Bornstein suggests that less direct methods of assessment (e.g., asking questions that are less obviously related to dependency) may improve diagnosis and clinical prediction in men. In general, PD diagnosis requires detailed multisource/multimethod assessment, and although systematic, structured approaches may reduce gender bias, they may be insufficient to uncover dependency in men. During interviews, carefully framing questions can help clinicians avoid artificially inflating stereotypical sex or gender differences (e.g., grilling men about their lack of independent decision making in work settings and women about fears of being abandoned by a spouse).

Depression and Gender

Treatment Research on evidence-based treatments (EBTs) specifically targeting dependent PD is extremely limited. For PDs overall, both psychodynamic and cognitive behavioral psychotherapy showed effectiveness in a 2003 meta-analysis by Falk Leichsenring and Eric Leibing, with psychodynamic psychotherapy demonstrating more enduring results. Because no EBTs exist for dependent PD at this time, Bornstein and others have suggested integrating evidence-based cognitive behavioral and psychodynamic techniques that target dependency. Effective EBTs for comorbid conditions are available, although dependent PD can complicate treatment. Patients with dependent PD may have ­particular difficulty in ending therapy, and extra work is needed to promote self-reliance as therapy progresses. Although outpatient treatment is the norm, one study comparing different treatment formats found that short-term inpatient work may best treat Cluster C symptoms. Psychopharmacological treatments of dependent PD generally depend on the comorbid conditions present, and little evidence exists for the efficacy of specific drugs targeting dependency.

Future Directions Dependent PD remains a controversial diagnosis. The nature of the often-cited gender bias is unknown and inconsistent in clinical and nonclinical settings. The assessment of dependency is complicated by gender and cultural variations, and indirect assessment may be particularly important in men. However, which indirect assessment methods are most valid remains to be seen. Dependent PD may not be a coherent, independent diagnostic category, but it does capture a clinical phenomenon that affects functioning and treatment. Treating dependent PD requires going beyond top-level empirical evidence as no specific, well-researched EBT exists at this time. Future research should explore ways in which clinicians can help individuals with dependent characteristics through approaches that are both short- and long-term. Kile M. Ortigo and Pavel Blagov See also Avoidant Personality Disorder and Gender; Borderline Personality Disorder and Gender;

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Histrionic Personality Disorder and Gender; Personality Disorders and Gender Bias

Further Readings Bornstein, R. F. (1996). Sex differences in dependent personality disorder prevalence rates. Clinical Psychology: Science & Practice, 3, 1–12. doi:10.1111/j.1468-2850.1996.tb00054.x Bornstein, R. F. (2005). The dependent patient: Diagnosis, assessment, and treatment. Professional Psychology: Research and Practice, 36, 82–89. doi:10.1037/07357028.36.1.82 Disney, K. L. (2013). Dependent personality disorder: A critical review. Clinical Psychology Review, 33, 1184–1196. doi:10.1016/j.cpr.2013.10.001 Klonsky, E., Jane, J., Turkheimer, E., & Oltmanns, T. F. (2002). Gender role and personality disorders. Journal of Personality Disorders, 16, 464–476. doi:10.1521/ pedi.16.5.464.22121

Depression

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Gender

Depression is understood by most mental health professionals as a psychiatric illness involving severe and persistent disturbance in a person’s mood. Although people of all genders may experience depression, research has revealed significant differences between men and women in the epidemiology of this disorder. The social construction and social learning of masculine and feminine gender roles may also affect the way individuals experience, express, and respond to this disorder. This entry addresses the role of gender in the diagnosis of depression by professionals, and in the various ways individuals experiencing the disorder cope with and respond to it, including seeking or not seeking help from professionals.

What Is Depression? There are several different types of disturbances in mood that fall under the general rubric of depression. These include bipolar disorder, psychotic depression, seasonal affective disorder, postpartum depression, and major depression. Because major depression is the most common of these disorders, and the one for which the role of gender has been

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most thoroughly investigated, it will be the focus of the remainder of this entry. The American Psychiatric Association periodically publishes specific criteria for the diagnosis of particular mental disorders. The criteria for major depression have remained fairly consistent over the past several versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to the 2013 version (DSM-5), a person can be diagnosed with major depression when they have a despondent mood daily for about 2 weeks or more. These feelings of sadness and despair may be self-reported, or they may be recognized by others (e.g., family members, the person’s therapist). The individual is often unable to participate in daily life functions and usually loses interest even in activities they once enjoyed. Physical symptoms include noticeable weight loss or noticeable weight gain, as well as excessive sleeping or difficulty sleeping. Other physical symptoms include fatigue, stunted psychomotor skills, and incapacity to concentrate, while other emotional symptoms of depression include self-blame, guilt, and worthlessness. Finally, one common symptom with depression is obsessive thinking about death—sometimes with passive or active thoughts about suicide. The symptoms must also cause significant distress or impairment in important areas of the person’s functioning. The symptoms also must not be due to another substance, medical condition, or other psychiatric disorder. It is important to note that the diagnosis of depression is made based on the presence or absence of this particular constellation of symptoms. This means that the diagnostic criteria do not necessarily imply any specific etiology, and it is likely that biological, psychological, social, and environmental factors all play a role in the development of the disorder. In addition, the existence of criteria for diagnosing depression does not necessarily mean that the depression has a clear and unambiguous ontological status. Put another way, because depression is often characterized as “a legitimate medical illness,” it can be tempting to assume that cultural, political, and social processes and identities (e.g., race, class, gender) are only superficially involved in shaping our collective sense of what depression is, and is not. An alternative to this view is the assumption that race, class, and gender are intimately linked to what society

constructs as illness versus health, mental or otherwise. How we view the role of social-cultural processes in the diagnosis and treatment of human problems in living has significant implications for how we think about questions such as “What is depression? Is it the same or different in men and women? How should we ‘treat’ it?” Taking up these issues in detail is beyond the scope of this entry. However, they should always be considered when critically analyzing particular studies and theoretical perspectives on gender and depression.

Gender and Epidemiology There appear to be no consistent sex differences in rates of depression among children, although some studies suggest that boys may show slightly higher rates prior to adolescence. However, from between 12 and 13 years, girls become twice as likely as boys to experience an episode of major depression. This 2:1 female-to-male ratio continues on through adulthood. The actual rates of depression vary widely by culture, social class, race, ethnicity, and nationality. However, the 2:1 female-to-male ratio appears to be relatively stable. The National Comorbidity Study—Replication, the most extensive study in the United States, was published in 2003 and relied on cold-calling a stratified sample. Trained diagnostic interviewers used structured interview to inquire about the prevalence and incidence of major depression based on strict DSM criteria. Based on a sample of 9,090, the study revealed an overall lifetime prevalence of 16.6% and a 12-month prevalence of 6.6%. The findings also revealed a lifetime odds ratio (female to male) of 1.7 for experiencing an episode of major depression. Transgender individuals may be at increased risk for depression (estimated as high as 44%), possibly due to stigma and other forms of minority stress. Higher rates are also observed among individuals who identify as lesbian, gay, or bisexual. Support of friends and family, and the presence of an accepting, nonstigmatizing community, can be very helpful in reducing the risk for depression. Since the mid-1990s, an increasing number of clinical and research publications have suggested that rates of depression may be underestimated in adult males. Clinical observations suggest that

Depression and Gender

many men may mask their depressed feelings through the expression of anger, substance abuse, excessive risk taking, and somatic symptoms. Consistent with this speculation, adult men are twice as likely as adult women to be diagnosed with a substance abuse disorder—the mirror opposite of the sex ratio for depression. Several studies also suggest that men are more reluctant than women to seek help for depression and more likely to resist the term depression to describe their symptoms. Stressful life events are risk factors for depression, and it appears that among men who have recently experienced a stressful life event (e.g., divorce, loss of a loved one), those who adhere to more traditional gender roles are less likely to endorse symptoms of sadness and more likely to report anger and other externalizing symptoms. Gender-based cultural norms may also play a role in the epidemiology of men’s depression. Among cultural groups with less traditional gender roles, the 2:1 female-to-male ratio is somewhat smaller. It is also possible that the traditional diagnostic criteria for depression are better suited to detecting the illness in women than in men. A 2013 study reanalyzed the data from the National Comorbidity Study—Replication using “gender-fair” diagnostic criteria, which included externalizing ­symptoms such as anger and substance abuse, in addition to the prototypic DSM symptoms. When these nonprototypic symptoms were included, the 2:1 ratio dropped significantly and approached equal rates of depression in men and women. Primary care physicians are also less likely to diagnose depression in men compared with women, and this may be the result of preconceived notions about the likelihood of the disorder occurring in females versus males. It is important to note that the existence of greater rates of anger, substance abuse, and other nonprototypically depressive symptoms in men does not necessarily mean that large numbers of men are masking depression or expressing the disorder in a different form. It may simply be that men are more likely to experience these problems whereas women are more likely to experience depression. Strong evidence of a “masked” or “hidden” form of depression would require methods for identifying the presence of the disorder independent of the particular symptoms. Because all

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mental disorders are currently diagnosed based on symptom presentation, as opposed to underlying etiology, this is not currently possible. Thus, although there appears to be some compelling evidence that rates of depression are underestimated in men, this remains an open question.

Gender, Relationships, and Coping It is widely assumed that men and women face different social expectations for what is considered “normal” with regard to the expression of emotion and the response to psychological distress. Women, for example, tend to be encouraged to express soft and vulnerable emotions such as sadness and anxiety and discouraged from expressing anger. Men, in contrast, are often shamed for expressing emotional vulnerability and encouraged through reinforcement and social modeling to express anger and dominance. These gender roles and norms can affect the way individuals experience, express, and respond to mental disorders such as depression. Feminine gender roles, for example, emphasize the experience and expression of vulnerable emotions such as sadness and anxiety, whereas masculine gender roles discourage men from recognizing and communicating these emotions. Masculine gender roles also emphasize extreme self-reliance, keeping a “stiff upper lip,” and solving problems on one’s own. Feminine norms, on the other hand, encourage reassurance seeking and reliance on others. There has been a considerable amount of research focused on the role of gender in the way individuals respond to depressed mood and/or the presence of an episode of major depression. In some studies, gender is synonymous with sex differences, and the analysis focuses on comparisons between males and females in particular psychological or social variables. In other studies, gender is conceptualized as individual differences in adherence to particular masculine and feminine roles and norms, and the focus is on the correlations between these individual differences and other variables of interest. Susan Nolen-Hoeksema and Lori M. Hilt re­­ viewed studies of sex differences in coping with depressed mood, with an eye toward understanding the role of gender socialization in rates of depression. Their review identified several consistent findings. First, women have been found to be

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more attuned to interpersonal relationships and more concerned about their roles and responsibilities in these relationships. Interpersonal stress is a risk factor for depression in general, and intensive focus on relational issues is predictive of depression in samples of women. Second, women are more prone to ruminating about the causes and consequences of their depressed mood, whereas men are more prone to distracting themselves. Rumination involves cognitively and emotionally “chewing” on distressing issues in one’s life. Individuals who ruminate may ask themselves, “Why am I feeling this way? What have I done wrong, and what could I have done differently to avoid feeling this way?” Of course, it can be adaptive to ask oneself these questions periodically, but individuals who ruminate report spending a great deal of time focused on their own internal processes. This tendency is predictive of the onset of an episode of major depression in those with depressed mood. In addition, the 2:1 female-to-male ratio of depression appears to be greatly reduced when statistically controlling for women’s greater tendency toward rumination.

Biology and Gender Several lines of research have focused on the role that biology may play in the 2:1 female-to-male ratio of depression. The two most common areas of focus are hormones and genetics. Variations in various hormone levels, including estradiol, progesterone, and testosterone, are associated with the presence of depressive symptoms in both women and men. Whether such variations are the cause of depression or the result is difficult to disentangle. For example, the timing of hormonal changes in women (e.g., puberty, menopause, childbirth) coincides with periods of increased risk for depression. However, these same periods arrive with significant psychosocial and environmental stressors as well. For example, the timing of puberty relative to one’s peers appears to be a better predictor of the onset of depression in teenage girls than absolute hormonal levels. In their 2009 review of the research on hormones and depression, Nolen-Hoeksema and Hilt concluded that hormonal processes may play a role in depression only in those individuals with a

genetic vulnerability to the disorder. There is now ample evidence that genetics plays a role in major depression, as evidenced by the higher concordance rates among genetically similar individuals, including monozygotic (identical) twins raised in separate environments. However, there is no consistent evidence that genetics is directly responsible for the higher incidence of depression among women compared with men.

Treatment and Help Seeking There is consistent evidence that particular psychotherapies and medications can be effective treatments for depression. It does not appear that either medication or therapy is more effective, although the combination of medication and treatment may be most effective for those who are severely depressed. Men are considerably less likely than women to seek help from mental health professionals, and this includes seeking help for depression. Men are also more likely to possess negative or stigmatizing attitudes toward professional mental health care, although the type of potential help moderates this effect (e.g., medications vs. therapy, different types of therapy). Men of color are particularly unlikely to seek professional help due to their experience of discrimination in the health care system, as well as the difficulty of finding therapists sufficiently attuned to multicultural issues and diversity. There is no consistent evidence that men and women respond differently to alternative treatment approaches, either psychotherapeutic or biological. However, there is considerable anecdotal evidence and clinical theorizing about the types of approaches that are well suited to females versus males. Feminist therapy, for example, has been offered as a potentially helpful treatment for women struggling with feelings of powerlessness and oppression in the context of patriarchal social systems. Group therapy may be particularly helpful for men who assume that they are alone or otherwise “abnormal” in their experience of depression. Many other sex-specific recommendations exist, and virtually all are based on the assumed congruence between particular treatment rationales and different components of masculine and feminine gender roles. Although intuitively

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compelling, few if any of these recommendations have been empirically tested in randomized controlled trials. Michael E. Addis See also Adolescence and Gender: Overview; Anxiety Disorders and Gender; Depression and Men; Depression and Women; Mental Health Stigma and Gender; Substance Use and Gender; Suicide and Gender

Further Readings Addis, M. E. (2008). Gender and depression in men. Clinical Psychology: Science and Practice, 15(3), 153–168. doi:10.1111/j.1468-2850.2008.00125.x Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58(1), 5–14. doi:10.1037/0003066X.58.1.5 Berger, J. L., Addis, M. E., Green, J. D., Mackowiak, C., & Goldberg, V. (2013). Men’s reactions to mental health labels, forms of help-seeking, and sources of help-seeking advice. Psychology of Men & Masculinity, 14(4), 433–443. doi:10.1037/ a0030175 Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the U.S. transgender population. American Journal of Public Health, 103(5), 943–951. doi:10.2105/AJPH.2013 .301241 Hatzenbuehler, M. L., Hilt, L. M., & Nolen-Hoeksema, S. (2010). Gender, sexual orientation, and vulnerability to depression. In J. C. Chrisler & D. R. McCreary (Eds.), Handbook of gender research in psychology, Vol 2: Gender research in social and applied psychology (pp. 133–151). New York, NY: Springer Science + Business Media. doi:10.1007/978-1-44191467-5_7 Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., . . . Wang, P. S. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA: Journal of the American Medical Association, 289(23), 3095–3105. doi:10.1001/ jama.289.23.3095 Nolen-Hoeksema, S., & Hilt, L. M. (2009). Gender differences in depression. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression (2nd ed., pp. 386–404). New York, NY: Guilford Press.

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Men

So what exactly is depression? How often have we heard others say that they feel down, low, out of sorts, or depressed? How often have we heard those words come out of our own mouths? How often have we heard our parents or close friends utter, “Don’t be sad, things will get better!” or “Everyone is sad sometimes.” Do these feelings constitute depression? Does being told not to feel a certain way make that emotion just disappear? According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are certain characteristics one needs to meet in order to be clinically diagnosed with depression. Some of these characteristics include insomnia, fatigue, irritability, weight loss, and fogginess. One of the stark contrasts between “feeling down” and being clinically depressed is the level of impairment that these feelings cause one to experience. Clinical depression is often seen as dramatically influencing one’s ability to function across occupational, social, and other vital areas in one’s life. So being told “not to be sad” or to “snap out of it” will not generally bring someone out of their depression. Typically, when one experiences feelings of sadness or despair, these feelings do not remain to the same degree for a long period of time. One is often able to pull oneself out of a “funk” or rely on others to cheer one up. When these feelings seem to go beyond the “normal” incubation time, it may be possible that one is experiencing a more severe form of depressed mood. If you or someone you know is feeling depressed, you should consult with a medical or mental health professional for accurate diagnosis and treatment. With that said, it is important to begin to recognize the differences that are experienced across individuals with depression. This entry begins by addressing some differences noticed across gender, with a special focus on men.

Sex Versus Gender Before discussing differences across gender, it is helpful to first distinguish some basic terminology and then look at how these differences may have developed over the course of time. For the purposes of this entry, sex shall be defined as a

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biological concept that distinguishes male and female, whereas gender will refer to the social group characteristics of masculine and feminine. Often these terms are conflated, but for the purposes of this entry, all future reference to male/ female and men/women will indicate the latter definition. To begin the discussion of the aforementioned disparities, it is vital to first recognize the theories that form the understanding of gender in this entry. Scholars have relied on gender role theory to begin to explain many of the observable differences they investigate and have also seen this theory blossom and take shape in the field of research since Margaret Mead’s initial examination. This theory views gender under the lens of cultural distinction and acknowledges a historical journey that has seen biological differences play out on both an individual level and a societal level. As with most attributes that are culturally constructed, gender roles are not universal and need to be seen within the context of the culture being examined. Even within the community being studied, it is important not to paint all members with a broad stroke and assume that these characteristics hold true for everyone. With that said, gender roles are viewed as learned behaviors often passed down through a socialization process. For example, the concept of modeling or imitating the behaviors of parents and social peers is most often the process by which one is socialized in thoughts and behaviors that are deemed appropriate based on gender.

Depression and Gender As stated earlier, oftentimes studies regarding gender differences in relation to mental health disorders refer to sex when they mean gender and refer to gender when they mean sex. Also, given the nature of some research, gender and sex are sometimes inextricably enmeshed. This notwithstanding, many researchers have noted the gender ­disparities that exist in the diagnosis of disorders such as borderline personality disorder and schizophrenia. Although researchers and scholars have begun to discuss some causes for these disparities, most often these differences are not considered in relation to help-seeking behaviors. In other words, although women are often characterized as having a higher prevalence for depression rates, what is often overlooked is the notion

that men report these symptoms at lower rates and seek treatment in even fewer instances. This does not necessarily mean that men are less likely to be depressed as much as it says that they often do not seek help when experiencing similar symptoms as their female counterparts. Another issue that is often overlooked is that symptoms related to depression may be exhibited differently in women than they are in men. The reasons for this may be related to gender socialization.

Depression Experience in Men According to the National Institute of Mental Health, men and women may experience depression differently. Men with depressed mood often display signs of irritability, lose interest in hobbies or family activities, and experience changes in their sleeping patterns, either sleeping more or having difficulty falling asleep. Another difference that has been noted is the experience of suicidality. Whereas women are often more likely to report suicidal ideation or attempt hurting themselves while feeling depressed, men are often more likely to successfully commit suicide when they are depressed. This notion alone should drive researchers and mental health providers to explore in depth how depression affects men on a larger scale. When looking at disparities in the treatment of depression across gender, certain realities begin to surface in beginning to understand what causes these differences. It has been reported that men often overlook signs of depression and are more reluctant to acknowledge signs associated with depression. Some explanations posit that feelings of sadness or despair are viewed as “weakness,” which men are often taught goes against how they should present themselves to the world. Although the criteria for diagnosing depression is the same across gender, it is vital to recognize what prevents men from coming forward to seek treatment. Although this entry will not include a detailed discussion of help-seeking behaviors, it is important to look at what may prevent a man from even recognizing the signs that he is depressed. Researchers and practitioners have written about the differences that exist in the experience and display of mood across gender. In men, depression can sometimes be exhibited as anger, which often does not throw up any “red flags,”

Depression and Men

depending on the man in question. Anger and irritability in men are often overlooked as a product of stress or personality. Men are more likely “excused” for displaying such behaviors as they are often seen as a product of upbringing and are more socially acceptable than when displayed by women. The experience and display of anger in men are sometimes even seen as a “normal” or, at times, a “healthy” response. The idea that men are “supposed to be” angry can sometimes be seen as a testament to their manhood. Young boys are even socialized to believe that anger and joy (and variations of these two emotions) are the only feelings that should be expressed publicly. Men experience depression for myriad reasons, similar to their female counterparts. Recent research has posited that men become depressed due to a number of factors, including failing relationships, issues with children, stress on the job, financial hardship, questions concerning retirement, and health concerns. Women may experience depression for similar reasons, but it is not entirely clear as to why both the expression and the rates of depression have such uniquely observable differences. As stated earlier, often men display symptoms such as anger, hostility, irritability, thrill seeking, and somatization. Somatization, or displaying physical symptoms related to feelings, often takes the form of headaches and gastrointestinal issues in men. It has even been argued that the higher rates of alcoholism and substance use in men may actually be related to expressions of depressed mood. Although men may experience depression somewhat differently than women, oftentimes the results of ignoring these symptoms and the overarching depression remain similar.

Future Work As is the case with most illnesses, ignoring symptoms and, in turn, the issue at hand can often lead to exacerbation or increase in the severity of the illness. Mental illness is no exception. Regarding depression, failure to seek treatment may result in the feelings of sadness and isolation worsening, as well as the introduction of new symptoms. Recent studies have posited that failure to treat depression in men may lead to sexual dysfunction, heart disease, inability to function at work, and increased

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feelings of despair. Behaviorally for men, failure to acknowledge and, in turn, treat depression may have a snowball effect that leads to consequences up to and including death. The effects of depression in men warrant more attention in the literature as well as in everyday conversation. Researchers and scholars can begin by looking at the expression of symptoms not typically attributed to clinical depression. It has already been established that many men exhibit signs of depression that fall outside the accepted spectrum related to depressed mood. Researchers should continue to look at the help-seeking behaviors of men regarding mental illness as a way to better understand what keeps this population in the shadows and away from mental health providers. To that end, work still remains in the area of stigma related to mental illness and, moreover, the stigma related to men who are depressed. Sidney Smith See also Depression and Gender; Gay Men and Health; Help-Seeking Behaviors and Men; Men and Aging; Men’s Group Therapy; Men’s Health; Men’s Issues: Overview

Further Readings Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. The American Psychologist, 58(1), 5–14. Bem, S. (1993). Lenses of gender: Transforming the debate on sexual inequality. New Haven, CT: Yale University Press. Branney, P., & White, A. (2008). Big boys don’t cry: Depression and men. Advances in Psychiatric Treatment, 14(4), 256–262. Horne, A., & Kiselica, M. S. (1999). Handbook of counseling boys and adolescent males: A practitioner’s guide. Thousand Oaks, CA: Sage. Kielholz, P. (1973). Psychosomatic aspects of depressive illness: Masked depression and somatic equivalents. In P. Kielholz (Ed.), Masked depression: An international symposium (pp. 11–13). Berne, Germany: Hans Huber. Mahalik, J. R., & Burns, S. M. (2011). Predicting health behaviors in young men that put them at risk for heart disease. Psychology of Men & Masculinity, 12, 1–12. Mahalik, J. R., Coley, R. L., Lombardi, C. M., Lynch, A. D., Markowitz, A., & Jaffee, S. R. (2013). Changes in health risk behaviors for males and females from

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early adolescence through early adulthood. Health Psychology, 32, 685–694. Shimanoff, S. (2009). Gender role theory. In S. Littlejohn & K. Foss (Eds.), Encyclopedia of communication theory (pp. 434–437). Thousand Oaks, CA: Sage.

Depression

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Women

Within the field of psychology, depression is primarily characterized by a persistent low mood, including sadness, irritability, and/or limited emotional range. Other symptoms of depression can include anhedonia (i.e., loss of interest in previously enjoyed activities); changes in appetite, sleep, or motor activity; or fatigue or energy loss. Psychological effects of depression include feelings of worthlessness, guilt, and/or hopelessness; suicidal ideation; or decreases in concentration. Some individuals may experience bodily aches and pains. Depressive episodes are often cyclical, with patterns of symptom remission and recurrence, although years of chronic low-grade depressed mood is possible as well. Overall, depression is known to influence thoughts, behaviors, and feelings, with functional impairments and an overall decreased sense of well-being. As with most mental disorders, depression is thought to present in individuals with genetic predispositions, environmental stressors, or, most commonly, a combination of both. Over the years, research has indicated that females tend to have higher prevalence rates of depression. This entry explores depression in women, with a discussion of key factors in female-specific etiology, including biological, developmental, and sociocultural ­etiological domains. The entry primarily focuses on women and depression in Westernized cultures, with a brief synopsis of racial identity, gender i­dentity, and sexual orientation diversity considerations.

Etiology Depression is twice as common in women as in men, a finding that is mostly consistent worldwide despite potential cultural differences. Interestingly, this sex difference seems to emerge during

adolescence. Ample research focus has been dedicated to understanding the underlying cause of this difference in rates of depression, but many of the findings have been inconclusive or have produced mixed results. A single causal variable has not been identified. Instead, a combination of biological, developmental, and sociocultural aspects likely influence the development of depression in women. Biological

A popular etiological notion is that the levels of female reproductive hormones, such as progesterone and estrogen, directly influence the ­development of depression in women. However, scientific evidence has not consistently supported this claim. Rather, researchers postulate that ovarian hormones indirectly influence depressive symptoms via serotonin (a common neurotransmitter linked to depression) networks, as well as changes to the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the stress response. Sex differences in the hippocampal region of the brain, an area that includes the hippocampus, amygdala, and prefrontal cortex, may also relate to sex differences in depression rates. This area of the brain is involved in emotions and memory and is crucial to the HPA axis regulatory processes. Hippocampal volume reductions have been implicated in depression and may be more common or pronounced in women. Developmental

Differences during developmental stages may also account for higher rates of depression in women. For instance, societal expectations to conform to traditional cisgender roles increase as a child moves through puberty. Gender differences in emotion expression begin in the preschool years and have been linked to socialization pressures. Girls are often socialized to internalize and convey submissive emotions, such as sadness and anxiety. Researchers have postulated that a tendency for boys to express anger may be related to the development of externalizing, dominant behaviors (e.g., hyperactivity, antisocial behavior, substance use), whereas the tendency for girls to express sadness and anxiety may be related to future internalizing behaviors (i.e., depressive symptoms). In addition,

Depression and Women

gender differences in coping with emotional experiences develop by adolescence, with girls responding to distress with patterns of rumination, or an inward focus on the feelings of distress versus finding potential solutions. Studies have shown that people who engage in ruminative patterns are more likely to develop depressive symptoms. Girls may experience decreases in opportunities and choices, as well as increased importance for physical appearance, all factors negatively associated with well-being. Furthermore, some researchers have found that girls experience more rigid parental restriction of behaviors than boys. In addition, social acceptance and popularity become more important to girls during puberty, which may negatively affect self-esteem and self-worth. Furthermore, negative self-concept may predict increases in depression, and some studies have indicated that girls tend to show poorer self-­ concept. As girls become more interpersonally oriented during adolescence and into adulthood, they become less attuned to their own needs and more focused on the needs of others. In addition, females may experience higher risk for depression due to conflicts in relationships, with several studies indicating that interpersonal stressors trigger depression more commonly in females. Increases in depression are associated with developmental stages involving menstruation, pregnancy/childbirth, and menopause. As previously discussed, the increase in depression during these phases is not due solely to changes in ovarian hormones. Instead, these changing levels of depression are likely reflective of the brain’s indirect response to the changes in hormone levels, through the HPA axis and serotonin networks. A number of psychosocial factors also influence the onset of depressive symptoms during periods of hormonal changes. For example, postpartum depression has been linked to social isolation, low social support, relational concerns, and lower levels of education. During menopause, which occurs in older adulthood, women may have health problems and other psychological concerns that increase their risk for depression. For example, having a serious physical health problem such as diabetes or mobility issues may make women more susceptible to feeling depressed about aging and being less active. In addition, depression has been linked to later

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cognitive impairment and dementia in older women specifically, who are disproportionately represented in higher numbers in the case of Alzheimer’s disease and some related diseases throughout later life. Sociocultural

Stressful life events can trigger depressive episodes, a widely accepted and empirically supported notion. From a sociocultural perspective, women experience a number of chronic strains that could contribute to higher rates of depression. For instance, women make less money than men, are more likely to live in poverty, and experience societal expectations to balance domestic work, child care, and a career. One study found that inequalities in workload in heterosexual relationships partially explained the gender difference in rates of depression. Furthermore, women more commonly face a number of other stressful life events, including lack of social power, sexual harassment in the  workforce, sexual abuse/assault, and partner-­ relational violence. Some feminist theory scholars argue that depression in women is incorrectly perceived as a medical condition and is primarily a reaction to the systematic oppression of women. Historically, women have been categorized as having inherent depressive issues associated with the female reproductive organs. Specifically, hysteria was the term used to describe patterns of neurological problems due to the presence of the uterus. In medieval times, such symptoms were even credited to the demonic possession of women. The notion that women have “raging hormones” and unpredictable bouts of emotionality can perpetuate the stereotype of the highly emotional, irrational female. In addition, some argue that depression diagnoses pathologize the female experience, with normative feminine behaviors, such as displays of emotion, being seen as symptoms requiring eradication. Traditional biomedical and psychological theories of depression in women may undermine the sociocultural impact of political, economic, and social aspects of a woman’s experience in the world. Given these arguments, it is important to include sociocultural gender aspects in the conceptualization of depression in women.

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Depression and Women

Diversity Considerations Depression is found in every culture and race and does not discriminate based on sex, gender, or sexual orientation. Consideration of diversity differences in depression rates, including sexuality (lesbian, gay, bisexual [LGB]), gender identity, and race, is crucial. Mental health issues among lesbian and bisexual (LB) women should be considered with caution. In the 1960s, homosexuality was classified as a psychological disorder, and the stigmatization of this notion left a lasting impression. When examining the differences in prevalence rates of depression among LB women, it is important to recognize potential underlying reasons and to avoid equating mental health concerns with identifying as LB. For instance, lesbian women may experience additional stressful life events compared with heterosexual women, including prejudice, social exclusion, and discrimination based on sexual orientation. A recent study found that depression was at least 1.5 times more common in LGB individuals, with LB women showing a higher risk for substance abuse. Ilan H. Meyer created a conceptual framework for understanding mental health issues in LGB individuals. This model builds on the common notion that stress, or physical, mental, or emotional strain, can lead to psychological disorders. The model incorporates the theory of minority stress, or the strain that individuals experience due to being a member of a minority group. Meyer postulates that mental health is affected by minority stress for LGB individuals, including external stressful events, expectations of these events and vigilance due to the expectation, and internalized negative messages from society. Within this model, experiences of prejudice, predicted rejection, concealment of sexual identity, and internalized negative attitudes about sexual orientation can lead to problems such as depression. Male-to-female transgender (trans) women also experience high rates of depression, with exact rates varying across studies. One study found an estimated prevalence of depression of 61.2% among trans women. Minority stress is likely to affect trans women, with societal lack of knowledge of the trans community and discrimination against individuals who do not conform to traditional gender norms. In addition, trans women may experience prejudice and discrimination in the

workforce, housing, and health care, which may lead to poverty, homelessness, and poor health, all known predictors of depression. Social support is a well-known protective factor for depression and other mental health concerns. Trans women may experience high rates of social isolation and rejection, as well as limited support from family. Some research has shown that depression may decrease in male-to-female women following hormone therapy and sex reassignment surgery, whereas other research has identified an increase in depressive symptoms. The psychological effect of medical interventions for sex reassignment in trans women depends on other factors, such as social support and internalized messages of acceptance/rejection, but this requires more research focus. Racial considerations are also necessary when discussing depression in women. From a minority stress perspective, racial minorities face added strain that is chronic and deeply engrained in oppressive societal processes and methods of institutionalized racism. An important theory that has emerged from feminism literature is intersectionalism, or the overlap of multiple minority identities and oppression. Intersectionalism can help one understand the experience of individuals with multiple minority identities, including racial minority women. Although studies have shown that women with lower socioeconomic status are at increased risk for depression, more research is needed to fully address the effects of this intersection of race, socioeconomic status, and gender. Non-genderspecific epidemiological studies have shown that White and Hispanic individuals may be more at risk for depression whereas African American individuals may be more at risk for a combination of depression and other mental health concerns. Research has also shown that racial minority women and women with lower socioeconomic status are less likely to receive care for mental health concerns, including depression. Rachel H. Messer and Elizabeth Devon Eldridge See also Biological Sex and Mental Health Outcomes; Bipolar Disorder and Gender; Cognitive Disorders in Women; Depression and Gender; Depression and Men; Emotions in Adolescence and Gender; Help-Seeking Behaviors and Women; Postpartum Depression

Developmental and Biological Processes: Overview

Further Readings Chaplin, T. M., Cole, P. M., & Zahn-Waxler, C. (2005). Parental socialization of emotion expression: Gender differences and relations to child adjustment. Emotion, 5(1), 80–88. Kessler, R. C. (2003). Epidemiology of women and depression. Journal of Affective Disorders, 74(1), 5–13. King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 70. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. Naninck, E. F. G., Lucassen, P. J., & Bakker, J. (2011). Sex differences in adolescent depression: Do sex hormones determine vulnerability? Journal of Neuroendocrinology, 23(5), 383–392. Noble, R. E. (2005). Depression in women. Metabolism, 54(5), 49–52. Nolen-Hoeksema, S. (2001). Gender differences in depression. Current Directions in Psychological Science, 10(5), 173–176. Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., & Gillman, M. W. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221–227. Rotondi, N. K., Bauer, G. R., Travers, R., Travers, A., Scanlon, K., & Kaay, M. (2012). Depression in maleto-female transgender Ontarians: Results from the Trans PULSE Project. Canadian Journal of Community Mental Health, 30(2), 113–133. Ussher, J. M. (2010). Are we medicalizing women’s misery? A critical review of women’s higher rates of reported depression. Feminism & Psychology, 20(1), 9–35.

Developmental and Biological Processes: Overview The terms sex and gender are used interchangeably to categorize an individual as a female or a male. The definitions of “sex” and “gender” are actually quite complicated and at times unrelated—as

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biological sex does not always dictate gender. In simplest terms, sex refers to one’s physiological makeup (e.g., sex chromosomes, reproductive hormones, reproductive body parts), whereas gender is socialized by cultural expectations of sex-typical roles and behavior. People who identify with the sex they were assigned at birth (e.g., a man who was born with male reproductive parts) may be categorized as cisgender, whereas a transgender or gender nonconforming person is someone whose assigned birth sex does not match their gender identity. In humans, sex can be defined by two fundamental components: (1) chromosomal sex and (2) hormonal sex. Chromosomal sex strictly refers to the inheritance of an XX (female) genetic profile versus an XY (male). Hormonal sex programs the production of sex-specific steroid hormones. Following the genetic map, once the chromosomal sex has been determined, gonadal sex is differentiated, and development of ovaries proceeds in females, while development of testes proceeds in males. The differentiation of the male phenotype is initiated by the presence of the sex-determining region in the Y chromosome. This gene encodes for the testes-determining factor, which activates a cas­ cade of reactions for the differentiation of testes from the cells in the germinal ridge of an embryo. When the Y chromosome is not present, the germinal ridge cells will differentiate into ovaries. The presence of these gonads generates the hormonal sex, which differentiates the internal sexual organs of each sex. In males, the presence of the testes results in the secretion of testosterone and the anti-­ Müllerian hormone, supporting the differentiation of the Wolffian system and the development of male internal organs. In females, the ovaries secrete estrogen, resulting in the differentiation of the Müllerian system and the development of the female internal reproductive organs. Chromosomal sex determination and hormonal sex differentiation combined lead the way to a ­cascade of biological reactions that yield the phenotypical sex. In males who do not have any anomalies affecting the secretion of testosterone, the enzymes necessary to produce and metabolize testosterone will produce enough of the hormone and its metabolites, like dihydrotestosterone (DHT), to support the development of a scrotum and penis; estrogen facilitates the development of a vagina

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and clitoris. As noted, the genetic absence or presence of the Y chromosome determines sexual differentiation of the gonads and hormones that ­dictate the development of sexual organs’ feminine or masculine features along with typical genderspecific behaviors that arise as a result of the feminizing and masculinization of the brain. Selective mutations could result in either chromosomal or hormonal anomalies, which lead to genetic variations that affect a series of events resulting in incomplete or partial masculinization in chromosomal males and females. Throughout the life span of these individuals, the question of gender may become more of a pressing issue, relying on selfpreference or just gender identity. Importantly, gonadal hormones exert their organizational effects on the brain, meaning they can permanently change the way the brain communicates. Both testosterone and estrogen play a significant role in neuronal structure, neural communication, and brain maturation. Evidence for this is observed in the organization of sexually dimorphic neural structures and physiology that result in the expression of gendertypical behaviors in men and women. Gender is independent of biological origins, since it describes an internal perception of self and defines the gender identity of an individual. Most of the time, sex and gender do coincide, and the exhibited behaviors are usually influenced by environmental, social, and/or cultural norms. In today’s world, whether official, legal, or not, individuals identify with an ample body of terms that define their current chromosomal sex aligned with a superimposed sexual gender.

Neural and Developmental Sex Differences The term sexual dimorphism often refers to the phenotypic differences between males and females, such as that of the reproductive organs. Sexual dimorphism is limited not only to male and female genitalia but also to differences in physiology, the nervous system, phenotype, and behavioral expression. Many of these gender-typical characteristics may be traced to the anatomical differences between the male and female brains. Although not significantly different in overall size, there are several neural structures with distinct characteristics that are significantly different in the male and female brains.

Many studies suggest that the organizational effects of hormones sustain sexual dimorphisms in the brain. Males often have larger brains than females; some studies report a size difference of about 10%. Size is only one characteristic that makes the male and female brains different. The human brain is divided into left and right hemispheres, often thought of as individual brains. The left hemisphere is often called the analytical half, whereas the right is known as the creative half of the brain. These “two” brains are connected by a large white matter tract called the corpus callosum. Although both males and females have two hemispheres, the corpus callosum is larger in females. Whereas the female brain has a substantial amount of cross-talk through the corpus callosum, the male brain is more lateralized in communication. There are several structures that are sexually dimorphic, most of which are found in the hypothalamus (the endocrine pacemaker in the brain). The sexually dimorphic nucleus of the preoptic area, SDN-POA, is a collection of large cells within the hypothalamus. It has been shown to play a role in social behaviors, specifically reproductive behaviors, in the rat brain. This area is often five times larger in males than in females. Perinatal and adolescent release of gonadal hormones plays a significant role in this difference; hence, it is also an example of the organizational effects of gonadal hormones. Females subjected to androgens early in life will develop a larger SDN-POA, more typical of the size found in males. Subjecting a male to excess estrogens or decreasing the amount of androgens, through castration, for example, decreases the size of the SDN-POA. Thus, it is believed that androgens promote neurogenesis, whereas estrogens stimulate apoptosis, or cell death, in this region of the brain. The amygdala, located in the temporal lobes, is primarily responsible for memory and emotional reactions. Males have a larger amygdala, approximately 1.5 times the size of its female counterpart. DHT, a steroid more common in males, increases the size of the amygdala. Positive emission tomography, which utilizes glucose to monitor the levels of blood flow in different areas, has shown that males use the right amygdala more often, whereas women use the left amygdala. Interestingly, the pattern of usage of the amygdala in homosexual males closely resembles that of heterosexual females. Although the amygdala is larger in males,

Developmental and Biological Processes: Overview

females often make stronger connections, which translates into increased retention of memories. These organizational changes that occur during development, particularly during adolescence, can result in the manifestation of mental health disorders like depression in females and schizophrenia in males. These are just three examples of sexually dimorphic nuclei that are involved in the regulation of social behaviors and go through significant restructuring during adolescence to facilitate the transition from childhood to adulthood. These are also neural structures that contribute to emotional perception and regulation, which are oftentimes described as sexually dimorphic. Nevertheless, as we continue to understand sex and gender differences, we see that they are not limited to just the brain but also to the rest of the body physiology.

Behavioral Sex Differences Sensory Systems

There are significant differences between men and women when it comes to the organization, perception, and characteristics of their sensory systems. Of course, there are considerable differences between individuals of the same sex, most of the time more so than with those of the opposite sex. Effect size is a measure of the variation between sexes corrected for the variation within each sex. It is classified into small, moderate, or large, based on the average differences relative to the standard deviation for that sex group. For example, aggression and rough-and-tumble play have a moderate effect size, being more prevalent in males than in females. It has been shown that early exposure to androgens, such as that which occurs in males, affects the expression of rough-and-tumble play. Interestingly, pseudohermaphrodites—those who are born with the primary sex characteristics of one sex but the secondary characteristics of the other—show levels of play that are intermediate between males and females. There are considerable differences in the sensory systems, which are also driven by sex. Olfaction is the process by which we sense and perceive odors. Females have 1,000 more olfactory receptors and are more sensitive to musk-like odors when compared with males. This phenomenon begins during puberty and is thus likely linked to

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estrogen. Female brains show more activation in the areas related to olfaction, such as the piriform cortex and amygdala. Consequently, females experience more positive reinforcement from certain odors, such as a better mood. This is most likely due to the role that the amygdala plays in olfaction and emotion. The olfactory system is key for chemosensory processing and can be associated with clinical anomalies when anomalies occur. Kallmann’s syndrome is a disorder that mainly affects males. It is characterized by failure of the gonadotropinreleasing (GnRH) neurons to migrate to the hypothalamus, their final destination. Individuals with this syndrome usually have altered olfaction or anosmia, a complete lack of smell. Taste sensation detects the chemicals dissolved in a solution in anything placed inside our oral cavity. Females, once again, are more sensitive to taste than males. This phenomenon often starts in puberty and becomes even stronger during pregnancy, likely due to increased levels of hormones in the circulation during gestation. This can also be thought of as a protective mechanism for the mother to detect anything that she is not supposed to consume in her food. Estrogen is often associated with a desire for sweet foods, whereas testosterone is associated with a preference for salty foods. Some suggest a correlation between mothers who are pregnant with a girl and crave sweet foods and those who are carrying a boy and yearn for salty foods. These findings are inconsistent, however. Nevertheless, females do have a more refined gustatory sensory system when compared with men. There are differences in the auditory sensory system between males and females as well. Females are more sensitive to auditory stimulation; however, unlike in the case of olfaction or gustation, this difference occurs at a much younger age, typically between 12 and 14 weeks. At this age, females are more responsive to auditory stimuli, whereas males respond more to visual stimuli, as will be discussed later. Evoked otoacoustic emissions are noninvasive tests often used in children who are too young to participate in standard hearing exams. This test measures the evoked frequency in response to specific stimuli. It is often utilized not only to search for hearing defects in younger children but also to study auditory differences between genders. Based on evoked otoacoustic emissions,

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females have been shown to be more responsive. Furthermore, these auditory sensitivities may be used as a predictor of homosexuality in twins. Homosexual males typically have responses closer to those of heterosexual females and can make the same distinctions to the evoked optoacoustic emissions. The visual system as a sensory processing system is an extensive process where light is transduced into electrochemical signals and ultimately perceived by the occipital cortex of the brain, projecting to the temporal and parietal lobes to provide information on object recognition, color ­distinction, and spatial information, among others. Males respond to visual information more so than females. This phenomenon starts at a young age and continues well into adulthood. Males have approximately 20% more neurons dedicated to vision. This is likely related to DHT, which plays a key role in regulating apoptosis, or cell death, in the visual system. The organization of the visual system is dependent on gonadal hormones during the critical periods of brain development, perinatally and on pubertal onset. Cognition

Dogma has described the right hemisphere of the brain as more involved in spatial processing and the left in verbal processing. As previously mentioned, males show more neural l­ ateralization— that is, they tend to use the neural structures found in one hemisphere of the brain more often than the other while processing information—whereas females typically show more symmetrical usage. One can hypothesize that the neural structures that connect the right and left hemispheres are larger in females than in males, as well as the structures associated with speech, language, communication, and emotional processing. For example, the corpus callosum, the white matter that connects the right and left hemispheres, is larger in females than in males. There are several differences in cognitive function between the sexes. Females are typically better at verbal skills, whereas males have better mathematical reasoning and visuospatial abilities. This may be attributed to the lateralized male function of the brain when compared with the female brain, which has more cross-talk between neural

structures. Nevertheless, even though males and females possess what we as a society may categorize as male- and female-typical attributes, they still have the ability to perform behaviors that we may consider are predominantly presented in the opposite sex. For example, females outperform males in manual tasks that require fine motor function, but males often have better targetdirected motor skills (e.g., hitting a bull’s eye on a target). Females are better at performing mathematical calculations, whereas males are better at mathematical reasoning. Sex differences are manifested early on in development and can even be observed in play behavior at a very young age. Young males often choose to play with vehicles and building blocks, whereas young females choose to play with dolls. This phenomenon can also be observed in nonhuman primates. Male and female monkeys offered toys to play with display preferences based on gender, just like human subjects; so these behaviors are not exclusive to human beings. Around the age of 6 years, boys, when asked to pick colored crayons to draw something, tend to choose “cold” colors, such as gray and blue, whereas girls often use “warm” colors, such as pink, red, and yellow. They also tend to draw different images. Boys tend to draw aerial views of buildings, streets, buses, or cars. Girls prefer to draw a house with flowers and a sun. When there are chromosomal or hormonal anomalies that affect the physiology of the individual, differences in these preferences and aberrant cognitive behaviors may be observed. Patient populations such as chromosomal females with congenital adrenal hyperplasia, who were exposed to excess androgens, tend to display male-typical behaviors and sometimes choose to live their lives as males, whereas chromosomal males who have nonfunctional androgen receptors and complete androgen insensitivity syndrome may choose to live their lives as women and engage in what we classify as female-typical behaviors. Gender Role and Identity

Gender roles are learned early in life; they are the sex-specific behavioral patterns that males or females are expected to follow, based on their cultural environment. Unlike gender identities, gender roles are learned. For example, 5-alpha reductase

Developmental and Biological Processes: Overview

is an enzyme utilized in steroid metabolism; notably it converts testosterone to DHT. Males, with a genotype of XY, who have a deficiency of 5-alpha reductase have ambiguous genitalia (a micropenis and undescended testes) early in life. During this time, they are often reared as girls. During puberty, the levels of this hormone increases, and their genitalia mature (the testes may descend). That is to say, there is a significant testosterone increase, and therefore, although they are being reared as girls, they begin to develop secondary sexual characteristics associated with males. Often, even when these individuals have spent the early part of their lives living as girls, they can make a successful transition to living as men because of the surge in testosterone. Gender identity is the process by which individuals come to view themselves as either male or female. It is not so much a learned behavior as it is what a person knows they are. It is established by 2 years of age and is irreversible after that. Gender identity can be affected by parental influences but is not dictated by them. For example, a study focused on Guevodoces, genotypical males with 5-alpha reductase deficiency who “grew a penis” (described earlier) only at the age of puberty, found that they were often raised as girls by their families but many identified as a male throughout childhood and after puberty. Sexual Orientation

Sexual preference is an outdated term that indicates a lifestyle choice, whereas sexual orientation is often not thought of as “chosen.” Rather, sexual orientation is dictated by biological factors. Although evidence is still inconclusive, one hypothesis is that the concentrations of certain hormones differ in heterosexual and homosexual individuals. For example, heterosexual males and homosexual females have higher concentrations of testosterone and are thus attracted to women. On the other hand, heterosexual females and homosexual males have lower levels of testosterone and higher levels of estrogen and are attracted to males. Some have proposed the 2D:4D digit ratio hypothesis, whereby the length of the index and ring fingers, respectively, are measured. If the ring finger is longer from the crease of the hand (bottom) to the tip of the finger when compared with the index finger,

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then it suggests that the fetus was exposed to higher levels of androgens in utero. This implies that women would have higher finger ratios than men. Studies have shown that homosexual men and transgendered male-to-female people have 2D:4D ratios more similar to heterosexual females than to heterosexual males. These studies have been done in humans, nonhuman primates, and rodent models of chromosomal anomalies that lead to hormonal anomalies, and the findings are consistent. Regulation feedback mechanisms may play a role in these differing hormone concentrations. Homosexual males may have a negative feedback loop to GnRH, decreasing their levels of testosterone compared with their heterosexual counterparts. In addition, if homosexual males are exposed to estrogen, their neural activity is the same as that of a heterosexual female. In addition, neural structures like the bed nucleus of the stria terminalis and the insterstitial nucleus of the hypothalamus have been identified as sexually dimorphic between males and females; however, these subnuclei have been identified to be similar in size in heterosexual females and homosexual males. One hypothesis would be that the differential effects of gonadal hormones on the brain could contribute to these morphological and biochemical differences. By definition, sexual orientation refers to whom an individual is attracted to and/or engages in romantic/intimate relationships with, whereas sexual identity is how an individual views themselves as being male or female. Sexual orientation and sexual identity are regulated differently by hormones and neural structures. There have been a few studies focused on understanding the biological underpinnings of gender dysphoria, which is what transgender individuals are diagnosed with during the process of transition. One study determined that transgender individuals have levels of hormones consistent with the gender they were assigned at birth, not following the same hormonal hypothesis as for individuals who are gay or lesbian. Interestingly, however, it has been shown that testosterone treatment in female-to-male transgender men decreases the gray matter in cortical regions related to language and speech. This is consistent with the findings that the female-tomale transition comes with behavioral and cognitive changes, specifically the loss of verbal fluency,

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a female-typical characteristic. Nevertheless, when one identifies gender dysphoria early, the American Academy of Pediatrics has recommended pubertal suppression with treatment of GnRH analogs to allow the individual time to transition with the support of mental health professionals and physicians. Full transition, including gender reassignment surgery and significant hormone treatment, is recommended in early adulthood and has been found to have good mental and physical health outcomes.

Sex Differences in Mental Health Because of the neurochemical and neuroanatomical differences of the male and female brains, each sex is vulnerable to different psychopathologies. Although women tend to experience the affective disorders more than men, like depression and body image disorders, men tend to suffer from attentiondeficit disorder, schizophrenia, and autism more than women. The underlying pathology of some of these conditions is due to circulating levels, or the lack, of hormones during the onset of sensitive developmental periods. Hormones and adolescence can be variables for vulnerabilities to drug addictions, mental health disorders, and pathologies related to a person’s physiological makeup. Hence, it is critical to further understand how sex and gender, and all of the variables that contribute to them, like genes and hormones, can affect mental health, and proposed treatments or therapeutic agents.

Sex Differences: What Does This Mean? Today, society is generally willing to appreciate that it is not just how a person behaves or how they look that defines who they are and how they identify. It is a marriage of myriad characteristics, through experience, genes, and neural networks, that can bring forth an individual’s sex and gender. Treatments and therapeutics have been designed and health care decisions made based on these characteristics. However, significant strides need to be made in understanding the biological processes of sex and gender and how they contribute to both neural and behavioral development. As society continues to encourage both males and females to

engage in what was once considered sex-typical behaviors, researchers will have to continue to ask whether hormones and the neural structures are affected by these experiential variables and how these contribute to sex and gender. Kaliris Salas-Ramirez, Silvia Perez, and Hesham Saleh See also Adlerian Theories of Gender Development; Behavioral Theories of Gender Development; Biological Sex and Cognitive Development; Biological Sex and Health Outcomes; Biological Sex and Mental Health Outcomes; Biological Sex and Social Development

Further Readings Bailey, J. M., Vasey, P. L., Diamond, L. M., Breedlove, S. M., Vilain, E., & Epprecht, M. (2016). Sexual orientation, controversy, and science. Psychological Science in the Public Interest, 17(2), 45–101. doi:10.1177/1529100616637616 Bao, A. M., & Swaab, D. F. (2011). Sexual differentiation of the human brain: Relation to gender identity, sexual orientation and neuropsychiatric disorders. Frontiers in Neuroendocrinology, 32(2), 214–226. doi:10.1016/ j.yfrne.2011.02.007 Becker, J. B., McClellan, M. L., & Reed, B. G. (2017). Sex differences, gender and addiction. Journal of Neuroscience Research, 95(1/2), 136–147. doi:10.1002/ jnr.23963 Breedlove, S. M. (2010). Minireview: Organizational hypothesis: Instances of the fingerpost. Endocrinology, 151(9), 4116–4122. doi:10.1210/en.2010-0041 Cahill, L., & Aswad, D. (2015). Sex influences on the brain: An issue whose time has come. Neuron, 88(6), 1084–1085. doi:10.1016/j.neuron.2015.11.021 de Vries, G. J., & Forger, N. G. (2015). Sex differences in the brain: A whole body perspective. Biology of Sex Differences, 6, 15. doi:10.1186/s13293015-0032-z Frings, L., Wagner, K., Unterrainer, J., Spreer, J., Halsband, U., & Schulze-Bonhage, A. (2006). Gender-related differences in lateralization of hippocampal activation and cognitive strategy. Neuroreport, 17(4), 417–421. doi:10.1097/01.wnr.0000203623.02082.e3 Gobrogge, K. L., Breedlove, S. M., & Klump, K. L. (2008). Genetic and environmental influences on 2D:4D finger length ratios: A study of monozygotic and dizygotic male and female twins. Archives of

Dialectical Behavior Therapy and Gender Sexual Behavior, 37(1), 112–118. doi:10.1007/ s10508-007-9272-2 Hamann, S. (2005). Sex differences in the responses of the human amygdala. Neuroscientist, 11(4), 288–293. doi:10.1177/1073858404271981 Hines, M., Constantinescu, M., & Spencer, D. (2015). Early androgen exposure and human gender development. Biology of Sex Differences, 6, 3. doi:10.1186/s13293-015-0022-1 Koscik, T., Bechara, A., & Tranel, D. (2010). Sex-related functional asymmetry in the limbic brain. Neuropsychopharmacology, 35(1), 340–341. doi:10.1038/npp.2009.122 Miller, L. R., Marks, C., Becker, J. B., Hurn, P. D., Chen, W. J., Woodruff, T., . . . Clayton, J. A. (2016). Considering sex as a biological variable in preclinical research. FASEB Journal, 31(1), 29–34. doi:10.1096/ fj.201600781R Pfannkuche, K. A., Bouma, A., & Groothuis, T. G. (2009). Does testosterone affect lateralization of brain and behaviour? A meta-analysis in humans and other animal species. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1519), 929–942. doi:10.1098/rstb.2008.0282 Schulz, K. M., & Sisk, C. L. (2016). The organizing actions of adolescent gonadal steroid hormones on brain and behavioral development. Neuroscience and Biobehavioral Reviews, 70, 148–158. doi:10.1016/ j.neubiorev.2016.07.036 Sisk, C. L. (2016). Hormone-dependent adolescent organization of socio-sexual behaviors in mammals. Current Opinion in Neurobiology, 38, 63–68. doi:10.1016/j.conb.2016.02.004 Stevens, J. S., & Hamann, S. (2012). Sex differences in brain activation to emotional stimuli: A meta-analysis of neuroimaging studies. Neuropsychologia, 50(7), 1578–1593. doi:10.1016/j.neuropsychologia .2012.03.011 Sutterer, M. J., Koscik, T. R., & Tranel, D. (2015). Sexrelated functional asymmetry of the ventromedial prefrontal cortex in regard to decision-making under risk and ambiguity. Neuropsychologia, 75, 265–273. doi:10.1016/j.neuropsychologia.2015.06.015

Dialectical Behavior Therapy  and Gender Dialectical behavior therapy (DBT) is a comprehensive psychotherapy that was initially developed

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to treat borderline personality disorder (BPD) and related suicidal behaviors. With more than a dozen randomized controlled trials investigating its efficacy, DBT is considered an evidence-based, empirically supported treatment for BPD, suicidality, and intentional self-injury. Among current therapies developed to treat BPD and related behaviors, DBT is the most widely studied in clinical trials and most widely utilized by clinicians. The purpose of this entry is to examine DBT in relation to gender. To do so, the entry will first review the diagnostic criteria for BPD and explore the prevalence of BPD across genders in community versus clinical populations. Next, it will provide a brief overview of DBT principles and components, examine the gender composition of samples included in DBT clinical trials, and discuss the ways in which DBT addresses gender in clinical populations.

Borderline Personality Disorder Definition, Diagnostic Criteria, and Related Impairment

BPD is characterized by a pervasive pattern of maladaptive impulsivity, as well as instability in affect, interpersonal relationships, and identity. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), at least five of the following nine symptoms must be present for an individual to meet the criteria for BPD: (1) extreme actions to avoid abandonment by others, (2) volatile relationships (with feelings that may quickly vary from intense love to hostility), (3) unsteady sense of identity, (4) harmful impulsivity in two or more areas (e.g., binge eating, substance abuse, risky sexual behavior), (5) repeated suicidal or self-injurious urges or behavior, (6) frequent and intense mood swings (sometimes lasting only a few hours), (7) a persistent sense of emptiness, (8) frequent feelings of extreme anger or displays of anger, and (9) temporary paranoid or dissociative symptoms when under stress. BPD is associated with intense psychological pain and functional impairment, including extensive psychiatric comorbidity, poor occupational performance, increased involvement in the criminal justice system, and elevated health care utilization. In addition, approximately 60% to 80% of

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individuals meeting the criteria for BPD engage in deliberate self-injury, and 8% to 10% die by suicide. Prevalence Across Genders

Community research shows that the lifetime prevalence of BPD in the United States is approximately 6%. In other words, 6% of individuals in the United States will meet the criteria for BPD during their lifetimes. The estimated prevalence of BPD in clinical populations (i.e., individuals attending psychotherapy) is slightly higher; up to 11% of individuals receiving outpatient therapy and 20% of those receiving inpatient treatment meet the criteria for a BPD diagnosis. For many decades, BPD was thought to be a disorder that predominantly affected women, as most individuals diagnosed and treated for BPD in clinical samples were women (i.e., up to 77%). In fact, several researchers and clinicians speculated that the diagnostic criteria for BPD simply reflected an exaggeration of characteristics that were socially acceptable for women but were unacceptable for men. However, beginning in the early 2000s, standardized research of the general population found that prevalence rates of BPD were no different in men than in women. In other words, in the general population, men are just as likely to meet the criteria for BPD as women. These findings led many researchers to speculate as to what might explain the difference between gender rates of BPD in the general population versus clinical populations. Although mental health professionals have explored several plausible theories, two explanations have received substantial support from a variety of research studies. In the first explanation, the disproportionate representation of women in clinical samples is due to selection or sample bias. Women are more likely to seek treatment for mental health issues than men, and this gender difference becomes even more pronounced when seeking mental health services for emotion-related difficulties (e.g., BPD) versus behavior-related difficulties (e.g., substance use disorders). Therefore, the overrepresentation of women diagnosed with BPD in clinical populations may be explained partially by the disproportionate number of women seeking treatment for BPD in clinical populations.

The second explanation for gender differences in clinical samples suggests a diagnostic bias. Research shows that women are more likely to be diagnosed with BPD than men, even when women and men report the same symptoms (with men being more likely to receive diagnoses of mood disorders, antisocial personality disorder, or narcissistic personality disorder—depending on the study and the presentation of symptoms). This diagnostic bias may be related to the still widely held misconception that BPD primarily affects women and/ or the socially constructed view of emotional reactivity as characteristically female. Regardless, due to some combination of selection/sample biases, diagnostic biases, and potential additional factors, treatments that focus on BPD are often attended primarily by women.

Principles and Components of DBT DBT is a comprehensive treatment that integrates aspects of cognitive behavioral therapy with zen mindfulness practice and dialectical philosophy. Dialectics involve the act of finding a balance or synthesis between two seemingly opposing positions. The central dialectic in DBT is the balance between acceptance and change. The DBT therapist works to accept and validate the client as the client currently is, while also helping the client make the changes necessary for achieving valued goals. This dialectic between acceptance and change is also taught directly to clients through the simultaneous teaching of (a) methods to help them accept themselves and the world as they actually are and (b) skills to change their behavior and their lives. DBT skills training includes four primary modules: (1) core mindfulness, (2) interpersonal effectiveness, (3) emotion regulation, and (4) distress tolerance. Although therapy sessions are structured to help clients survive their suicidal urges and impulses, the overall goal of DBT is not just to help clients survive. Instead, the goal is to help each client build a life worth living. All skills and components of DBT are ultimately geared toward the fulfillment of this overall goal. DBT’s conceptualization of BPD is based on biosocial theory, which has been supported by extensive research. According to biosocial theory, the emotional and behavioral dysregulation central to BPD is the result of a transaction between a

Dialectical Behavior Therapy and Gender

biological tendency toward emotional vulnerability and an invalidating childhood environment. An invalidating childhood environment is one in which important caregivers consistently fail to provide acknowledgment, understanding, and respect in response to the person and the person’s emotions. Such environments often fail to reinforce adaptive behaviors (e.g., regulation of emotions) and instead reinforce maladaptive behaviors (e.g., angry outbursts, threats of suicide). Thus, the biosocial conceptualization views clients’ maladaptive behaviors as understandable reactions to long-term environmental reinforcers. To decrease the client’s engagement in these maladaptive behaviors, DBT provides a nonjudgmental, validating environment in which to teach, shape, and reinforce new, more adaptive ways of coping. DBT involves four therapeutic components: (1) in­­dividual therapy sessions, (2) weekly skills training groups, (3) between-session coaching calls (provided as needed), and (4) therapist consultation groups. The individual sessions, training groups, and coaching calls serve to increase capabilities, enhance motivation, encourage generalization of skills to the natural environment, and ­create structural reinforcers of adaptive behaviors. The consultation group serves to enhance therapists’ abilities to treat clients effectively, while also decreasing the chances of therapist burnout. Notably, some treatment providers offer components of DBT without including all four modes of treatment; however, such services do not reflect the comprehensive treatment that has been studied in most randomized clinical trials. Substantial evidence has shown that comprehensive DBT (i.e., including all four modes of treatment) decreases the frequency and medical severity of suicide attempts and self-injurious behaviors, while also reducing hospitalizations and treatment dropout rates. Some studies have also found DBT to reduce hopelessness, depressive symptoms, and overall suicidal ideation. Although DBT was originally developed as a therapy for adults with BPD and related suicidal behaviors, the treatment has also been adapted to target additional disorders and populations characterized by emotional and behavioral dysregulation. It is important to note that the vast majority of DBT studies have focused on individuals with BPD as their primary diagnosis; however, research

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has also begun investigating DBT modified to treat eating disorders, substance use disorders, aggression, attention-deficit/hyperactivity disorder, treatment-resistant depression, additional personality disorders, forensic populations, and ­ adolescents with suicidality and/or other disruptive behaviors. Overall, the results from evaluations of these adaptations have ranged from promising (eating disorders; adolescents) to mixed (substance use disorders); however, most adaptations need further research before efficacy can be fully determined.

Rates of Women and Men in Clinical Trials of DBT Randomized controlled trials are the most stringent method of investigating a treatment’s effects, and all randomized controlled trials of DBT targeting suicidal behaviors have consisted of samples that were entirely or almost entirely female. Randomized trials and quasi experiments of DBT customized for other disorders (i.e., binge eating) or modified for other populations (i.e., adolescents) have often recruited both women and men; however, females also tend to be disproportionately represented in these trials—with female participants constituting at least 75% of most samples. (Quasi experiments include trials that do not involve random assignment or selection, thus decreasing the certainty that any difference in effects between treatments are caused specifically by the treatments themselves.) Considering that research has shown equal rates of BPD in women and men in the general population, this disproportionate representation of women in DBT research is an area that deserves exploration. The unequal distribution of women in clinical trials of DBT can generally be explained by the same factors underlying the unequal distribution of women diagnosed with BPD in clinical samples. First, women are more likely than men to seek psychotherapy, especially for emotion-related issues; thus, women are more likely than men to attend clinical trials for BPD and related behaviors. Second, emotional reactivity is viewed by some as a characteristically female trait, and women are more likely than men to be diagnosed with BPD, even when men display similar symptoms. This diagnostic bias can lead more women

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than men to be referred to DBT trials by other providers. Finally, when DBT was developed by Marsha Linehan in the early 1990s, BPD was still widely considered to be a disorder primarily of women. Although the DBT treatment manual (published in 1993) discussed possible reasons for the overrepresentation of women meeting BPD criteria, it is natural that the first DBT trials recruited women, since BPD was thought to principally affect women. Even after community research suggested BPD to be equally represented in men and women, clinical trials often continued to focus specifically on women, largely because experience showed that the sample would consist predominantly of women even if attempts were made to recruit both genders. By recruiting only women, researchers were able to focus on a more homogeneous sample (i.e., a sample in which characteristics were more similar across participants), thereby increasing the ability to detect differences across treatment conditions. Notably, even in DBT studies that have included male participants, the small sample sizes and low number of male participants have generally limited any investigation of whether treatment outcome was affected by gender. Thus, gender effects have either been controlled as a covariate or not evaluated at all in most studies. Of note is the fact that the only DBT studies with entirely male samples have been conducted in forensic settings and have focused on the stereotypically male traits of aggression and disruptive behaviors. (These trials were quasi experiments and therefore require additional research before determining efficacy.) In addition, although DBT trials have not excluded participants who identified as lesbian, gay, bisexual, queer, or transgender (LGBQT), research has yet to investigate whether treatment compliance or outcome differs in LGBQT individuals. In fact, most studies failed to document whether LGBQT clients are even enrolled in treatment. Similarly, research has yet to evaluate whether modifications of components of DBT might improve efficacy based on gender or sexual orientation—or whether such modifications are even needed. Thus, investigations into the potential roles of gender and/or sexual orientation are strongly needed in DBT research.

DBT and Gender in Clinical Practice Despite the preponderance of DBT research focusing on women, DBT programs in clinical settings often include men, albeit at a much lower rate than women. Although the rate of men in DBT differs dramatically across programs and settings, treatment sites often report that men constitute up to 20% of clients receiving DBT, a rate that is not markedly different from the average percentage of men diagnosed with BPD in clinical samples. (Notably, rates of LGBQT individuals receiving DBT are rarely documented.) Some DBT programs offer separate skills training groups for women and men, with the rationale that clients will be more comfortable sharing intimate life details when surrounded by others of the same gender. Conversely, many other programs offer mixedgender skills groups, with the rationale that clients will be more likely to generalize skills if those skills are learned and practiced in an environment that more closely mirrors the natural environment (i.e., an environment that includes both women and men). As of 2015, research had not investigated whether separate or mixed-gender groups affected treatment outcome. However, despite the need for research on DBT in relation to gender, it is important to note that adherent DBT is routinely customized to fit the individual needs of a diverse array of clients. Throughout DBT, the therapist works with each client to define a life worth living based on that particular client’s values and then works with the client to take the steps necessary to build such a life—all while validating any difficulties the client might experience along the way. DBT is focused on understanding and accepting clients as they are, including the client’s experiences of gender, gender norms or beliefs, and sexual orientation. An adherent DBT therapist will discuss and validate each client’s emotions, reactions, and goals, including those related to gender or other areas of diversity. Maladaptive behaviors (i.e., self-injury) are defined and targeted not because they are judged as “bad” (or because the client is judged as “bad” when engaging in them) but because they interfere with creating a life that the client deems worth living. Thus, an effective DBT therapist considers gender and all of its related components when working with the client to create a case conceptualization,

Disability and Adolescence

to develop and modify treatment goals, and to implement the treatment—as well as when communicating with the client throughout the course of therapy. Although such individualization of treatment does not negate the need for research related to gender, it does demonstrate that DBT can at least partially address gender through its focus on each client’s specific values and goals. Regardless, research is needed to investigate the effects of gender on DBT compliance and outcomes. Peggilee Wupperman and Emily R. Edwards See also Behavioral Approaches and Gender; Borderline Personality Disorder and Gender; Personality Disorders and Gender Bias; Self-Injury and Gender; Suicide and Gender

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Bjorklund, P. (2006). No man’s land: Gender bias and social constructivism in the diagnosis of borderline personality disorder. Issues in Mental Health Nursing, 27(1), 3–23. Dimeff, L. A., & Koerner, K. (Eds.). (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. New York, NY: Guilford Press. Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., . . . Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69(4), 533–545. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press. Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). New York, NY: Guilford Press. Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., . . . Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.

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Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., . . . Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475–482. Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73–80. Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, B., & Silk, K. R. (2005). The McLean Study of Adult Development (MSAD): Overview and implications of the first six years of prospective follow-up. Journal of Personality Disorders, 19, 505–523.

Websites Behavioral Research and Therapy Clinics, DBT: http:// depts.washington.edu/uwbrtc/ Behavioral Tech, DBT Resources: http://behavioraltech .org/resources/ National Alliance on Mental Illness (NAMI), DBT Fact Sheet: http://www2.nami.org/factsheets/DBT_ factsheet.pdf

Disability

and

Adolescence

Disability and adolescence is an emerging topic for researchers studying social identity and disability as it intersects with gender and other prominent identity categories. This entry briefly introduces disability and adolescence research as it relates to the psychology of gender and discusses theoretical approaches pertinent to disability and adolescent identity development. The entry concludes with a discussion of the role disability plays in adolescent development and directions for future research.

Disability and Adolescence: Background and History Adolescence is a time when the developing person tries on and discards an innumerable amount of social identities. Adolescents may discard identities and peer groups as quickly as a pile of clothes. All adolescents are in the midst of trying to find a place in the world and a supportive peer group.

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For many adolescents with disabilities, this may be a substantially harder task. Research on stigma management notes the pressure of calls for a combination of downplaying and claiming disability to  manage a stigmatized identity. Many adolescents do not want to be seen as different from their peer group, or if they do, it is often a form of rebellion. Adolescents may be reluctant to identify as disabled or anything else that separates them from the status quo of the dominant peer group. At the same time, they may ask internal questions about their own disability status. For instance, in Nick Watson’s 2002 landmark study, adults with disabilities were reluctant to identify as disabled, despite long-term membership in the disability rights community. Reluctance to identify as disabled is also consistent with previous racial and cultural identity development models. The first stage, conformity and lack of social consciousness, refers to conformity and acceptance of dominant paradigms as a starting point of identity development. For developing adolescents, conforming to a chosen peer group helps them blend in and meet approval. In much of the research, people with disabilities report a sense of “growing up different,” which is often internalized. Despite having a disability and feeling different, parents often told them they were “normal” and negated their experiences, leading to further identity confusion. Within the Deaf community, Deaf people do not consider themselves disabled and consider deafness normal and an important cultural characteristic. This may be a result of immersion in the Deaf community and contact with others with the same or similar identity status. In Kathleen Bogart’s 2014 research on the differences between congenital and acquired disability, those with long-term disabilities were found to be better adapted than the newly disabled.

Adolescents With Disabilities and Vacillating Identity Status If adolescents accept their disability status, they are likely to face a great sense of dissonance since how they feel is not reflected in the dominant or popular culture. Early in their development, people with disabilities conform to rigid societal norms and do not question existing social structures that favor

one group over another. Oppression and stigma are accepted as the way things are, and negative beliefs about disability are internalized. For adolescents, this means assimilating to the dominant culture as much as possible by hiding or downplaying their disability. Adolescents may attempt to pass as nondisabled. They may feel inferior, with a generalized negative sense of self. They may also recognize conflicting cultural messages and the absence of positive role models in the media. Without questioning the dominant culture, people with disabilities remain immersed in the idea that their bodies and identities are shameful and something to be cured or hidden. Empirical research notes that persons with disabilities may face exacerbated feelings of shame and stigma. Sometimes this results in a generalized sense of low self-esteem, body image issues, or feeling ugly. Research often describes this as an aspect of development leading to integration. Disability is mediated through public and private spaces. This may include performances such as minimizing disability in an attempt to pass as nondisabled or exaggerating disability to ensure necessary accommodations. Aspects of disabled identity can be understood in terms of social learning and peer interactions. Internalized feelings of difference, beginning in adolescence, may continue throughout the life span. Relating to others may become increasingly difficult as people with disabilities withdraw from potentially judgmental interactions and situations. For example, friendships and intimate relationships can be shrouded by narratives about being “less than,” a burden, and less socially and sexually desirable. In the literature, adolescents are not proud of their disability at a dissonant stage of development. However, they do not want their disability denied. This creates a double bind. Despite a lack of self-confidence, having their ability status minimized or disregarded is an insult to their identity. Although adolescents may not be proud at this developmental stage, there is still a desire for acknowledgment and validation at this point. Adolescents with disabilities want their feelings and experiences validated, especially when they feel isolated from their peers: emotionally, physically, and psychologically. Depending on “tracking” at the intermediate and high school levels, adolescents with disabilities may not have any contact with disabled peers or may not have any

Disability and Adolescence

contact with nondisabled peers. Despite efforts to put students in the least restrictive environment, unintentional segregation still exists. For adolescents with disabilities, significant people in their lives often negate the presence of the disability and its impact on life experience. They may have to work through the dilemma of being told that their experiences are not real or are similarly invalidated. In the literature, these are referred to as “disorienting dilemmas” and encompass interruption, dissonance, and conflict regarding overt and covert messages received about ­disability from childhood, adolescence, and beyond. Adolescents with disabilities, even when they have not come to terms with the disability, may still want to be acknowledged as members of the disabled population. Although they do not want to necessarily be considered different, they do want others to realize that tasks of daily living are more difficult for them or that they have to struggle for independence in a way their peers do not. Like other minority populations, people with disabilities want to be seen in their totality and not have their disability dismissed or otherwise trivialized. The denial of disability by the nondisabled is a form of microaggression that is not easily resolved. However, adolescents may not identify as disabled even when exposed to the population. They may view themselves as nondisabled or as less disabled than others. This may be due to impermanent ego strength. These feelings may be breached as additional exposure occurs. A successful mentor with a disability may help the adolescent deal with feelings of isolation and provide preliminary exposure to the disabled community that provides peer support. In turn, this may increase self-esteem and promote positive identity development. Although adolescents may not be comfortable acknowledging their ability status, they still crave verification of their disability. Some research suggests that disability and the associated medical trauma may actually promote posttraumatic growth. As disabled identity is integrated over the life span, disability may become a positive self-concept. Examples of medical trauma may include a lack of control over one’s body when seeking medical treatment, especially when one is most self-­conscious about having a “normal” body and fitting in. Many medical exams, especially at teaching hospitals, require adolescents to undress and be observed

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by a tirade of doctors, who treat the patient like a specimen rather than a person. Physical therapy extends the metaphor that the body is “wrong,” and more attention is paid to muscles and bones than to the person. Emphasis is placed on a “cure” rather than increased comfort, function, and adaptation. Medical humanities courses or critical disability studies courses, outside the college of ­ physical therapy or the college of medicine, may help medical professionals in training understand the history, experiences, and feelings of children, adolescents, and adults who enter the medicalindustrial complex.

Issues Related to Disability, Adolescence, and Adulthood The intermediate and high school experience may also be more emotionally and socially difficult because adolescents with disabilities may miss out on milestone experiences or achieve them later in life. They may miss out on social activities such as prom, may miss significant periods of school due to surgery and recovery, and face other issues that potentially arrest their social, psychological, and physical development. Also, relationships with parents may be especially strained regarding a lack of separation and individuation. When their peers are driving independently, working after-school jobs, or playing sports, adolescents with disabilities may not have the same experiences. Parents or guardians may keep adolescents with disabilities more sheltered, and they may be denied the opportunity to do the same things as their peers, adding to social immaturity and less peer interaction. When adolescents with disabilities begin dating, and even before that, it is important to note the increased likelihood of sexual abuse and relational violence. Women with disabilities may experience relationship and sexual violence and are more at risk than their able-bodied peers. They are more likely to experience sexual violence, underreport its occurrence, and lack support services for getting out of abusive relationships and dealing with the aftermath. Rhoda Olkin addresses the issues faced by women with disabilities who want to leave their partners, including issues of physical and sexual abuse. Rape crisis centers and domestic violence shelters may not be physically accessible or may not provide the same level of support guaranteed to women who are not disabled.

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Adolescents with disabilities who identify as lesbian, gay, bisexual, transgender, or questioning may also be prone to safety issues and have less access to mental health support services. It may be impossible or dangerous to come out to parents or guardians, who provide support in many aspects of daily living, for fear of being cut off or kicked out. Decreased independence means decreased access, and it may be difficult to reach lesbian, gay, bisexual, and transgender community support groups due to lack of transportation and the need for physical or personal assistance. Mental health professionals should consider these possibilities when working with adolescents with disabilities. Dating is part of the transition from adolescence to adulthood. For adolescents with disabilities, milestones are often achieved later in life. The tripartite of work, accessible housing, and intimate partnerships are markers of independence and the transition to adulthood. For adolescents with disabilities, these areas are often hard-won despite having intelligence and advanced degrees. Vocational rehabilitation counselors are often ill prepared for helping clients make these transitions.

Research Directions Future research needs to address the developmental delays that separate adolescents with disabilities from their same-age peers and find ways to bridge the gap when these differences occur. Peer mentors with disabilities may be useful in addressing questions, self-esteem, and identity issues. Research on the differences between congenital and acquired disability in adolescents could also help people in the helping professions who are working with this population to determine the most effective treatment modalities. For instance, adolescents with disabilities may benefit from techniques from positive psychology, strengthsbased assessment, narrative therapy (especially when reframing disability), and feminist therapy. Career counseling and guidance regarding higher education also warrant further study considering the staggering rates of underemployment and unemployment among people with disabilities, even those with advanced degrees. Research needs to ascertain what works and how to deal with what is next when highly qualified disabled applicants enter a workplace laden with stigma and

prejudice related to disability. All helping professionals can encourage their clients to follow their dreams and help them make logical decisions to get there. Counselors and psychologists can help with the college application process, advocate for their clients, and help them with adjustment issues. Although this entry points to the many challenges faced by adolescents with disabilities, they also have much to gain through their insight and experience, including posttraumatic growth and integration. Stacey L. Coffman-Rosen See also Ability Status and Gender; Disability and Childhood; Family Relationships in Adolescence; Friendships in Adolescence; Identity Construction

Further Readings Bogart, K. R. (2014). The role of disability self-concept in adaptation to congenital or acquired disability. Rehabilitation Psychology, 59(1), 107–115. Guldin, A. (2000). Self-claiming sexuality: Mobility impaired people and American culture. Sexuality and Disability, 18(4), 223–238. Kinavey, C. (2006). Explanatory models of selfunderstanding in adolescents born with spina bifida. Qualitative Health Research, 16(8), 1091–1107. Overboe, J. (1999). “Difference in itself”: Validating disabled people’s lived experience. Body & Society, 5(4), 17–29. Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice. Hoboken, NJ: Wiley. Taub, D. E., McLorg, P. A., & Fanflik, P. L. (2004). Stigma management strategies among women with physical disabilities: Contrasting approaches of downplaying or claiming a disability status. Deviant Behavior, 25(2), 169–190. Watson, N. (2002). Well, I know this is going to sound very strange to you, but I don’t see myself as a disabled person: Identity and disability. Disability & Society, 17(5), 509–527.

Disability

and

Aging

Disability refers to a wide range of health states that impair bodily, physical, cognitive, sensory, social, or self-care functions. This entry treats the

Disability and Aging

concept broadly, using the World Health Organization definition of disability as “a complex phenomenon, reflecting the interaction between features of a person’s body and features of the ­ society in which he or she lives.” In the context of aging, disability is often a transition or series of transitions rather than a stable state, representing a change in everyday function and precipitating change in social roles and self-identity. Limitations on activities of daily life increase with time for most older adults, demanding adaptation. Disability transitions are an important—and common—feature of aging in high-income countries. In the United States, 40% of adults 65 years and older report living with disability. In 2014, National Center for Health Statistics estimates using a broader measure of limitation found that the majority of older adults had basic functional impairments. Gender plays an important role in shaping the epidemiology and experience of disability. This entry proceeds by introducing the most common approaches to measuring disability, followed by some of the theoretical and empirical relationships among disability, aging, and gender. The following sections describe sex differences in morbidity and mortality as they relate to aging and disability, then gender differences in the social-psychological transitions associated with aging and disability. The next sections address gender differences in disability associated with aging, aging and disability onset as part of the life course, and disability transitions. The final section briefly describes the growing recognition in the 1990s and 2000s that gendered differences in the demography, social psychology, and mental health consequences of disability and aging may be converging as gender norms evolve.

Measuring Disability in the Context of Aging The most influential framework for classifying disability in research is the World Health Organization’s International Classification of Functioning, Disability and Health, commonly referred to as the ICF. The ICF model is meant to span and ultimately integrate national health and disability reporting, epidemiological research, and clinical assessment. It is organized along poles of functions

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and disability. Functions are categorized to include bodily and physical functions, activities, and participation. Disability, in turn, is impairment or restriction of any of these bodily and physical functions, activities, or participation. The ICF model is powerful because it encompasses and categorizes a broad range of operational definitions of disability and relates them to their social context. However, some authors of the literature on aging have noted that the ICF classifications do not precisely match up with many preexisting measures of disability used in gerontology research, resulting in a hodgepodge of operational definitions and conceptual frameworks. The Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics use two broad constructs for measuring disability derived from the ICF framework: (1) basic actions difficulty and (2) complex activity limitation. Basic actions difficulty prevalence is a summary indicator referring to the proportion of the population with one or more functional limitations in sensory, movement, cognitive, emotional, or behavioral domains. Basic actions difficulty indicators are intentionally broad and detect more disability in populations—the 2014 CDC Health, United States report estimated the prevalence of at least one basic actions difficulty in the U.S. population to be 24.7% among 18- to 64-year-olds and 58.9% among those 65 years and older. The complex activity limitation construct, on the other hand, describes the impact of functional impairment on lives and experiences by identifying whether or not a functional impairment affects individuals’ ability to carry out social roles. Prevalence estimates based on complex activity limitation are much lower than those based on basic actions difficulty. Finally, especially in gerontology research, disability is often measured with variants of two longstanding scales: (1) activities of daily living (ADLs) and (2) instrumental activities of daily living. While there is considerable variation in the specific activities rated, measurement of ADLs and instrumental activities of daily living focuses on the ability to carry out specific tasks. These scales measure disability in terms of narrowly defined functional independence but provide little information about quality of life, engagement in social activities, or other activities that fall under the “participation” category in the broader ICF model.

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Sex, Aging, and Disability In all but a handful of countries, women live longer than men—a pattern that has significant consequences for the burden of disability among older adults. In high-income countries, women live up to a decade longer than their male counterparts. These patterns vary along several social dimensions, including race, ethnicity, education, and socioeconomic status. For example, in the United States, African American women live longer than African American men but still have significantly shorter life spans than White women. Years of education and other indicators of socioeconomic status positively influence life span for both men and women. The importance of these other social determinants of longevity means that gender differences in life span can vary significantly by region, even within the same society. For example, women in certain counties in the American South live shorter lives than those in the rest of the United States. Furthermore, the difference in life expectancy for men and women in these areas is narrower than in higher-income, more highly educated parts of the country. Women also experience higher rates of morbidity, some of which contribute to disability. By some estimates, women are at least 11 times more likely to experience acute illness than men. Women are also more likely to experience chronic, non-lifethreatening health conditions that may diminish their quality of life and develop into disability. Because women are more likely to survive into late life than men, the sex differences in morbidity burden are further magnified. While women in the United States live about 5 years longer than their male counterparts on average, they are also more likely to live with functional disability during the final years of their life and to live with it for longer periods of time. By 2010, the average American man could expect to live 9.6 years of his life with disability, while the average American woman could expect to experience 11 years of disability in her lifetime. Furthermore, because women have tended to marry men slightly older than themselves and men have shorter life spans, women are less likely to have functional and affective support from a spouse as they face disability later in life. In short, women live longer lives than men on average, but they are likely to spend more years living with disability, especially late in life. Because of

gendered age asymmetry in marriage preferences, women are more likely than men to care for an aging partner with disability and then be left without a caretaker later in their own life when their ability to perform daily tasks declines. This observation will be explored further in the next section.

Gender and Social-Psychological Transitions in Late Life As individuals age and transition out of social roles that may have been central to their identity at earlier stages in the life course, they experience role loss. Role loss has been associated with the emergence of a range of disabling outcomes, including depression, depressive symptoms, cognitive decline, and faster progression of functional decline. Gender identity conditions both the experience of role loss for individuals and its consequences for disability and well-being. First, gender conditions the types of social roles that men and women inhabit and patterns which roles are more central to individuals’ identity. The roles that adults are transitioning from as they age and the roles they will transition into are both shaped by gendered expectations. Second, gender influences the consequences of role loss for individuals through differences in social environments, social resources, and coping styles. In addition, caregiving remains a gendered activity. Women are more likely to age into caregiving for a spouse or other loved one with disability than to receive such care within the family themselves. They are also less likely to receive care from a spouse should they develop functional limitations. This is partly a consequence of the demographic patterns mentioned in the previous ­section: Women tend to be slightly younger than their male spouses and are likely to outlive them. Indeed, in 2010, around three quarters of men over 65 years of age were married, but the majority of women over 65 years of age were not. Women over 65 are thus more than twice as likely as men to live alone, magnifying the potential social impact of a functional limitation that might be considered minor in a larger household.

The Demography of Disability Women are more likely to experience a number of chronic conditions associated with disability, including arthritis, diabetes, and migraine headaches.

Disability and Aging

They are also more likely to experience depression and anxiety. Men, on the other hand, have higher prevalence of emphysema, gout, and loss of limb. Older women are nearly twice as likely as men to report needing help with ADLs. Older women are also more likely than men to report difficulty socializing as a result of impairments, but the gap is less stark. In the United States, race is also significantly associated with disability in late life. Among older adults in the United States, non-Hispanic Whites report the lowest rates of activity and participation limitations. Rates are higher for Hispanics and higher again for non-Hispanic blacks.

Disability and the Life Course Disability, defined broadly as in the World Health Organization’s ICF framework, is a widespread, even normative experience and a part of the aging process. Furthermore, while the relationship between aging and disability is popularly characterized as a feature of late life, it is clear that the onset of functional limitations begins much earlier for a substantial proportion of the population. The better part of the overall disability burden in the United States, for example, is among people under the age of 65 years. Recent attention to preretirement aging adults in the 55- to 64-year-old range demonstrates that, for many, the development of activity limitations is a process that begins in middle life rather than late life, progressing unevenly through the remainder of the life course. Previously, gerontologists referred to aging without disability as successful aging. In the 2000s, however, the assumptions inherent in this term came under closer scrutiny. Qualitative research with participants from diverse backgrounds suggests that most people living with late-life disability believe that they are aging successfully and do not necessarily perceive increased functional limitations as a failure to age well. Instead, aging adults identify both functional domains (e.g., ADLs) and subjective domains (e.g., adaptation, attitude, and emotional well-being) as central to successful aging.

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individual and environmental factors influence the likelihood of depressive symptoms in relation to disability onset; higher levels of social support, mastery, and self-esteem are associated with fewer depressive symptoms. All other things being equal, in older populations, being female is associated with increased depressive symptoms associated with disability transition compared with men.

Converging Differences as Gender Norms Evolve In the 1990s and 2000s, gerontologists began to note that gender differences in the demography, social psychology, and mental health consequences of disability and aging might be converging. Rapid social change in gender norms in every social institution from family to education to workplace has changed the ways in which men and women experience aging. In certain senses, women’s lives became more like men’s lives during the second half of the 20th century: Women became more likely to smoke regularly, to consume alcohol, to work full-time outside the home, and to be socialized into competitive or risk-taking mind-sets. These social changes have been partly reflected in a narrowing life expectancy gap between women and men: The male-female gap in life expectancy at birth in the United States diminished from a high of 7.6 years in the 1970s to just 5 years by the mid-2000s. This diminishing gender gap in life expectancy may eventually result in a more equal distribution of men and women living with disability in late life, muting some gender differences in late-life disability experience. For example, these demographic changes could decrease the proportion of women living in single households in late life, mitigating the social and psychological impact of disability transitions. Mari Armstrong-Hough See also Aging and Gender: Overview; Aging and Mental Health; Biological Sex and Health Outcomes; Gender Socialization in Aging; Isolation and Aging; Late Adulthood and Gender; Men and Aging; Transgender Experiences of Aging; Women and Aging

Disability Transitions Nonetheless, disability transitions late in life can bring considerable distress. In longitudinal studies, onset of disability is associated with significant increase in depressive symptoms. A number of

Further Readings Binstock, R. H., & George, L. K. (Eds.). (2011). The handbook of aging in the social sciences. Amsterdam, Netherlands: Elsevier.

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Institute of Medicine. (2007). The future of disability in America. Washington, DC: National Academies Press. National Center for Health Statistics. (2014). Health, United States, 2014: With special feature on adults aged 55–64. Hyattsville, MD: Author. World Health Organization. (2002). Towards a common language for functioning, disability and health: ICF. Retrieved from http://www.who.int/classifications/icf/ icfbeginnersguide.pdf?ua=1 World Health Organization. (2016). Health topics: Disabilities. Retrieved from http://www.who.int/topics/ disabilities/en/ Yang, Y., & George, L. K. (2005). Functional disability, disability transitions, and depressive symptoms in late life. Journal of Aging and Health, 17(3), 263–292.

Disability

and

Childhood

According to the Centers for Disease Control and Prevention, “developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime.” The CDC estimates that one in six, or about 15% of, children aged 3 through 17 years in the United States has at least one disability. Disabilities that occur in childhood often fall under the umbrella of what is referred to as “developmental disabilities.” There are many types of disabilities, and the same type of disability can affect people differently. Disabilities may result in a variety of limitations or restrictions that are affected by factors such as environment, age, experience, socioeconomic status, and gender. Some disabilities are easily detectable, whereas others are not. Childhood disabilities include conditions such as attention-deficit/hyperactivity disorder, autism, cerebral palsy, muscular dystrophy, fetal alcohol spectrum disorders, hearing or vision loss, intellectual disabilities, paralysis, sickle cell disease, spina bifida, dyslexia, and epilepsy. Some disabilities are genetically based, whereas others are caused by environmental factors. Some disabilities are progressive and chronic, while some cause minimal impairment in functioning. Disabilities vary greatly in terms of their impact on the child’s development and intellectual, educational, and social functioning.

Disabilities differ from disorders. A disorder may lead to a disability given the level of impairment, but disorders are often understood as mental conditions as opposed to physical conditions. Understanding disability in childhood relies on what is meant by disability, as the meaning can change depending on the setting. There is no universal definition for disability. The lack of a consistent definition has affected research and our ability to effectively identify and manage the needs of this heterogeneous population. In school and other settings in the United States, children with disabilities can be referred to as children with special needs. Children may then consequently or independently qualify as having a disability within the school setting. Within the school setting, disabilities often refer to conditions that impair the child’s ability to function within a typical setting or with typical instruction. Mental health conditions can qualify as a disability within school settings. The function of identifying a disability within the school setting is to create appropriate goals and accommodations for the child through the school’s child study team. Parents are often involved in this process by accepting the school’s goals, while outside professionals such as psychologists and developmental specialists may become involved to further assess the child and their specific needs. After discussing early intervention and the association of disabilities with childhood maltreatment, this entry examines the issue of stigma related to disabilities, including those based on gender and identities.

The Benefits of Early Intervention It has been well documented that correct identification of a disability and assistance with addressing the needs of the child are most effective when they take place as early as possible. Early interventions assist with providing appropriate education for the parents and caregivers while also providing appropriate support for the child. Early interventions are common for children with developmental disabilities and can result in a lessened need for services during childhood and later in life, can lead to more effective engagement in educational settings, and have been able to drastically reduce the presentation of some disorders. Early-intervention specialists exist within hospital and medical settings, as well as in mental health and educational settings. These services are often cost-effective and,

Disability and Childhood

more important, improve quality of life for the children and their families. Early interventions are also effective for conditions other than developmental disabilities. For example, early identification and assistance with learning disorders are important for providing appropriate learning conditions within the school setting. Lack of identification may lead to misdiagnosis and confusion for the child, their family, and the school. It may also prevent the learning and performance in school that could take place with a proper understanding of the disability.

Disabilities as a Risk Factor for Maltreatment or Abuse Researchers have found a connection between childhood disabilities and incidents of maltreatment or abuse. Among the higher estimates, studies by Patricia M. Sullivan and John F. Knutson have reported that children with disabilities are 3.4 times more likely to be maltreated than their nondisabled peers. They also found that children with behavioral disorders are at the highest risk for all types of maltreatment; neglect was the most common form of maltreatment across all disability types. There is a lack of strong data on incidents of abuse due to issues with definitions of abuse and of disabilities, along with a lack of reporting. There is also lack of data regarding the reasons for the higher incidents of abuse, but many have reported that parental stress, along with increased need for supervision and management of challenging behaviors, can contribute to abusive behaviors. A child’s lack of ability to recognize abuse or communicate effectively about abuse can also act as a risk factor. Scholars such as Maureen S. Durkin and Carissa Gottlieb (2009) have described that we should shift our thinking about people with disabilities “from ‘objects of charity’ to ‘subjects with rights’— and to make a commitment to enforce those rights” (p. 7).

Disability and Stigma The concept of “disability” is a social construction used to describe an extremely diverse, and in many ways dissimilar, group of individuals who may not fit into predetermined social norms or roles. The “disability” is not inherent in the person, or child, but in our environment and its norms. The terms

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special and special needs also hold negative connotations and the idea that there is something special, and therefore not regular, about the child. The burden is then placed on the individual for being “special” as opposed to the system. The binary that exists between the terms special and regular results in a stigmatization of the “other.” Thus, social stigma exists for some children with disabilities. Differences in physical, social, and educational functioning can lead to stigmatization or being seen as an “other” by their peers. Lack of understanding and lack of contact are also contributors to the creation and maintenance of stigma. Double discrimination refers to discrimination based on more than one category. In terms of disability in childhood, this can refer to having a ­disability and existing within additional categories such as gender, sexuality, race, or socioeconomic status. For example, having a physical disability along with being homosexual could create additional stigma or barriers, such as an increased sense of invisibility or additional ostracism by power structures such as the educational systems, governmental agencies, business structures, and others in society. Conditions associated with certain disabilities, or certain types of disabilities, may carry different stigmas. Mental disorders or disabilities may not be as respected as those disabilities considered to be medical conditions. They may also be missed, misdiagnosed, and misunderstood. A child with a behavioral disturbance may be seen as more responsible for their condition than a child with a more traditional medical condition. For example, a child with attention-deficit/hyperactivity disorder may be perceived as causing their hyperactivity or refusing to manage their hyperactivity. Consequently, adults may blame the child for their behavior, which could result in the child blaming themselves for their behavior. This sort of stigma or treatment by authority figures can affect the child’s self-esteem or various aspects of the child’s development and functioning. Children with disabilities who display behavioral problems may be corrected with discipline instead of being offered treatment. These children may then experience themselves as misbehaved or “bad,” which can have a significant impact on their self-concept and future behavior. There is also a high incidence of juveniles with emotional and educational

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disabilities in juvenile correctional facilities. Some have drawn a connection between mismanaged disabilities and zero-tolerance policies in schools that require suspensions, expulsions, and police involvement. A better understanding of disabilities within the school system may lead to a reduction in referrals to juvenile justice agencies. In addition, appropriate treatment of emotional and educational disabilities within juvenile correctional institutions may serve as a protective factor against recidivism.

the special education teacher will work to assist those children identified as having a disability or, as is otherwise referred to, as having special needs. Children who have been identified with a special need often have an individualized education plan, also commonly referred to as an IEP, which recognizes specific educational needs, selects methods for meeting those needs, and sets goals for tracking the child’s progress.

Gender and Proper Identification

When examining the experiences of children with disabilities, it is crucial to understand how other identities may influence one’s experiences. First, there is a sizeable body of literature that has explored how different racial groups navigate raising children with disabilities. For instance, studies with African Americans, Latina/os, and Asian Americans all find that there are challenges in raising children with disabilities, ranging from the cultural factors in accepting the child’s ability status to navigating ableist and racist systems and institutions. Despite this, there are still other identities that have not been fully investigated—­ including children with disabilities who identify as transgender or gender nonconforming as well as children who may begin to develop their sexual orientation identities and identify as lesbian, gay, bisexual, or queer.

Research has highlighted how childhood disorders are diagnosed and understood differently depending on gender. To serve as an example, boys with attention-deficit disorder can be misunderstood as having a behavioral condition such as oppositional defiant disorder because behavioral problems are consistent with a stereotype we hold for boys. Gender expectations or stereotypes often influence perceptions of behavior and thus can affect perceptions of childhood disorders or disabilities. These perceptions may affect the diagnosis, treatment, or acceptance of a condition. Inclusion in School Settings

According to the National Association for the Education of Young Children, inclusion is a process by which adults promote belonging, participation, and engagement of children with and without disabilities. Within a school setting, even differences that could otherwise be invisible, such as learning differences or disabilities, can be known by classmates. Children can be pulled into special education settings or groups, away from the other students, thus indicating that a difference exists. Some schools have moved toward an inclusive environment where children with varying needs are educated in the same room with children who have not been identified with a disability or special needs. Depending on the severity of the child’s disability, coteaching takes place, with special education and general education teachers working together in the same room to target different children. The coteacher may be a teaching assistant or a special education teacher. The general education teacher may provide the lesson to the entire group, and during practice of application of the lesson,

Other Identities

Pamela LiVecchi See also Disability and Adolescence; Disability and Aging

Further Readings Centers for Disease Control and Prevention. (2015). Facts about developmental disabilities. Retrieved from https://www.cdc.gov/ncbddd/developmentaldisabilities/ facts.html Durkin, M., & Gottlieb, C. (2009). Prevention versus protection: Reconciling global public health and human rights perspectives on childhood disability. Disability and Health Journal, 2(1), 7–8. Hibbard, R. A., & Desch, L. W. (2007). Maltreatment of children with disabilities. Pediatrics, 119(5), 1018–1025. Sullivan, P. M., & Knutson, J. F. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse & Neglect, 24(10), 1257–1273.

Discursive Approaches

Websites UNICEF, Children With Disabilities: http://www.unicefusa .org/mission/protect/disabilities U.S. Department of Education, Building the Legacy: IDEA 2004: http://idea.ed.gov

Discursive Approaches Discursive approaches are any means of studying ideas, beliefs, events, and other variables by examining how particular entities are constructed through written and spoken human communications. The term discourse is most frequently used to denote any written or spoken text, such as conversations, advertisements, books, scientific ­ publications, speeches, letters, courtroom proceedings, texts, and e-mails. However, some discourse analysts, such as Ian Parker and Vivien Burr, use ­discourse to refer to systems of meanings and statements that together produce a specific version of events. French philosopher Michel Foucault defined “discourse” as a group of statements functioning to construct knowledge in a way that reflects existing power relationships. Varying perspectives on discourse will often correspond to particular types of discursive analyses, yet still share the same aim: to examine how knowledge is constructed via human interaction. This entry briefly introduces different methods of analyzing discourse and the theoretical assumptions behind discursive methodologies. Implications for psychology and gender are also discussed.

Social Constructionism Discursive approaches understand the world through a social-constructionist framework, recognizing language as an active part of social practice and as an entity worth studying in its own right. Rather than as merely descriptive, language is recognized for its constructive function: the ways in which objects, ideas, and events are talked about, contribute to, and shape meaning. Currency is a direct example of this: Metal coins or paper bills are worth nothing unless some government or society ascribes value to them. On the other hand, personality can be viewed as constructed and negotiated: We give different descriptions of

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ourselves in different situations (i.e., job interviews or a first date), often attempting to accentuate our positive characteristics. Defining features of personality also vary depending on who is doing the talking; our own self-descriptions will differ from those given by our parents, coworkers, friends, enemies, and so forth. Although there is no single definition of social constructionism that would adequately describe all the researchers and writers who adopt such a perspective, social psychologist Kenneth Gergen identified four assumptions that can be said to underlie all social-constructionist methodologies: 1. A critical stance toward taken-for-granted knowledge (i.e., since our perspective is governed by socially created definitions and categories, our perception of, and knowledge about, the world cannot be an objective or unbiased representation). 2. Knowledge is historically and culturally specific (i.e., the concepts and categories that we use to understand the world are products of our current culture and time period). 3. Knowledge is sustained by social processes (i.e., it is through daily interaction that knowledge is constructed, and language is the system through which that knowledge is created and shaped). 4. Knowledge and social action go together (i.e., knowledge is not passive; different conceptions of the world support some social actions and deny others).

Analyzing “Talk” Discursive approaches transcend various disciplines within the areas of psychology, sociology, philosophy, anthropology, and linguistics. A researcher’s interests, theoretical orientations, and assumptions about how discourse should be defined will further influence the ways in which particular discourses are explored. The following are common methodological divisions in the field of discursive work. Discourse Analysis

Discourse analysis (DA), while sometimes used as an umbrella term for various discursive

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approaches, also refers to a method of analyzing discourse that examines how people use language to achieve interpersonal objectives in interaction. DA seeks to understand how speakers draw from different repertoires and linguistic devices to construct particular versions of events. Consider the implicational differences in a company’s CEO saying, “Mistakes were made” as opposed to “We made a mistake”; both sentences essentially make the same contention, but the former takes responsibility away from the speaker. Discursive Psychology

Building on this understanding of DA, discursive psychology (DP), a term coined by Derek Edwards and Jonathan Potter, examines psychological matters as they are constructed and made sense of by people in everyday life. Such an approach looks at how psychological categories are used to perform different actions for different purposes; it asserts that psychologists and researchers need to be sensitive to context, as individuals may express different opinions in different situations. For example, attitudes toward certain policies or ideas may change depending on the ways in which the ideas are presented and on who is doing the presenting. DP researchers ask questions about how individuals account for the source of their troubles, how people use emotional states when giving narrative accounts, and how people present themselves as fair and rational when accounting for decision making. Critical Discourse Analysis

DA and DP focus on particular linguistic devices and the specific interactional goals such devices accomplish, also known as a bottom-up approach. Critical discourse analysis (CDA), on the other hand, takes a top-down approach and looks at how particular power dynamics are enacted, reproduced, and reinforced through discourse. CDA analysts examine how particular words, phrases, and linguistic strategies are used to perpetuate and legitimize inequalities. CDA functions as a social critique, questioning the legitimacy of existing constructions of events and investigating how particular descriptions can actuate stereotypes, which then perpetuate biased attitudes toward specific

groups. For instance, CDA studies can examine how various media construct crimes or international conflicts or how different socioeconomic classes are talked about in policy debates. Foucauldian Discourse Analysis

Foucauldian discourse analysis, like CDA, seeks to identify and examine societal inequities, but it also focuses on the historical evolution of discourses and how certain discourses have shaped the development of institutional practices. Studies under the Foucauldian discourse analysis purview include examining the ways in which clinical diagnoses have changed over time, how medical and mental health professionals talk about their clients and justify their descriptions and approaches, or how mental illness is constructed in the media and in legislative accounts.

“Doing” Gender Regardless of the form they take, discursive approaches question the nature of existing truths and social categories by viewing phenomena as enacted and maintained through human communication. Accordingly, the prominent understanding of gender is situated around the socially accepted dichotomy of “male” and “female” and the characteristics that accompany belonging to these categories. In complying with cultural gender norms, certain behaviors and beliefs about gender are reinforced, creating the appearance of an objective binary and allowing for the appraisal of virtually any behavior as either womanly or manly. Gender theorist Judith Butler refers to these constant performances of male and female as gender performativity. An individual is always “doing” gender, whether they are performing or deviating from socially accepted gender constructions. Even in engaging in behaviors seemingly oppositional to conventional gender roles, the notion that there are only two, mutually exclusive, categories of gender is still being reinforced. Discursive studies on gender strive to understand the various ways in which individuals do gender and the implications of such actions. Frequently asked questions include the following: How does gender contribute to various constructions of identity and personality (and vice versa)?

Dissociative Disorders and Gender

How can gender discourses reinforce the dominance of one gender category while marginalizing others? How do gendered systems, such as patriarchy, intersect with other societal ideologies such as consumerism or capitalism? Julia Shulman See also Critical Race Feminism; Cross-Cultural Differences in Gender; Gender and Society: Overview; Gender Identity; Gendered Behavior; Identity Construction; Masculinity Ideology and Norms; Social Role Theory; Third-Wave Feminism

Further Readings Billig, M. (1987). Arguing and thinking: A rhetorical approach to social psychology. Cambridge, England: Cambridge University Press. Burr, V. (1995). An introduction to social constructionism. London, England: Routledge. Butler, J. (2002). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Potter, J., & Wetherell, M. (1987). Discourse and social psychology: Beyond attitudes and behaviour. London, England: Sage. Tuffin, K. (2004). Understanding critical social psychology. London, England: Sage. Wetherell, M., Taylor, S., & Yates, S. J. (Eds.). (2001). Discourse theory and practice: A reader. London, England: Sage.

Dissociative Disorders and Gender Dissociative disorders (DDs) reflect a complex set of psychiatric presentations associated with a predominance of severe dissociative symptoms, such as depersonalization, amnesia, identity confusion, and identity alterations. These symptoms are typically produced by the structured separation of psychobiological systems that support perception, awareness, memory encoding and retrieval, sense of identity, and motor control. According to the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), there are three major types of DDs: (1) dissociative identity disorder (DID), (2) dissociative amnesia

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(DA), and (3) depersonalization/derealization disorder (DDD). DA is typically characterized by the inability to remember personal i­nformation—sans cognitive or neurological issues and above and beyond forgetfulness. Individuals with DID possess or exhibit more than one identity or personality. Individuals with DDD feel detached from their body, surroundings, or mental processes (i.e., they feel like they are observing themselves as an outsider or like they are living in a dream). Diagnoses of “other specified dissociative disorder” or “unspecified dissociative disorder” are given to a DD that is not completely categorized by one of the preceding three types. In this entry, the association between gender and DDs is examined, with special focus on the influence of gender on DID symptoms.

DDs and Sex, Sexual Orientation, and Gender Identity In individuals diagnosed with DID and DA, research has found a high prevalence of exposure to traumatic stressors like child abuse and neglect; conversely, DDD is not necessarily related to trauma. Beyond the sex differences that are present in different DDs, multiple gender identities and ­different gender-typed behavior can coexist in a single person who has a complex DD, such as DID. Consequently, the contributing influence of social ­construction to, and the fragility of, gender development is displayed in disorders such as DID. There are conflicting reports about biological sex differences in DDs, which demonstrate either no sex difference in the prevalence of DDs or a higher prevalence of DDs in women. The higher prevalence of DDs in women may be due to the fact that men with symptoms of DDs may go undiagnosed. Furthermore, men with symptoms of DD may enter the legal system rather than the health system, often after being criminalized for their overt aggression. There are some sex differences with regard to children. In preschool children exposed to sexual abuse, pathological dissociation has a different trajectory based on the child’s sex, with boys ­demonstrating an increase in symptoms over the year following disclosure but girls showing a reduction. Girls’ reduction in dissociation might relate to more protective coping styles, appropriate

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attribution of blame, and support from the nonoffending parent. There seems to be a greater prevalence of DID patients identifying as lesbian, gay, bisexual, or queer (LGBQ) than of those identifying as LGBQ in the general population. Bisexuality particularly appears inflated in DDs—although there is a dearth of empirical research to explain the causes for this. Future researchers should examine multiple factors in LGBQ patients with DD symptoms, including trauma (e.g., from early-childhood abuse or sexual violence), which might explain the prevalence of LGBQ patients with DDs. Furthermore, while there has been a push for psychologists to be more affirming of transgender and gender nonconforming (TGNC) people, there is some research that reveals a connection between gender dysphoria and DDs. In 2015, Marco Colizzi and his colleagues found a 30% lifetime prevalence of DDs in patients with DSM gender dysphoria. However, their sample size was small and skewed in that almost half of the participants were likely to have reported a history of a lifetime major depressive disorder or childhood trauma. Future research studies conducted with larger representative sample sizes, including TGNC participants without histories of depression or trauma, are needed.

Influence of Gender in DID Symptoms Like other psychiatric conditions, DID is by definition unique on account of its discriminating symptoms and distinct collection of features. It is also rather unique on account of demonstrating the existence of different gender identities in one person. It is thought that between 50% and 66% of people with DID have at least one oppositegender dissociative identity. The psychological reasons why male identities develop in female DID patients may differ to some degree from the reasons why female identities develop in male DID patients. In female DID patients, male identities may develop to protect the child from the horror of the abuse by portraying an identity that is strong, tough, and able to withstand the assaults, as will be explained after examining the nature of gender development. Gender development progresses throughout childhood, and learned gendered behavior may explain the various manifestations of gender in DID. By approximately 2 or 3 years of age, children

have a sense of their own gender identity and that of others; they can even use gender labels to describe themselves or others (e.g., girl, man). Around this time, they are beginning to engage in more gendertyped behavior (e.g., playing with dolls or tractors); they are also starting to develop gender stereotypes (e.g., toughness being associated with men and softness with women). Gendered stereotypes become more sophisticated and flexible in later childhood, but gender development can be disrupted if the child is victimized at an earlier age. If targeted by physical or sexual abuse, a little girl may draw on culturally relevant stereotyped views of males to create a means of managing the pain and horror with the development of a male-gendered identity that is “strong” in the face of it. Such an identity also gives the girl an escape from her powerlessness by allowing her a degree of agency over the attacks in the form of modifying her gender identity without the perpetrator’s knowledge and in defiance of them (“You’re attacking a vulnerable girl, so to maintain some semblance of agency, I’m going to be a strong boy”). By identifying as a boy, the abuse of the girl is in effect disavowed. The development of a male identity in a female child may also derive from the desire to protect not only her terrified self but also other siblings in the family unit. Psychologist Christopher Rosik provided the amalgam case of Gina, who had a male identity Alex. Alex, in his own words, developed to protect Gina from the sexual abuse of her stepfather and uncle so she could be like her younger brothers, who were not abused. The development of an opposite-gender identity seemed motivated by a desire not only to protect Gina by being “tough like a male” but also to protect Gina’s younger brothers by offering a “male” substitute so they remained unharmed. In the fantasies used to manage the abuse, Alex could protect both Gina and her younger brothers. Young girls who survive childhood abuse may also develop male gender identities as a result of admiring the perceived strength, power, and control of their perpetrators; their dissociation may include disavowing their weakness and powerlessness and identifying with the perpetrator’s characteristics. Accordingly, individuals with DID may possess dissociative male identities that even devalue their dissociative female identities as weak and vulnerable, while treating women in the same aggressive and abusive way as they were treated. In

Division of Domestic Labor

doing so, survivors of childhood abuse may gain some sense of agency over what occurred to them. Both stereotyped gender development and opposite-sex identification in DID are also evident in boys. For boys with DID, female gender identities often follow the cultural stereotypes around caring and softness, with such identities developed to provide internal soothing and nurturance. These female gender identities may be based in part on the identification and internalization of caring women in the boy’s life. Thus, trauma-generated tough male identities that may protect and/or persecute the female patient and caring mother figure identities that may soothe the male patient are often evident in DID. Boys with DID may also develop hypermasculine identities, characterized by aggressiveness, narcissism, and lack of sensitivity. Opposite-gender identities may also provide an outlet for DID patients who may experience themselves as transgender or gender nonconforming but who do not feel fully comfortable in embracing a TGNC identity. While research on the development of dissociative opposite-gender identities and their relationship to sexual orientation is scarce, there are some trends that may occur when an individual with DID begins developing sexual feelings and engaging in sexual relationships or behaviors. For instance, men with DID who engage in same-sex sexual relationships may dissociate to opposite-gender heterosexual identities (i.e., they take on the identity of a heterosexual woman in a relationship with a man). Such identities may allow men with DID symptoms to deal with any same-sex sexual urges that they view as unacceptable (due to societal heterosexism or because of sexual abuse by a perpetrator of the same sex). In conclusion, it appears that early relational trauma, dissociation, and socialization (learned through stereotypes, modeling behavior, or experiential learning) influence the foundation of gendered behavior in DDs. Future research on trauma and dissociation (particularly among LGBQ and TGNC people diagnosed with DD) will help elucidate the relationship between DDs and gender. Martin J. Dorahy and Christa Krüger See also Gender Socialization in Childhood; Identity Construction; Identity Formation in Adolescence; Identity Formation in Childhood; Personality Disorders and Gender Bias; Posttraumatic Stress

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Further Readings Colizzi, M., Costa, R., & Todarello, O. (2015). Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real? Psychiatry Research, 226, 173–180. Howell, E. F. (2002). “Good girls,” sexy “bad girls,” and warriors: The role of trauma and dissociation in the creation and reproduction of gender. Journal of Trauma & Dissociation, 3, 5–32. Kersting, A., Reutemann, M., Gast, U., Ohrmann, P., Suslow, T., Michael, N., & Arolt, V. (2003). Dissociative disorders and traumatic childhood experiences in transsexuals. Journal of Nervous and Mental Disease, 191(3), 182–189. McFarland, S. H. (2004). Self-creation and the limitless void of dissociation: The “as if” personality. Journal of Analytical Psychology, 49(5), 635–656. Rivera, M. (2002). Informed and supportive treatment for lesbian, gay, bisexual and transgendered trauma survivors. Journal of Trauma & Dissociation, 3(4), 33–58. Rosik, C. H. (2012). Opposite-gender identity states in dissociative identity disorder: Psychodynamic insights into a subset of same-sex behaviour and attraction. Journal of Psychology and Christianity, 31, 278–284. Ross, C. A. (2002). Sexual orientation conflict in the dissociative disorders. Journal of Trauma & Dissociation, 3, 137–146. Shiah, I. S., Yang, S. N., Shen, L. J., Chang, A. J., Gau, Y. C., Chen, Y. J., & Chen, C. K. (2004). Psychopathology and dissociative experiences of male Taiwanese patients with gender identity disorder. Journal of Medical Sciences, 24(3), 135–140.

Division

of

Domestic Labor

Domestic labor refers to the unpaid labor associated with running a household and raising a family; it includes the performance of household chores, child care, and emotional work (i.e., behaviors that are designed to increase others’ emotional well-being). The division of domestic labor is one of the most frequent sources of conflict between heterosexual married and cohabitating partners. The entry explains some of the consequences of inequitable divisions of household labor, observes how domestic labor is divided between heterosexual

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married and cohabitating partners, and reviews the social and individual factors that contribute to inequitable divisions of domestic labor. Although this entry will focus primarily on different-sex couples (i.e., one female and one male partner), research trends regarding domestic labor for ­same-sex married and cohabitating couples will be discussed.

Consequences of Inequitable Divisions of Domestic Labor Disagreement over how household labor is to be distributed is among the top three sources of conflict for couples. Importantly, these conflicts tend to be intense and can significantly affect partners’ relational satisfaction, professional success, and individual well-being. Women who perceive that they perform a disproportionate amount of household labor experience decreased relational satisfaction and increased thoughts of divorce. Bearing primary responsibility for running a household while engaged in work for pay also can reduce one’s ability to compete in the labor force, resulting in decreased wages, opportunities, and retirement benefits. Finally, although many workers experience work/life conflict, those who experience work overload due to unpaid domestic labor report increased levels of stress, burnout, depression, and physical and mental illness.

How Domestic Labor Is Divided Although the broadest definition of domestic labor includes household chores, child care, and emotion labor, most studies of domestic labor focus on the allocation of household chores. Household chores typically include stereotypically feminine tasks such as cooking, bed making, and laundry as well as traditionally masculine tasks like lawn care, car service, and household repairs. Studies consistently find that women perform approximately two thirds of household chores. This finding holds true whether couples are married or cohabitating, whether they endorse egalitarian or traditional beliefs, and whether the men in these relationships are employed or unemployed. Child care is recognized as an important aspect of domestic labor, though it is not included in every study, both because not every couple has children and because it can be difficult for

respondents to view child care as labor. Nonetheless, Clair Dush Kamp and other researchers have determined that women perform approximately 62% of child care, even when parents perceive that they share child care responsibilities equally. Emotional labor includes communication behaviors like offering encouragement, showing appreciation, listening, and expressing empathy. It also encompasses activities such as gift giving, tradition maintenance, relationship work, and remembering special occasions, such as birthdays. Although emotional labor is recognized as important, often it is characterized as being a part of women’s nature and, therefore, often is not viewed as labor.

Why Domestic Labor Is Inequitably Distributed Why do women perform a disproportionate amount of domestic labor? Although no single explanation can explain all of the difference in men’s and women’s performance, a number of theories have been proposed and tested. Among these are relative resource theory, sex/gender socialization theories, and the integrated theory of the division of domestic labor. Relative resource theory is among the most frequently studied explanations for how domestic labor (especially household chores) is divided. A central tenet of this theory is that women perform more domestic tasks because they have relatively fewer economic resources to offer and therefore have less bargaining power than their partners, so they are unable to “buy” themselves out of domestic labor. Mixed support has been found for this perspective. For example, Michael Bittman and his colleagues found that wives’ contributions to domestic labor decreased with increases in their earnings—up to a point. Once women contributed more than half of the family income, they found that the balance shifted toward women performing more household labor. In fact, when wives were the sole breadwinners, their household contributions were equivalent to the contributions of the spouses of men who were the sole breadwinners. As one might expect, it has also been argued that biological sex and/or gender roles are significant contributors to how domestic labor is allocated, and Janeen Baxter has found that biological sex accounts for 17% of the variance in who performs household labor. Gender role theories claim

Division of Domestic Labor

that gender socialization is largely responsible for the sex differences in the performance of household labor. According to these theories, children observe the sex-based division of tasks in their homes and learn which are appropriate for girls and which for boys. Studies reveal that from a young age, girls are taught and required to perform indoor tasks while boys are encouraged and taught to engage primarily in outdoor household tasks. This socialization serves not only to teach children what tasks each sex performs but also, perhaps more important, to develop different competencies in girls and boys. A third theory, Jess Alberts, Sarah Tracy, and Angela Trethewey’s integrative theory of the division of domestic labor, adds to the sex/gender theories by exploring how one’s threshold level or tolerance for disorder, among other factors, interacts with sex and gender socialization to create differential domestic labor performance. They argue that one’s tolerance for disorder influences how quickly one responds to uncompleted tasks. For example, partners may have different tolerance levels for how full a garbage can is before they perceive that it needs to be emptied. If one partner is bothered by a trash can once its contents reach the rim while the other partner is not disturbed until the can is overflowing, the first partner is likely to empty the can before the second even perceives that a problem exists. A consistent pattern of such behavior can result in low-threshold individuals completing more domestic tasks. This theory has been supported in research conducted by Kendra Knight; she determined that women report significantly lower threshold levels for household disorder generally and lower threshold levels specifically for all of the domestic tasks she examined, except dusting.

Same-Sex Couples Despite the increased social recognition and acceptance of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the United States, as well as the legalization of same-sex marriage in the United States in 2015, there is a dearth of research on the division of domestic labor among same-sex couples. Although LGBTQ people have been in existence for as long as heterosexual and cisgender people have, a vast amount of violence, stigma, and historical discrimination may have prevented

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LGBTQ couples from cohabiting, getting married, or both. Theorists have argued that same-sex couples show greater equality in division of ­ responsibility, given their flexibility with gender ­ roles—which many different-sex couples may feel compelled to adhere to. Other theorists have argued that power is most salient in same-sex ­couples, in that the individual with the greatest independence or financial control does the least housework or child rearing. Emerging research finds that samesex couples are more likely to report equal distributions of responsibility for household chores (e.g., cooking, laundry) and financial management (e.g., budget managing, investment managing). However, research finds that within same-sex couples, lower earners take primary responsibility for cooking, while higher earners are responsible for financial management. Within same-sex couples, partners who work fewer hours tend to take primary responsibility for cooking or laundry and less for financial management; however, partners who work more hours do report sharing secondary responsibility. Finally, when comparing same-sex couples with different-sex couples, it is found that men in same-sex relationships report the highest satisfaction with the division of domestic labor and child care, with women in different-sex relationships reporting the lowest satisfaction with the division of domestic labor and child care. Jess K. Alberts See also Caretakers, Experiences of; Gender Roles: Overview; Gender Socialization in Men; Gender Socialization in Women

Further Readings Alberts, J., Tracy, S., & Trethewy, A. (2011). An integrative theory of the division of domestic labor: Threshold level, social organizing and sensemaking. Journal of Family Communication, 11, 21–38. Drago, R. W. (2007). Striking a balance: Work, family, life. Boston, MA: Dollars & Sense. Matos, K. (2015). Modern families: Same- and differentsex couples negotiating at home. New York, NY: Families and Work Institute. Wiseman, S., Boeije, H., & van Doorne-Huiskes. (2008). “Not worth mentioning”: The explicit and implicit nature of decision-making about the decision of paid and domestic work. Community, Work & Family, 11, 341–363.

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Doing Gender

Doing Gender Candace West and Don H. Zimmerman, in 1987, first presented the concept of “doing gender” as a contrast to the idea that gender is a static, personal characteristic. Rather, gender is a characteristic with some flexibility, which is achieved through successfully performing the socially constructed behaviors assigned to one’s sex. Gender is inherently interactional, such that individuals enact gender with the awareness that others will assess their performance. Doing gender has been one of the most frequently cited concepts in social science research on sex and gender. This entry describes the original conceptual contributions, various expansions on doing gender, and the concept’s application in research. The entry concludes with critiques of the original conceptualization and how the concept has been applied in research.

basis for assessing gender performance. Reciprocally, actors reinforce essentialist beliefs when they conform to gender norms. Because essentialist beliefs are central principles of societal organization, and sex category is present across circumstances (i.e., actors never cease to have a sex), sex category occupies an omnirelevant social status. Therefore, all activities can be evaluated in terms of one’s sex category and gender performance (e.g., doing something like a man/woman). In this sense, doing gender is constant and unavoidable. Moreover, actor awareness that others are holding one accountable for one’s gender performance makes doing gender an inherently interactional process. When individuals conform their gender performance to their sex category during interactions, it reinforces beliefs that men and women are essentially different. Consequently, separate spheres of work allocation and institutionalized inequalities are created and re-created through doing gender.

Conceptual Contributions of Doing Gender

Variations on Doing Gender

A major contribution of the doing gender notion is the distinction between the concepts of sex, sex category, and gender. Sex refers to the biological criteria used to assign gender at birth (e.g., chromosomes, genitalia). Sex category refers to how others may identify or infer one’s sex through either biological criteria (e.g., “He has a penis, so he is a male”) or social identification displays (e.g., “He has men’s clothing/hairstyle, so he must be biologically male”). Sex category may or may not be congruent with sex criteria. For example, others may assume, based on appearance, that someone is female (i.e., sex category), although he has a male anatomy or chromosomes (i.e., sex). Gender refers to enacting normative configurations of behavior appropriated to a sex category (i.e., being feminine or masculine); this enactment is also referred to as doing gender. One’s gender may match one’s sex category (e.g., a feminine female), or it may differ (e.g., a masculine female). Doing gender posits that actors are held accountable for doing gender in a manner consistent with their sex category. Institutionalized beliefs that men and women have essentially different natures (i.e., essentialist beliefs) form the

Two major variations on doing gender exist. One variation focuses on the concept of “undoing gender”—when individuals use nonconforming ­ behaviors to challenge the male/female binary or traditional gender norms. However, as these efforts transform and expand the standards for gender, new forms of masculinity and femininity are created. Accountability to sex category may never be eradicated (i.e., “undone”) but rather is redefined. Therefore, some have argued that gender is not “undone” but, rather, “redone.” Another variation focuses on the concept of “doing difference.” In 1995, West and Sarah Fenstermaker asserted that race and class categories are also socially constructed, not manifestations of essentially different natures. As with doing gender, the authors argue that essentialist explanations for gender, race, and class categories reinforce institutional structures of domination and oppression. Some authors have critiqued taking a sociological approach to studying the inequalities that arise from individual lived experience and social relations. However, West and Zimmerman argue that the relationship between categorization and accountability can be studied through observing experiences in social interactions.

Domestic Care Industry and Women

Research Applications Doing gender has been one of the most foundational and widely used concepts in research on gender. Empirical foundations for the concept were originally based in research on child gender socialization, the allocation of tasks according to sex category (e.g., household labor), and transgender experiences. More recent research has continued applying the “doing gender” approach to these and other topics. For example, research in labor has found that gendered task allocation tends to reinforce essentialist beliefs and inequalities within industry and the home. Scholarly work deconstructing heteronormativity and exploring the experiences of transgender individuals highlights the important distinctions between sex, sex category, and gender. Health research connects some men’s tendencies to neglect their health care and to participate in crime to their performance of traditional masculinity.

Critiques A weakness in the original presentation of doing gender was the lack of suggestions for methodological testing. In a later publication, West and Zimmerman endorsed extant research that had successfully employed the following methods to study how people do gender: conversational analysis, unstructured interviews, diaries, ethnographic studies, and record examination. West and Zimmerman note that any method examining descriptions of how social frameworks hold individuals accountable for performing sex category could be used to study doing gender. Other critiques have been levied against how the concept of doing gender has been misapplied in research. First, its inherently feminist concerns with inequality are often neglected. Second, the concept of sex category, the basis for gender assessment, is not fully and explicitly incorporated into research on doing gender. Third, any uniform behavior confined to a group of men or women is described as doing gender, regardless of whether the behavior conforms to or challenges traditional notions of gender. Deliberately nonconforming behaviors may be better characterized as undoing or redoing gender. C. Rebecca Oldham, Jennifer Lindsey, and Sylvia Niehuis

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See also Biological Sex and Social Development; Gender Role Socialization; Institutional Sexism; Race and Gender; Socioeconomic Status and Gender; Transgender People

Further Readings Connell, C. (2010). Doing, undoing, and redoing gender? Learning from the workplace experiences of transpeople. Gender & Society, 24(1), 31–55. Messerschmidt, J. W. (2009). “Doing gender”: The impact and future of a salient sociological concept. Gender & Society, 23(1), 85–88. West, C., & Fenstermaker, S. (1995). Doing difference. Gender & Society, 9(1), 8–27.

Domestic Care Industry and Women Domestic workers are those individuals hired to work in private homes. They engage in paid work for the maintenance of households and the care of individuals, which includes tasks such as cleaning homes, general housekeeping, garden work, and cooking. Domestic care work specifically refers to jobs that involve tending to the basic needs of infants, children, the elderly, people with disabilities, and other individuals. Although private homes are often thought of as places of permanent residence (e.g., a house or apartment), they can also include temporary housing for vacations (e.g., hotels), a hospice, and nursing facilities.

Domestic Work: Critical but Undervalued The domestic work industry is critical for the economic well-being of most nations. It is a major source of employment—accounting for approximately 53 million jobs worldwide, though this figure is likely an underestimation given that numerous domestic workers are employed without formal contracts and are thus not reflected in national figures. The International Labour Organization estimates that the actual number of domestic workers worldwide is closer to 100 million. Beyond being an important source of jobs, the employment of domestic workers also allows

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individuals within households to take on higher skilled jobs. For example, being able to hire a nanny or an au pair to care for a young child might allow the primary caregiving parent to enter or reenter the workforce. Alternatively, an adult with an aging parent could hire a caregiver so that they do not have to leave their job in order to care for that parent. Despite their importance, paid domestic work and domestic care work are often low paid and constitute a devalued sector within many societies. In many nations, there are few guidelines and laws specifically protecting the rights of domestic workers, and thus the conditions of their employment are often unregulated and subject to many abuses, including insufficient pay, long hours and no sufficient rest periods or days off, poor living conditions, verbal and physical abuse, and underage employment.

Domestic Care Industry and Gender Issues Domestic care work is heavily intertwined with various issues and concerns around gender. Many of the tasks that domestic workers perform are traditionally considered “feminine” (e.g., cooking, cleaning homes, providing care for children). Perhaps consequently, the domestic industry is a heavily gendered field—with approximately 83% of jobs in this sector worldwide being occupied by females. In a 2013 study examining data from more than 100 countries, the International Labour Organization found that females outnumbered males in the domestic work industry in all countries except Yemen, West Bank and Gaza, Iraq, Nigeria, Mongolia, Pakistan, and Tajikistan. The gendered nature of the domestic work and domestic care industry presents numerous complicated issues for women. On the one hand, this ­sector is an important source of jobs for women— especially for those who might otherwise not be able to find employment in other sectors. This opportunity is especially helpful for impoverished women with little or no education and limited employment experience. In that sense, it provides numerous individuals with an opportunity to earn money to cover their needs and the needs of their families. Nonetheless, the domestic industry constitutes a highly unregulated sector

with few legal protections. Thus, the abuses, low wages, and poor working conditions that can be found in this industry disproportionately affect women. Migration is another factor that is inextricably intertwined with women’s issues and the domestic care and domestic work sectors. The domestic industry involves substantial migration—whether it is from rural to urban areas within the same country or from one nation to another. Such migration is often fueled by economic need and income imbalances across regions and nations, and many of those who migrate tend to be young and of childbearing age. Although it is difficult to find clear figures of how many migrant domestic workers are parents, family separation is a rampant occurrence among migrant domestic workers. For example, researchers have documented how numerous Filipina women migrate abroad yearly to work as nannies, au pairs, and other caregivers. In the meantime, their children and families are left behind. Although parental absence presents challenges regardless of whether it is the mother or the father who is away, given traditional Filipino norms around the role of the mother as the primary caregiver, there is emerging research that suggests that maternal absence poses a higher challenge for the children left behind.

Future Directions Given the projected continued demand for domestic workers and domestic care workers around the world, as well as increasing awareness of the vulnerabilities of individuals employed in this sector—scholars and policymakers are increas­ ingly recognizing the need to ensure the rights and protections of those employed in this industry. The International Labour Organization put forth the Convention on Domestic Workers, which is a set of ­standards laying out reasonable conditions and wages for those employed in paid domestic work (e.g., standards for minimum wage, benefits, living conditions). As of 2015, more than 20 nation-states have ratified this set of standards. As most domestic workers are female, this convention has the potential to affect the lives and well-being of ­millions of women and girls. However, as the convention has only been recently introduced and adopted in many nations,

Dual Diagnosis and Gender

the extent to which the tenets of this convention are applied and its effectiveness in protecting the rights of domestic and domestic care workers remain to be seen. Maria Rosario T. de Guzman See also Immigration and Gender; Motherhood

Further Readings International Labour Office. (2013). Domestic workers across the world: Global and regional statistics and the extent of legal protection. Retrieved from http:// www.ilo.org/wcmsp5/groups/public/---dgreports/--dcomm/---publ/documents/publication/wcms_173363 .pdf International Organization for Migration. (2012). Rural women and migration. Retrieved from http://www .iom.int/jahia/webdav/shared/shared/mainsite/ published_docs/brochures_and_info_sheets/RuralWomen-and-Migration-Fact-Sheet-2012.pdf Parreñas, R. (2005). Long distance intimacy: Class, gender and intergenerational relations between mothers and children in Filipino transnational families. Global Networks, 5(4), 317–336. doi:10.1111/j.1471-0374.2005.00122.x

Dual Diagnosis

and

Gender

Dual diagnosis is a condition in which clients have been diagnosed as having both a mental health disorder and a substance use disorder, as discussed in the Diagnosis and Statistics Manual of Mental Disorders (DSM). The term co-occurring disorders has recently replaced the terms dual diagnosis and dual disorders in an effort to better describe the existence of a mental health disorder and substance use disorder as opposed to a combination of presenting mental health disorders. According to the Substance Abuse and Mental Health Services Administration, a co-occurring diagnosis refers to the coexistence of both a mental health issue and a substance use disorder that are a result of something other than a cluster of symptoms from an existing disorder. In 2014, 7.9 million adults in the United States had both a mental illness and a substance use

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disorder. Clients with comorbidity experience greater pathology, increased risk for suicide, and greater drug usage than noncomorbid clients. While statistics suggest co-occurring mental health and substance use disorders as prevalent in today’s society, it is important to keep in mind that rates of co-occurring disorders vary depending on the drug of choice. In addition, rates of mental health disorders range significantly among individuals using substances. Clients presenting with co-occurring diagnoses may pose an increased challenge to treatment approaches. It may be difficult to accurately diagnose both the mental health and the substance use problem. Oftentimes, an individual may present for treatment as a result of one issue and not the other, therefore masking the coexisting problem. In addition, addressing both problems concurrently can become overwhelming and create increased obstacles if the individual does not have the appropriate coping mechanisms. Individuals with a co-occurring diagnosis of posttraumatic stress disorder (PTSD) and alcohol dependence are more likely to experience increased clinical impairment than individuals experiencing either diagnosis alone. Multiple authors such as Michelle L. Drapkin, David Yusko, Carly Yasinski, David Oslin, Elizabeth A. Hembree, and Edna B. Foa suggest that this co-occurrence is associated with increased functional impairment, such as lower income or unemployment. The result of these compounding difficulties can lead to further impairment in an individual’s life, therefore affecting prognosis and treatment outcomes. Volumes of empirical evidence have demonstrated that mental health disorders and addictive disorders are highly correlated. Although there is a strong correlation between substance use disorders and mental health, studies exploring how gender influences individuals with co-occurring diagnoses are limited. However, the research that is available has demonstrated that gender does appear to be an influencing factor in either cooccurring disorders or how clinicians diagnose those disorders. This may be either because of gender differences between male and female clients or because of gender biases that might ­ be present within the clinical community. Each of these issues is discussed in the following sections.

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Gender Differences Differences between men and women in substance abuse rates and patterns of co-occurring diagnosis have been found in both clinical studies and general population surveys. Men and women are affected by mental health in different ways. This becomes evident when looking at the incident rates by diagnostic category, age of onset, and paths to recovery. For example, women report depression symptoms at much greater rates than their male counterparts. Also, women with a history of alcohol abuse are at a greater risk of experiencing major depressive disorder than are men with alcohol abuse disorder. A study conducted by Nolen-Hoeksema and colleagues found that women experienced greater chronic strain than men, therefore contributing to factors leading to symptoms of depression. These findings might be explained by cultural expectations, which can vary greatly between women and men. For example, men may be expected to be strong, independent, and emotionally withdrawn, whereas women may be viewed as being emotional, irrational, and dependent on others. These expectations can influence the ways in which clinicians, and society as a whole, conceptualize, and quite possibly stereotype, behaviors based on these constructed societal and gender norms. Social and personality factors such as cultural norms around experiencing and demonstrating emotions, restriction in work opportunities, and increased susceptibility to interpersonal violence or abuse may explain women’s increased susceptibility to and/or diagnosis of depressive symptoms. Some of the social and environmental factors women experience can be related to the power dynamic differences between men and women. As a result of women’s lower power and status, they may encounter greater negative events and have less control over significant areas in their lives as opposed to men. These power differentials can significantly influence individuals’ sense of control over their life, therefore affecting their emotional and mental health and overall well-being; these issues might also lead to increased use of substances, such as alcohol, to numb women from the experience of vulnerability and pain from these events. Cognitive and behavioral theories of depression postulate that chronic lack of control, or a sense of

lack of control, over one’s environment leads people to develop expectations they are not able to fulfill. The inability to accomplish these expectations can lead to symptoms of depression, such as decreased self-esteem, loss of motivation, and inability to identify ways in which individuals can control their environment, thus creating increased helplessness and a decreased sense of self-efficacy. In other words, women’s lack, or sense of lack, of control over their lives can influence their perceptions of self-efficacy, thus increasing feelings associated with depression. A study conducted by Susan C. Sonne and colleagues examining gender differences in a clinical sample of individuals with both PTSD and alcohol dependence found that men reported an overall earlier age of onset of alcohol dependence. In addition, men reported greater alcohol use intensity and cravings as well as more severe legal problems as a result of their alcohol use. However, women reported larger exposure to sexually related trauma, increased avoidance of trauma-related feelings and thoughts, and more social impairment as a result of PTSD. Results also suggested that PTSD existed in women before their alcohol dependence. Cultural expectations around when it is permissible for persons to use substances might lead to earlier onset of use and dependence in men, as men are supposed to be more masculine and able to “hold their liquor” better than women. However, women’s risk for sexual violence and fears of victim blaming, and how the general culture treats survivors of sexual assault, might preclude women from finding a safe place in the aftermath of abuse, whereas men may have access to resources, such as the U.S. Department of Veterans Affairs, to assist with dealing with symptoms of trauma and crisis. Keren Lehavot and colleagues explored a clinical sample of men and women with a co-occurring diagnosis of alcohol dependence and PTSD and found results supporting Sonne and colleagues’ findings of gender differences in PTSD. Other researchers have suggested that women were seven times more likely to experience PTSD than men. While women experience greater rates of PTSD than men, Lehavot and colleagues’ results also suggested a relationship between PTSD severity and increased endorsement of drinking as a coping mechanism independent of gender. Therefore,

Dual Diagnosis and Gender

greater PTSD severity was positively associated with increased motives for drinking in both men and women. While some studies support the correlations between PTSD and alcohol dependence based on gender, other studies have found inconsistencies within their data. Lehavot and colleagues have suggested that these inconsistencies may be a result of sample differences, therefore warranting further investigation. Furthermore, other studies have found that women had significantly higher rates of all anxiety and mood disorders and paranoid, borderline, histrionic, and avoidant personality disorders. Juxtaposed with women, men exhibited higher rates of narcissistic and antisocial personality disorders. Although it is possible that something about the brain structure of or hormones released by men and women might be different, it is more likely that there may be diagnostic biases in the ways clinicians view men and women that may lead to these different clinical impressions between the genders.

Gender Role Biases Stereotypical masculine characteristics have historically been considered more socially desirable than stereotypical feminine characteristics. Therefore, a double standard of health and behavior expectations has been established, further separating the ways in which men and women are viewed. These socially desirable and undesirable behaviors can ultimately create what are seen as normal and abnormal behaviors, respectively. A study conducted by Layne K. Stromwall and Nancy C. Larson explored women with co-­ occurring diagnoses and found scores on mental health subscales to be significantly lower than the national average, with some scores as much as 2 standard deviations below the national mean. These findings are consistent with women’s greater rates of depression and overall emotional distress. In addition, Stromwall and Larson’s study found that women’s perceptions of their mental and physical health were considerably worse than those of men. John Robertson and Louise F. Fitzgerald ex­­ plored clinicians’ evaluations, assigned diagnoses, and proposed treatment plans for two White male clients presenting with symptoms of depression.

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The two clients presented were identical with the exception of family roles and occupations, thus allowing for exploration of sex role bias in clinical assessment and treatment approaches. The results suggested that clinicians associated nontraditional roles and behaviors with greater pathology and were more likely to attribute depression to the client’s current life situation. In addition, clinicians were more likely to target the client’s nontraditional roles and behaviors as a primary focal point of their therapeutic intervention. As gender roles are becoming less gender specific, it is crucial for mental health professionals to adjust their approaches as necessary. Clinical assessments, analysis, and interventions should incorporate the evolving gender roles, and clinicians must become aware of the adverse effects of conforming to traditional gender norms. Robertson and Fitzgerald’s study raises three important questions: (1) Are these findings a result of gender discrimination and bias in the mental health profession? (2) Could they be a result of a deficit in clinical training? (3) Are traditionally feminine behaviors undesirable in such a way that clinicians inherently attribute more severe pathology? If treatment modalities are to be effective when working with clients experiencing co-occurring disorders, clinicians must ensure that gender bias and discrimination are not surfacing in their work.

Treatment Approaches When working with clients presenting with symptoms suggesting a co-occurring diagnosis, it is important to determine whether or not the presenting symptoms are a result of drug use or a mental health problem, rather than independent but coexisting issues. For example, the effects of withdrawal can cause symptoms resembling psychological disorders such as depression and anxiety. Observing a client outside the time frame of intoxication or withdrawal is necessary to ensure an accurate diagnosis of either a co-occurring disorder or a disorder that relates to a recent substance use. If a client does present with a co-occurring substance use or mood disorder, it is important for clinicians to remember that a major predictor of treatment outcomes is the client’s readiness to change. Therefore, clinicians should assess clients’

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current stage of change and utilize interventions that will encourage client readiness and change. Different interventions are useful at different stages of change, so clinicians should do their due diligence to review the stages of change in order to ensure that accurate interventions are being utilized at whatever stage of change the client is currently located. Integration and treatment teams are needed to provide holistic and comprehensive treatment to individuals struggling with co-occurring disorders. Support and understanding, rather than increased stigmatization and alienation, are needed for clients to make strides in their recovery process. In addition, treatments for multiple diagnoses are needed, and treatment will look different for clients presenting with a single disorder. When providing treatment for co-occurring conditions, it is important to take into consideration women’s additional responsibilities, such as caring for children, therefore providing appropriate accommodations to ensure client engagement and participation. Treatment for women should be designed differently than for men. Common issues that women experience should be integrated into the treatment modalities, such as historical trauma and marginalization. Having separate groups based on gender can also be advantageous to the therapeutic process and environment, as well as outcomes.

Areas for Further Consideration As the conversation around sex and gender continues to evolve, the ways in which researchers study these two categories should also evolve. When considering differences in psychological disorders and substance use disorders, clinicians and researchers must be clear about whether they are exploring sex or gender. As gender expression and identity are becoming a more common topic of discussion, it should also be reflected in the literature and, more important, in clinical implications. Treatment for persons who identify as transgender or intersex may look different from traditional treatment options for cisgender males or females, regardless of the assigned gender at birth. Open and frank discussions with these clients are important in treatment, as the clinician assumptions may also serve to sever the therapeutic relationship between the counselor and the client.

While literature exploring gender differences in mental health and substance use disorders exists, a majority of research focuses on a particular mental health diagnosis, such as depression or PTSD, coupled with a specific substance, most commonly alcohol. Therefore, it is difficult to develop a comprehensive understanding of the influence of, and factors associated with, a cooccurring diagnosis. Research into polysubstance use, or substances beyond alcohol, is necessary in these changing times. In addition, the changes from the text revision of the fourth edition of the DSM (DSM-IV-TR) to the fifth edition (DSM-5) from substance abuse and dependence to substance use disorders can pose some challenges with regard to previous literature that focused on one diagnosis over the other. The diagnostic criteria for a substance use disorder differ from the criteria used for substance abuse and dependence disorders. Therefore, literature that aligns with the DSM-5 is scarce and should be further reviewed to explore any nuances or differences between the older and newer diagnostic clarifications and strategies, and what gender differences might currently exist. Angela Catena and Kristopher M. Goodrich See also Gender Affirming Medical Treatments; Gender Bias in the DSM; Gender Microinequities; Gender Socialization in Men; Gender Socialization in Women

Further Readings Drapkin, M. L., Yusko, D., Yasinski, C., Oslin, D., Hembree, E. A., & Foa, E. B. (2011). Baseline functioning among individuals with posttraumatic stress disorder and alcohol dependence. Journal of Substance Abuse Treatment, 41, 186–192. doi:10.1016/j.jsat.2011.02.012 Evans, K., & Sullivan, J. M. (2001). Dual diagnosis: Counseling the mentally ill substance abuser (2nd ed.). New York, NY: Guilford Press. Goldstein, R. B., Dawson, D. A., Chou, P., & Grant, B. F. (2012). Sex differences in prevalence and comorbidity of alcohol and drug use disorders: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Studies on Alcohol and Drugs, 73, 938–950. Lehavot, K., Stappenbeck, C. A., Luterek, J. A., Kaysen, D., & Simpson, T. L. (2014). Gender differences in relationships among PTSD severity, drinking motives,

Dual Minority Status and alcohol use in a comorbid alcohol dependence and PTSD sample. Psychology of Addictive Behaviors, 28(1), 42–52. doi:10.1037/a0032266 Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology, 77(5), 1061–1072. Robertson, J., & Fitzgerald, L. F. (1990). The (mis) treatment of men: Effects of client gender roles and life-style on diagnosis and attribution of pathology. Journal of Counseling Psychology, 37(1), 3–9. Sonne, S. C., Back, S. E., Zuniga, C. D., Randall, C. L., & Brady, K. T. (2003). Gender differences in individuals with comorbid alcohol dependence and posttraumatic stress disorder. American Journal on Addictions, 12, 412–423. doi:10.1037/a0032266 Stromwall, L. K., & Larson, N. C. (2004). Women’s experience of co-occurring substance abuse and mental health conditions. Journal of Social Work Practice in the Addictions, 4(1), 81–96.

Dual Minority Status Dual minority status refers to individuals who identify with two different minority statuses. This entry briefly introduces and defines dual minority status as it relates to psychology and gender. Different perspectives and approaches to dual minority status are discussed. The entry concludes with a discussion of clinical approaches to working with individuals from dual minority statuses. For the purposes of the current entry, the focus will be on racial/ethnic identity, sexual identity, and gender identity. The terms dual-status minority and dualidentity minority may be used interchangeably. Researchers have noted that dual-identity individuals, throughout their development, adapt and learn to alternate between their two identities. Within this adaptation process, dual-identity minorities may learn to reconcile inconsistent values or cognitions and expand their self-definition. When they are forced to choose one salient identity only, there may be internal conflict.

Racial and Ethnic Identity Although race and ethnicity are not the same, for the purposes of this entry, the two categories are listed as one minority status. There are multiple

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dimensions of identity within and across multiple minority clients. An aspect of racial/ethnic identity development is the process of acculturation. Acculturation is defined as the changes within an individual in cultural attitudes, values, and behaviors that result from contact between two distinctive cultures: (1) the cultural group to which the person belongs and (2) another, dominant cultural group. Researchers have found that children who migrated tended to acculturate at a faster rate than their parents because of higher levels of exposure to host cultural values in schools and within peer groups. Other researchers have suggested that the rate of acculturation is different for males and females, in that women tend to report more emotional acculturative stress than men.

Sexual Identity Sexuality is a fundamental aspect of an individual’s identity and how one relates to others. Sexual identity involves one’s subjective experience and development as a sexual being, whether one is bisexual, gay, lesbian, or heterosexual. For the most part, the literature on sexual identity development focuses on the development of one’s sexual orientation identity. Sexual orientation refers to one’s sexual object choice based on sexual and affective desires, attractions, and behaviors—these include attractions to the same sex (gay, lesbian), more than one sex (bisexual), and a different sex (heterosexual). While the majority of theory and research on sexual orientation identity development focus on lesbian and gay individuals, recent scholars have also examined heterosexual identity development.

Gender Identity Sandra Bem describes women as having two different gender identity images—one they consider descriptive of their at-home situation and the other, descriptive of their at-work situation. If home and work were the only contexts to consider, the inconsistencies found in each setting would likely lead to higher levels of sex role conflict and result in dysfunctional work or personal outcomes. For men, societal expectations are such that there should be similarity in both situations. Given that there are very few men who identify with feminine

476

Dual Minority Status

gender identity, men are more likely to adopt a single role regardless of their at-home or at-work situation.

Intersection of Minority Statuses Individuals from a racial or ethnic minority group may be facing multiple challenges. Adding another minority status such as gender identity or sexual identity may contribute to increased stress and confusion. Human development theorists have noted that healthy development involves an integration of multiple statuses or identities. In moving through different phases of development, a closer examination of each status is required. For example, one’s sexual identity may be primary given the context and developmental stage the individual is currently in. For others, racial/ethnic identity may be primary given the context of family gatherings or other situations that recognize their family of origin as primary. Further challenges may arise when racial and ethnic groups hold less positive views of homosexuality or LGBTQ group membership. With regard to the coming out process for LGBTQ identified individuals, they may not find acceptance from their racial/ethnic group during this significant developmental stage. Conversely, members of racial/ethnic minority groups who are reconciling their racial/ethnic identity may not gain support from sexual minorities as they cycle through different stages of racial/ethnic identity development.

A Dual-Identity Model One model of identity development for gay Asian Pacific Islander men proposed by Terry Gock in 1992 addresses how individuals can resolve the conflict between race and sexuality. The first stage of this model is called status quo, representing a period of accepting cultural and familial values about race, gender, and sexuality without exploring alternatives. The second stage is called identity awareness. At this stage, individuals become aware of having a sexual identity in addition to a racial/ ethnic identity. The assumption is that individuals’ awareness of being Asian Pacific Islander precedes their awareness of their gay identity. At the third stage, dilemma of allegiance, individuals may

experience personal conflict between their racial/ ethnic and sexual identities. The fourth stage is called selective allegiance. During this stage, individuals begin to identify more closely with and prioritize one group identity over the other. Finally, at the fifth stage, identity integration, a state of harmony between both facets of the individual’s self-concept will be achieved.

Factors That Contribute to Primary and Secondary Identities A number of factors may contribute to one’s ability or need for a primary and a secondary identity. This may be due to political reasons, career issues, or personal choice. Regarding clinical considerations, it is important for therapists to use multiple lenses of identity development (e.g., gender, cultural identity, sexual orientation) in their conceptualization of clients’ worldviews. Because clients hold multiple identities, it is necessary to understand how the intersection of all of their identities (and subsequent experiences) may influence their presenting problems. Relatedly, clinicians may consider how discrimination and stigma have contributed to any psychosocial distress. Negative events associated with their dual minority status, such as homophobia, racism, anti-immigrant sentiments, and discrimination based on stereotypes across a variety of social contexts, generate vulnerability to the adverse consequences of discrimination and put individuals with dual minority identity at high risk for stress and poor psychological outcomes. The minority stress model (first proposed by Ilan Meyers) provides a useful theoretical framework to explain how sexual minority status intersecting with racial/ethnic minority status may affect one’s psychological well-being through stresses such as discrimination and violence, internalized homophobia among sexual minorities, and expectations of rejection. Furthermore, recent research on intersectional microaggressions provides examples of the types of subtle or unintentional discrimination that people with multiple identities may encounter, based on their multiple identities. For instance, when women of color are ignored, exoticized, or deemed as intellectually inferior, one might wonder if such treatment is due to their racial/ethnic background, their gender, or both.

Dual Minority Status

Dual-Identity Conflict Within Individuals While many individuals may learn to “code switch” between different settings (learning what is acceptable behavior at a family gathering or at a work-related event), individuals with multiple ­marginalized identities may experience conflicts in having to separate distinct parts of themselves in different contexts. Based on Erik Erickson’s model of development, the goal of development is to integrate these disparate aspects of oneself. For a person with dual minority status, the process of integrating different group memberships into one coherent identity may be a goal. For instance, a person who identifies as LGBTQ but also identifies as a person of color may feel more integrated when they are able to be openly LGBTQ within their family and racial/ethnic community, while also being able to be proud of, and connected to, their racial/ethnic identities when they are with LGBTQ people of diverse racial/ethnic groups. Having a coherent identity may not be the goal for all dual-identity individuals, since some people may be obstacles to their integrating their identities in ways they feel comfortable with. For in­­ stance, if an LGBTQ person is a member of a rigidly religious family that is overtly homophobic or transphobic, it may be difficult for them to come out to their family—knowing their family’s history and belief systems. In this case, it might not feel logical (or safe) for the individual to integrate their identities in this way. When identities cannot be integrated in this way, one goal may be

477

to help the individual identify coping strategies when in different contexts and comfortably interact with individuals within their minority status communities. Sara Cho Kim See also Exoticization of LGBTQ People of Color; Exoticization of Women of Color; LGBTQ People of Color and Discrimination; Minority Stress; Women of Color and Discrimination

Further Readings Chen, Y.-C., & Tryon, G. S. (2012). Dual minority stress and Asian American gay men’s psychological distress. Journal of Community Psychology, 40, 539–554. doi:10.1002/jcop.21481 Crawford, I., Allison, K. W., Zamboni, B. D., & Soto, T. (2002). The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men. Journal of Sex Research, 39, 179–189. Estrada, D., & Rutter, P. (2006). Using the multiple lenses of identity: Working with ethnic and sexual minority college students. Journal of College Counseling, 9, 158–166. Goclowska, M. A., & Crisp, R. J. (2014). How dualidentity processes foster creativity. Review of General Psychology, 18, 216–236. doi:10.1037/gpr0000008 Operario, D., Han, C.-S., & Choi, K.-H. (2008). Dual identity among gay Asian Pacific Islander men. Culture, Health & Sexuality, 10, 447–461. doi:10.1080/ 13691050701861454

The SAGE Encyclopedia of

Psychology and Gender

Editorial Board Editor Kevin L. Nadal John Jay College of Criminal Justice and The Graduate Center at City University of New York

Associate Editors Silvia L. Mazzula John Jay College of Criminal Justice and The Graduate Center at City University of New York David P. Rivera Queens College, City University of New York

Editorial Board lore m. dickey Louisiana Tech University Michelle Fine The Graduate Center at City University of New York Michi Fu Alliant International University Los Angeles Beverly A. Greene St. John’s University Jioni A. Lewis University of Tennessee, Knoxville Gina C. Torino SUNY Empire State College

The SAGE Encyclopedia of

Psychology and Gender 2

Edited by Kevin L. Nadal

John Jay College of Criminal Justice and The Graduate Center at City University of New York

FOR INFORMATION:

Copyright © 2017 by SAGE Publications, Inc.

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Description: First Edition. | Thousand Oaks : SAGE Publications, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2017014081 | ISBN 9781483384283 (hardcover : alk. paper) Subjects: LCSH: Gender identity. | Developmental psychobiology. Classification: LCC BF692.2 .S234 2017 | DDC 155.3/3—dc23 LC record available at https://lccn.loc.gov/2017014081

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17  18  19  20  21  10  9  8  7  6  5  4  3  2  1

Contents Volume 2 List of Entries   vii Entries E 479 H 817 F 537 I 913 G 589

Sara Miller McCune founded SAGE Publishing in 1965 to support the dissemination of usable knowledge and educate a global community. SAGE publishes more than 1000 journals and over 800 new books each year, spanning a wide range of subject areas. Our growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Los Angeles | London | New Delhi | Singapore | Washington DC | Melbourne

List of Entries Ability Status and Gender Ability Status and Sexual Orientation Abortion Abstinence Abstinence in Adolescence Abstinence-Only Education Acceptance and Commitment Therapy Acquaintance Rape Adlerian Theories of Gender Development Adolescence and Gender: Overview Affirmative Action Ageism Agender. See Genderqueer Aging and Gender: Overview Aging and Mental Health Agoraphobia and Gender Alcoholism and Gender Alexithymia Allies Ambivalent Sexism Androcentrism Androgyny Anorexia and Gender Anti-Feminist Backlash Antisocial Personality Disorder and Gender Anti-Trans Bias in the DSM Anxiety Disorders and Gender Arab Americans and Gender Arab Americans and Sexual Orientation Arab Americans and Transgender Identity Asexuality Asian Americans and Gender Asian Americans and Sexual Orientation Asian Americans and Transgender Identity Assisted Reproduction and Alternative Families Assisted Suicide, Euthanasia, and Gender Attraction Avoidant Personality Disorder and Gender

Behavioral Approaches and Gender Behavioral Disorders and Gender Behavioral Theories of Gender Development Bem Sex Role Inventory Benevolent Sexism Biculturalism and Gender Biculturalism and Sexual Orientation Biculturalism and Transgender Identity Bi-Gender Biological Sex and Cognitive Development Biological Sex and Health Outcomes Biological Sex and Language and Communication Biological Sex and Mental Health Outcomes Biological Sex and Social Development Biological Sex and the Brain Biological Sex Differences: Overview Biological Theories of Gender Development Biopsychology Biphobia Bipolar Disorder and Gender Bisexual Identity Development Bisexuality Black Americans and Gender Black Americans and Sexual Orientation Black Americans and Transgender Identity Body Dysmorphic Disorder and Gender Body Image Body Image and Adolescence Body Image and Aging Body Image Issues and Men Body Image Issues and Women Body Modification Body Objectification Borderline Personality Disorder and Gender Brain Lateralization Breastfeeding Buddhism and Gender Buddhism and Sexual Orientation Bulimia and Gender vii

viii   List of Entries

Bullying, Gender-Based Bullying in Adolescence Bullying in Childhood Butch Bystanders Campus Rape Career Choice and Gender Career Choice and Sexual Orientation Caretakers, Experiences of Child Adoption and Gender Child Neglect Child Play Childhood and Gender: Overview Children With LGBTQ Parents Children With Transgender Parents Children’s Cognitive Development Children’s Moral Development Children’s Social-Emotional Development Christianity and Gender Christianity and Sexual Orientation Cisgender Cissexism Cognitive Approaches and Gender Cognitive Disorders in Men Cognitive Disorders in Women Cognitive Theories of Gender Development Colonialism and Gender Coming Out Processes for LGBTQ Youth Coming Out Processes for Transgender People Community and Aging Competition and Gender Comprehensive Sexuality Education Congenital Adrenal Hyperplasia Consciousness-Raising Groups Contraception Conversion Therapy. See Sexual Orientation Change Efforts Couples Therapy With Heterosexual Couples Couples Therapy With Same-Sex Couples Criminal Justice System and Gender Criminal Justice System and Sexual Orientation Criminal Justice System and Transgender People Criminalization of Gender Nonconformity Criminalization of Men of Color Criminalization of Transgender People Critical Race Feminism Cross-Cultural Differences in Gender Cross-Cultural Models or Approaches to Gender Cultural Competence

Cultural Gender Role Norms Cyberbullying Cycles of Abuse Date Rape Delusional Disorder and Gender Demasculation. See Masculinity Threats Dependent Personality Disorder and Gender Depression and Gender Depression and Men Depression and Women Developmental and Biological Processes: Overview Dialectical Behavior Therapy and Gender Disability and Adolescence Disability and Aging Disability and Childhood Discursive Approaches Dissociative Disorders and Gender Division of Domestic Labor Doing Gender Domestic Care Industry and Women Dual Diagnosis and Gender Dual Minority Status Eating Disorders and Gender Ecofeminism Education and Gender: Overview Egg Donation Emasculation. See Masculinity Threats Emotional Abuse Emotions in Adolescence and Gender End-of-Life and Existential Issues Equal Employment Opportunity Equal Pay for Equal Work Equality Feminism Estrogen Ethics in Gender Research Ethics in Psychotherapy and Gender Ethics of Self-Care for Psychologists Evolutionary Sex Differences Exhibitionism and Gender Existential Approaches and Gender Existential Theories of Gender Development Exoticization of LGBTQ People of Color Exoticization of Women of Color Family Relationships in Adolescence Fat Shaming Fatherhood

List of Entries   ix

Female Sex Offenders Femininity Feminism: Overview Feminism and Men Feminist Identity Development Model Feminist Psychology Feminist Therapy Femme Fetal Programming of Gender Fetal Sex Selection Fetishism and Gender First-Wave Feminism Fraternities Friendships in Adolescence Frotteurism and Gender Gambling and Gender Gay Male Identity Development Gay Men Gay Men and Dating Gay Men and Feminism Gay Men and Gender Roles Gay Men and Health Gay Men and Romantic Relationships Gender Affirming Medical Treatments Gender and Society: Overview Gender Balance in Education Gender Bias in Education Gender Bias in Hiring Practices Gender Bias in Research Gender Bias in the DSM Gender Conformity Gender Development, Theories of Gender Discrimination Gender Dynamics in Clinical Supervision Gender Dynamics in Clinical Training Gender Dynamics in Group Therapy Gender Dynamics in Psychotherapy Gender Dysphoria Gender Equality Gender Expression Gender Fluidity Gender Identity Gender Identity and Adolescence Gender Identity and Childhood Gender Identity Disorder, History of Gender Marginality in Adolescence Gender Microinequities Gender Nonconforming Behaviors

Gender Nonconforming People Gender Nonconformity and Transgender Issues: Overview Gender Norms and Adolescence Gender Presentation and Childhood. See Gender Variant Role Expression in Childhood Gender Pronouns Gender Reaffirming Surgeries Gender Role Behavior Gender Role Conflict Gender Role Socialization Gender Role Strain Paradigm Gender Role Stress Gender Roles: Overview Gender Segregation Gender Self-Socialization Gender Self-Socialization Model Gender Socialization in Adolescence Gender Socialization in Aging Gender Socialization in Childhood Gender Socialization in Men Gender Socialization in Women Gender Stereotypes Gender Studies in Higher Education Gender Studies in K–12 Education Gender Tracking in Education Gender Variant Role Expression in Childhood Gender Versus Sex Gender-Based Violence Gender-Based Violence in Athletics Gender-Based Violence in the Media Gender-Biased Language in Research Gendered Behavior Gendered Behaviors in Adolescence Gendered Organizations Gendered Stereotyped Behaviors in Childhood Gendered Stereotyped Behaviors in Men Gendered Stereotyped Behaviors in Women Genderqueer Gilligan’s Moral Development Theory Glass Ceiling. See Women and Leadership; Women in Corporate Positions, Experiences of; Workplace Sexual Harassment Government and Gender Grieving and Gender Hate Crimes Toward LGBTQ People Health at Every Size Health Issues and Gender: Overview Hegemonic Masculinity

x   List of Entries

Help-Seeking Behaviors and Men Help-Seeking Behaviors and Women Heteronormative Bias in Research Heteronormativity Heterosexism Heterosexist Bias in the DSM Heterosexual Male Identity Development Heterosexual Male Relationships Heterosexual Men and Dating Heterosexual Men and Feminism Heterosexual Privilege Heterosexual Romantic Relationships Heterosexual Women and Dating Heterosexuality Histrionic Personality Disorder and Gender HIV/AIDS Homophobia Homosexuality Hormone Therapy for Cisgender Men and Women Hormone Therapy for Transgender People Hostile Sexism Hostile Work Environment. See Women’s Issues: Overview; Workplace Sexual Harassment Human Rights Humanistic Approaches and Gender Humanistic Theories of Gender Development Hypochondriasis and Gender Hysterectomy Identity Construction Identity Development and Aging Identity Formation in Adolescence Identity Formation in Childhood Immigration and Gender Immigration and Sexualities Immigration and Transgender Identity Impostor Syndrome In Vitro Fertilization Inferiority Complex Infertility Institutional Sexism Intermittent Explosive Disorder and Gender Internalized Heterosexism Internalized Sexism Internalized Transphobia International Perspectives on Women’s Mental Health Interpersonal Therapies and Gender

Intersectional Identities Intersectional Theories Intersex Intimacy Intimate Partner Violence Intimate Partner Violence in Same-Sex Couples Islam and Gender Islam and Sexual Orientation Isolation and Aging Judaism and Gender Judaism and Sexual Orientation Juvenile Justice System and Gender Kinsey Reports Kinsey Scale, The Kohlberg’s Stages of Moral Development Labor Movement and Women Late Adulthood and Gender Latina/o Americans and Gender Latina/o Americans and Sexual Orientation Latina/o Americans and Transgender Identity Legal System and Gender Lesbian, Gay, and Bisexual Children Lesbian, Gay, and Bisexual Experiences of Aging Lesbian Identity Development Lesbians Lesbians and Dating Lesbians and Gender Roles Lesbians and Health Lesbians and Romantic Relationships LGBQ Older Adults and Health LGBTQ Athletes, Experiences of LGBTQ Community, Experiences of Transgender People in LGBTQ Community, Gender Dynamics in LGBTQ People of Color and Discrimination LGBTQQ-Affirmative Psychotherapy Long-Term Care Low Testosterone Machismo Male Privilege Mania and Gender Marianismo Marriage Marriage Equality Masculinities Masculinity Gender Norms

List of Entries   xi

Masculinity Ideology and Norms Masculinity in Adolescence Masculinity Threats Masturbation Matriarchy Measuring Gender Measuring Gender Identity Measuring Gender Roles Measuring Sexual Orientation Media and Gender Men and Aging Menopause Men’s Friendships Men’s Group Therapy Men’s Health Men’s Issues: Overview Men’s Studies Menstruation Mental Health and Gender: Overview Mental Health Stigma and Gender Microaggressions Middle Adulthood and Gender Military and Gender Military Sexual Trauma Minority Stress Misogyny Motherhood Multiculturalism and Gender: Overview Multiracial People and Gender Multiracial People and Sexual Orientation Multiracial People and Transgender Identity Narcissistic Personality Disorder and Gender Native Americans and Gender Native Americans and Sexual Orientation. See Two-Spirited People Native Americans and Transgender Identity Nature Versus Nurture Neofeminism Neurofeminism Neurosexism Nonbinary Gender. See Gender Nonconforming People Obsessive-Compulsive Disorder and Gender Orgasm, Psychological Issues Relating to Pacific Islanders and Gender Pacific Islanders and Sexual Orientation Panic Disorder and Gender

Pansexuality Parental Expectations Parental Messages About Gender Parental Stressors Parenting Styles, Gender Differences in Passing Pathologizing Gender Identity Patriarchy Pedophilia and Gender Peer Pressure in Adolescence Perimenopause Perpetrators of Violence Personality Disorders and Gender Bias Physical Abuse Physical Assault, Female Survivors of Physical Assault, Male Survivors of Physical Assault, Transgender Survivors of Pornography and Gender Postpartum Depression Posttraumatic Stress Disorder and Gender Posttraumatic Stress Disorder and Gender Differences in Children Posttraumatic Stress Disorder and Gender Violence Power-Control and Gender Pregnancy Pregnancy Discrimination Pretend Play Psychoanalytic Approaches and Gender Psychoanalytic Feminism Psychoanalytic Theories of Gender Development. See Psychodynamic Theories of Gender Development Psychodynamic Approaches and Gender Psychodynamic Feminism Psychodynamic Theories of Gender Development Psychological Abuse Psychological Measurements, Gender Bias in Psychological Measurements, Sexual Orientation Bias in Psychopathy and Gender Psychosexual Development Psychosis and Gender. See Schizophrenia and Gender Puberty Puberty Suppression Queer Queerness

xii   List of Entries

Quid Pro Quo. See Women’s Issues: Overview; Workplace Sexual Harassment Race and Gender Racial Discrimination, Gender-Based Racial Discrimination, Sexual Orientation–Based Rape Rape Culture Reliability and Gender Reparative Therapy. See Sexual Orientation Change Efforts Reproductive Cancer and Mental Health in Men Reproductive Cancer and Mental Health in Women Reproductive Rights Movement Research: Overview Research Methodology and Gender Revictimization Role Models and Gender Romantic Relationships in Adolescence Romantic Relationships in Adulthood Safe Sex Safe Sex and Adolescence Sampling Bias and Gender Schizoid Personality Disorder and Gender Schizophrenia and Gender Second-Wave Feminism Self-Fulfilling Prophecy and Gender Self-Injury and Gender Sex Culture Sex Education Sex Education in Schools Sex Work Sexism Sexism, Psychological Consequences for Men Sexism, Psychological Consequences for Women Sexual Abuse Sexual Assault Sexual Assault, Adolescent Survivors of Sexual Assault, Child Survivors of Sexual Assault, Female Survivors of Sexual Assault, Male Survivors of Sexual Assault, Survivors of Sexual Coercion Sexual Desire Sexual Disorders and Gender Sexual Dysfunction Sexual Harassment Sexual Identity

Sexual Offenders Sexual Orientation: Overview Sexual Orientation as Research Variable Sexual Orientation Change Efforts Sexual Orientation Disturbance, History of Sexual Orientation Dynamics in Clinical Supervision Sexual Orientation Dynamics in Clinical Training Sexual Orientation Dynamics in Group Therapy Sexual Orientation Dynamics in Psychotherapy Sexual Orientation Identity Sexual Orientation Identity Development Sexuality and Adolescence Sexuality and Aging Sexuality and Men Sexuality and Social Media Sexuality and Women Sexually Transmitted Diseases Sleep Disorders and Gender Sleep Disorders and LGBTQ People Slut Shaming Social Anxiety Disorder and Gender Social Class and Gender Social Class and Sexual Orientation Social Media and Gender Social Role Theory Sociodramatic Play/Role-Play Socioeconomic Status and Gender Sodomy Laws Somatization Disorder and Gender Sororities Sperm Donor Spirituality and Gender Spirituality and Sexual Orientation Sports and Gender Spousal Rape Stalking STEM Fields and Gender Stereotype Threat and Gender Stereotype Threat in Education Stigma of Aging Stranger Rape Street Harassment Substance Use and Gender Substance Use Disorders and Gender. See Substance Use and Gender Subtle Sexism Suicide and Gender Suicide and Sexual Orientation Superwoman Complex

List of Entries   xiii

Superwoman Squeeze Surrogacy Take Back the Night Teacher Bias Teaching Feminism Teaching Human Sexuality Teen Fathers Teen Mothers Testosterone Theories and Therapeutic Approaches: Overview Third Gender Third-Wave Feminism Title IX Trans* Transgender and Gender Nonconforming Adolescents Transgender and Gender Nonconforming Identity Development Transgender Children Transgender Day of Action Transgender Day of Remembrance Transgender Experiences of Aging Transgender People Transgender People and Dating Transgender People and Health Disparities Transgender People and Resilience Transgender People and Romantic Relationships Transgender People and Violence Transgender Research, Bias in Transgender Studies Transmisogyny Transphobia Transphobia Bias in the DSM. See Anti-Trans Bias in the DSM Transsexual Transvestic Fetishism Turner Syndrome Two-Spirited People

Validity and Gender Vicarious Sexism Vicarious Trauma Victim Blaming Violence Against Women Act Violence and Gender: Overview Voting and Gender Voyeurism and Gender White/European Americans and Gender White/European Americans and Sexual Orientation White/European Americans and Transgender Identity Womanism Women and Aging Women and Leadership Women and War Women Athletes, Experiences of Women in Academia, Experiences of Women in Corporate Positions, Experiences of Women in Government, Experiences of Women in Public Safety, Experiences of Women in Religious Leadership, Experiences of Women in STEM Fields, Experiences of Women in the Military, Experiences of Women Leaders in Political Movements, Experiences of Women of Color and Discrimination Women’s Friendships Women’s Group Therapy Women’s Groups Women’s Health Women’s Issues: Overview Women’s Studies Womyn Workplace and Gender: Overview Workplace Sexual Harassment Worldviews and Gender Research

E Eating Disorders

and

greatly changed over time. Popular culture content has shown an increase in the frequency of images showing seminaked men since the turn of the 21st century. This, paired with the increased media pressure for men to be muscular, has had an influence on male body image ideals and an increase in male body image insecurity. This increased body attention in men also accounts for more prevalent eating disorder diagnoses in men than were once believed to exist. Although popular culture alone will not create eating disorders in people, the increased media pressure has contributed to the biopsychosocial etiology and development of eating disorders in women and men. Education about media literacy and popular media campaigns have been developed to challenge the social perception that thin equates to beauty in women and that muscles equate to attractiveness in men.

Gender

Eating disorders do not discriminate and can affect anyone at any point in time, regardless of age, gender identity, socioeconomic status, race, ethnicity, sexual orientation, or cultural background. The incidence of and level of impairment from eating disorders are actually quite similar for men and women. Despite the similar rates of occurrence of eating disorders in both genders, women are more likely to be diagnosed with eating disorders than men and are more likely to admit to disordered eating behaviors than men. Men account for 1 in 10 clinically diagnosed cases of eating disorders. This number is likely underreported as historically men have been significantly underrepresented in the eating disorder literature. All of this contributes to the stigma that eating disorders are “female diseases.” This entry considers the role popular culture plays in the prevalence of eating disorders and then examines the relation of gender with eating disorders, including symptomology and treatment.

Gender Differences in Eating Disorders Eating disorders are symptomatically different between men and women, both psychologically and behaviorally. In the typical female experience of eating disorders, a drive for thinness and body dysmorphia motivate pathological eating behaviors. In contrast, men report that muscle dissatisfaction and dysmorphia drive disordered eating. Men tend to present to treatment at a later age of onset and are less likely to have attempted suicide than women. In addition, men’s desired body mass index is higher than that of women. Because the male experience of eating disorders is different

Popular Culture In the 1970s, great attention was brought to women’s bodies and the value of female thinness. This trend has persisted, and women are likely to report decreased mood and self-esteem after viewing popular culture magazines, commercials, and other media that exhibit thin and beautiful women. Social attitudes about men’s bodies have 479

480

Eating Disorders and Gender

from the female experience, a masculine reconceptualization in both diagnostic criteria and language about eating disorders is necessary. The function of emotions in eating disorders is also different in men and women. For both men and women, the inability to internally identify emotions predicts eating disorders. However, an inability to express emotions outwardly predicts eating disorders only in women. This is likely due to the social pressure and expectation for men to be emotionally nonexpressive and for women to be verbally and emotionally expressive. In women, problems with emotional expressivity have been linked not only to eating disorders but also to dysfunctional interpersonal relationships. In addition, traumatic histories differ in men and women with eating disorders. A large percentage of eating disorder patients report a history of sexual abuse. This statistic is smaller for males than for females, likely due to underreporting and feelings of shame. Females may work to consciously or unconsciously use food to manipulate their bodies in reaction to sexual trauma. This can be seen by the desire to lose feminine curves by restricting food intake; to purge traumatic experiences, which may cause them to feel “dirty” or shameful, through self-induced vomiting; or to create a protective barrier against sexuality through overeating or bingeing on food. Childhood bullying is a more common factor in males; some may react by attempting to appear more masculine or work out excessively to become physically larger, in order to protect themselves from being victimized. Weight history is also different in men and women with eating disorder diagnoses. Before developing eating disorders, men have histories of being mildly to moderately obese and are particularly susceptible if childhood obesity had been a problem. Women generally have “felt fat” before using compensatory behaviors to lose weight, but usually they have normal weight histories. More women than men report that they feel they cannot control what or how much they eat, although more men consistently report overeating. Men also tend to be motivated to lose or even gain weight in order to achieve optimal athletic performance or to avoid developing their fathers’ medical illnesses. Women typically focus on the goal of achieving thinness.

Sexual Orientation, Gender Identity, and Eating Disorders There is a complex relationship between sexual orientation and eating disorders for both genders. Research indicates that lesbian women experience less body dissatisfaction overall than heterosexual women. Despite this, lesbian and bisexual female teens may be at higher risk of binge eating and purging than heterosexual female peers. Gay men have increased rates of eating disorder diagnoses compared with heterosexual men and also reportedly experience more intense anxiety related to media influence and body image. However, more heterosexual females struggle with body image concerns than gay males. Men with feminine gender roles have a higher prevalence of disordered eating than men with masculine and androgynous roles. Gay males may also experience higher levels of peer pressure to maintain a particular body type than straight men. However, not all gay subcultures stress body image. Being a gay male is not a consistent predictor of developing eating disorders, but this population is more at risk of developing disordered eating. Transgender and gender nonconforming individuals experience heightened body dissatisfaction and concern with appearance. Thus, gender identity may be a risk factor for developing an eating disorder. Theories supported by research suggest that people with gender identity disorder manipulate eating in unhealthy ways either to suppress features of their biological gender or to accentuate features of their desired gender. However, after gender affirming medical treatments, there is ­typically an improvement in body satisfaction and self-esteem, which results in a sharp decrease in disordered eating. In fact, postoperatively, people generally report feeling more attractive, more confident, and less insecure about body image.

Gender and Treatment The majority of eating disorder treatment programs have been historically designed with only females in mind. In fact, there are several eating disorder treatment centers that are exclusive to females. This is problematic, given the similar incidence and prevalence of eating disorders in men and women. In coed eating disorder treatment

Ecofeminism

centers, men tend to be a minority of patients, with about 1 male for every 10 females. Males have consistently reported feeling discomfort while in treatment, given their minority status at treatment centers and the typically feminine focus of therapy groups. Men have different concerns regarding family dynamics and roles, body image, social stressors, and stigmas, which are not always comparable with those in women. In some cases, males have actually shown better treatment outcomes than females because of their tendency to want to “fix” problems. Men generally feel safer revealing personal vulnerabilities in all-male groups. However, resources are limited because treatment paradigms have typically been geared toward females. This is beginning to change as men consistently seek treatment and help. The removal of amenorrhea from the criteria for anorexia in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is considered a success for the male eating disorder community, as it will help dispel the widely held belief that eating disorders are suffered exclusively by women. Research shows that feeling safe and accepted, being part of therapy groups where life experiences are normalized, and being treated on an individual basis with a tailored treatment approach consistently predict better prognoses for both males and females with eating disorders. Cara Jacobson See also Anorexia and Gender; Body Image Issues and Men; Body Image Issues and Women; Health at Every Size

Further Readings Connors, M. E., & Worse, W. (1993). Sexual abuse and eating disorders: A review. International Journal of Eating Disorders, 13, 1–11. Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. Khoosal, D., Langham, C., Palmer, B., Terry, T., & Minajagi, M. (2009). Features of eating disorder among male-to-female transsexuals. Sexual and Relationship Therapy, 24(2), 217–229. Perry, R. M., & Hayaki, J. (2014). Gender differences in the role of alexithymia and emotional expressivity in

481

disordered eating. Personality and Individual Differences, 71, 60–65. Strother, E., Lemberg, R., Standford, S. C., & Turberville, D. (2012). Eating disorders in men: Underdiagnosed, undertreated, and misunderstood. Eating Disorders, 20, 346–355.

Ecofeminism Ecofeminist theory associates systems of gender with the way in which humans perceive and behave toward the natural environment. Although most scholarship on ecofeminism has come from disciplines such as sociology, geography, and the humanities, core assumptions about the functions of ­ecofeminism are deeply rooted in psychology. The core tenet of ecofeminism is that individuals and societies create attitudes, beliefs, and behaviors that marginalize women and the environment by prioritizing men over women and humans over the nonhuman environment in a hierarchical social structure.

Hegemonic Value Systems Psychological research on values contrasts hierarchical or hegemonic value systems with horizontal or egalitarian value systems. Although these values are not mutually exclusive, individuals who typically endorse one value tend to not endorse the other value and tend to do so across situations. In other words, those who value hierarchy or are dominance oriented are less likely to value egalitarian processes and more likely to gravitate toward hierarchies when thinking about any social groups. Thus, a basic principle of ecofeminism is that marginalization of groups, such as women or the environment, is a product of the tendency to value hierarchies over egalitarianism. Growing research on conservation psychology, which focuses on individuals’ interaction with the natural world, frequently finds gender differences, which can easily be interpreted as “women are naturally more caring about nature than men.” However, ecofeminism would suggest that concern about the natural environment is not a product of genetic disposition but, rather, is based on an egalitarian assumption that all living things deserve equal treatment.

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This possibility is supported by psychological research on other social issues, which finds that regardless of their social status women are less likely than men to express prejudice and discrimination toward marginalized social groups. An ecofeminist framework would suggest that such gender differences occur because women have experience with the injustice of marginalization and are therefore more likely to reject hierarchical values. This social, rather than biological, explanation also helps account for the finding that many men are deeply concerned about environmental issues as well as other social issues.

Gender Role Norms Concerns about the environment may also be related to gender due to the gender socialization process. Girls and women are taught to behave in loving and caring ways and to put the needs of others before themselves. Boys and men, on the other hand, are often socialized to avoid feeling and showing concern for those outside of ­themselves and to avoid engaging in behaviors that are feminine. These gender norms may influence women to value egalitarianism and men to value hierarchy and, subsequently, influence whether they are willing to express concern for marginalized groups.

Research Related to Ecofeminism Empirical research in psychology is beginning to examine the intersection of gender and the environment, which can test the underlying assumptions behind ecofeminist theories. For example, men tend to avoid engaging in pro-environmental behaviors that are stereotypically “feminine” (e.g., air drying laundry rather than using a clothes dryer) or expressing stereotypically feminine emotions about environmental issues (e.g., sadness), while women are just as likely as men to express emotions or engage in pro-environmental behaviors that are stereotypically “masculine.” Thus, women’s and men’s willingness to express concern and engage in pro-environmental behaviors suggests that sex differences stem from men’s ­adherence to social norms rather than women’s natural ­tendencies toward concern for others. Other research has examined the influence of individual and cultural-level values. For example,

states and countries whose residents tend to value hierarchical over egalitarian values are more likely to implement laws and policies devaluing women, children, and future generations and harming the environment. Other research finds an influence of social dominance orientation on attitudes and behaviors toward both human and nonhuman out-groups.

Applications of Ecofeminist Theory to Psychological Research Some pro-environmental communication with the public has structured messages to fit within the current value framework of a particular audience. This would suggest that messages aimed at men or political conservatives, who are both more likely to value hierarchical systems, should differ in content from messages aimed at women or political liberals, who are both more likely to value egalitarian systems. This is supported by findings that men prefer hierarchical arguments (e.g., “The policy would make our country a world leader”) over egalitarian arguments (e.g., “The policy would care for others”), although women value both types of arguments equally. However, tailoring messages about the environment to a hierarchical value system may backfire and may miss opportunities for restructuring value systems and creating social change. Messages emphasizing hierarchical values (e.g., gaining money) can, in the long-term, be harmful. First, these messages reinforce values that are often the source of social and environmental problems (e.g., drilling for fossil fuels because it is profitable). Second, hierarchical messages can have a boomerang effect on support for issues that do not continue to adhere to these values (e.g., installing insulation). Instead, intrinsic rather than external motivations for acting on behalf of others are more likely to sustain consistent pro-environmental action and egalitarian treatment toward marginalized groups. Ecofeminist theory suggests alternative ways for psychologists to address intrinsic motivations by framing messages with egalitarian values. Ample research in the field of social psychology demonstrates that hierarchical values among high-power group members, which play out in forms such as racism and sexism, can become more egalitarian

Education and Gender: Overview

with exposure to the similarities and positive ­attributes of low-power groups. Correspondingly, research suggests that when individuals focus on the positive and inherent worth of animals or the natural environment, they are less likely to see humans as the pinnacle of a hierarchy and are more likely to be willing to engage in pro-environmental behavior. Thus, the tenets of ­ ecofeminism may help psychologists understand some of the motivations behind pro-environmental engagement and to use the understanding of ­psychological processes to inform environmental communication and intervention programming. Brittany Bloodhart See also Cultural Gender Role Norms; Feminism: Overview; Gender Discrimination; Gender Role Socialization; Gendered Stereotyped Behaviors in Men; Gendered Stereotyped Behaviors in Women

Further Readings Bloodhart, B., & Swim, J. K. (2010). Equality, harmony, and the environment: An ecofeminist approach to understanding the role of cultural values on the treatment of women and nature. Ecopsychology, 2, 187–194. Clayton, S., & Opotow, S. (Eds.). (2003). Identity and the natural environment: The psychological significance of nature. Cambridge: MIT Press. Dhont, K., Hodson, G., Costello, K., & MacInnis, C. C. (2014). Social dominance orientation connects prejudicial human-human and human-animal relationship. Personality and Individual Differences, 61, 105–108. Kasser, T. (2011). Ecological challenges, materialistic values, and social change. In R. R. Biswas-Diener (Ed.), Positive psychology as social change (pp. 89–108). New York, NY: Spring Science + Business Media.

Education

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Gender: Overview

Sex and gender inequality in education are global and pervasive issues creating significant challenges and barriers for women across the world. Educational access affects income, employment, social status, social mobility, social positioning, power,

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and well-being. As the world continues to identify strategies to include women in education, U.S. public education explores effective and inclusive practices for sex and gender equality and gender integration. In the United States, education puts the nation at a competitive level while offering training to all (i.e., males, females, transgender people, lower/upper classes, racial/ethnic minorities, and Whites), but educational access, learning resources, and student experiences are not the same for all groups. The following entry provides an overview of students’ educational experiences in U.S. public education. Specifically, issues of gender identity and psychological processes in education at individual and societal levels are explored. The entry highlights the intersectionality of identities (e.g., race, ethnicity, class, gender, and sexuality) in the context of educational experiences and success. Utilizing a psychosociocultural perspective, psychological, social, and cultural factors influencing students’ gendered educational experiences are discussed.

History of Education and Inclusion of Different Identities The onset of formal education was initiated by the early settlers of America, with schools established 10 to 20 years after their arrival. The purpose of education was to provide basic workforce and literacy skills. Town schools were instituted to develop tradesmen, along with grammar schools and the eventual creation of Harvard College, all of which were intended for males. Nonetheless, in the 18th century, “dame schools” (i.e., the first schools in colonial America for children) emerged for both sexes, but primarily males continued their studies. By contrast, females had schooling that focused on housekeeping and family responsibilities, and their studies rarely extended beyond “dame schools.” Females were only provided the opportunity for formal schooling when spaces were available or when boys were not in session. Over time, however, females’ involvement in family finances and other important decision-making processes led to a more inclusionary educational movement. With regard to race, slaves were not granted the right to an education and often were taught

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minimal skills in the plantations. Distance was noted as a reason to hire tutors for sons of slaves, and on occasion, daughters sat in to learn. Occasionally, daughters were taught to read the Bible but were often not taught to write. During colonial times, education was forbidden in the South. In 1740, South Carolina passed a law prohibiting anyone from teaching slaves to read and write. In some cases, slave owners still taught the slaves to read and write for job purposes. It was not until 1825 that the first U.S. public high school for girls opened. During the same period, single-sex academies or seminaries emerged, offering education in literacy, ethics, religious moral beliefs, and home economics. During this time, the Catholic Church had great influence and established numerous schools to inculcate good values. Ultimately, the academy movement helped create opportunities for women, in turn leading to the establishment of women colleges. Although this was significant, coed education took precedence given the cost of a sex-binary education. In 1918, the Commission on the Reorganization of Secondary Education made a case for two educational tracks: one track for college (primarily for males) and the other vocational. Although girls had strong academic standing, they were still required to take domestic science and home economics; many were steered toward limited occupational choices. In college, female enrollment showed a slow increase leading up to the 1920s, and the 1930s marked a peak of women PhD earners. The 1940s and 1950s showed a dip in female enrollment, often attributed to the Depression, World War II, and postwar 1950s events that reaffirmed traditional roles. Colleges provided free education for all veterans, including residence fees and textbooks, with the GI Bill negatively affecting female enrollments. In 1972, the U.S. Congress passed Title IX, making discrimination based on a person’s sex in federally funded education programs illegal. As of 2015, girls represent 46% of the 1.1 million students in prekindergarten, and 36% (compared with 38% males) participate in nursery schools. Girls are evenly represented in math and science courses, and they outnumber their counterparts in Advanced Placement science, foreign ­languages, and other subjects. Yet more boys take Advanced Placement tests and pass them. While girls represent almost half (49%) of elementary

and secondary education, they constitute more than half (57%) of postsecondary education. In 2009–2010, females represented 57.4% of students receiving a baccalaureate degree and 62.6% receiving a master’s degree. Although there is a good representation of females in higher education, only 31% of degrees in science, technology, engineering, and mathematics (STEM) are awarded to women. Examining race, ethnicity, and social class in education, the literature supports the fact that income is strongly associated with higher academic performance and college admissions. Specifically, Latinas/Latinos and African Americans trail behind White students (even low-income Whites) in academics and graduation (73%, 69%, and 86%, respectively). By race and sex, racial/ethnic minority boys show lower performance than their female counterparts. They attain high school degrees less and are less likely to go to college. In fact, even when African American male students have high eighth-grade testing scores, they still are less likely to graduate, be college ready, and attend college. Moreover, African American males (and Latinos) are most likely to enter public postsecondary education via community college, leaving many ­ with debts they cannot repay or fewer transfer outcomes. At the college level, Latina/Latino and African American students are still widely underrepresented. Examining groups by ethnicity, specific ethnic groups show less academic progress than others. For example, Mexican Americans and Puerto Ricans show the least educational attainment among the Latina/Latino groups. Similarly, Filipinos and Hmong students show different educational trajectories from other Asian ethnic ­ groups. By class, the poorest racial/ethnic minorities still show significant underrepresentation in elite institutions of higher education. It is noteworthy, however, that Latinas and African American females show higher enrollment at the college level, higher integration and involvement in school, and a higher percentage of degree attainment than their male counterparts.

Class, Sex, Gender, and Race/Ethnicity in Education Access, quality of education, resources, and climate are key elements to understanding the

Education and Gender: Overview

educational processes of U.S. education. Examining student educational experiences, low-income and racial/ethnic minority students have fewer resources and educational programs for preparation and educational support. Many attend segregated and underfunded schools with a weak curriculum and overcrowded classrooms. With ­ regard to sex differences, boys are called on more than girls in the classroom and are given more direction and feedback on their work. Moreover, teachers are noted to tolerate misbehavior from boys more than from girls; girls are more likely to be bullied based on sex, with boys more frequently being the aggressor. Last, driven by a complexity of factors (encouragement, role modeling, support, and perceived opportunities), girls report less interest in STEM and are more likely to pursue degrees in non-STEM disciplines. Examining gender in education, binary gender education imposes a sex-based structure in which children are raised as a boy or a girl (depending on the sex assigned at birth). Although the discussion of transgender students is a new forum, it is an important one that is central to many students’ realities. Many transgender students report being bullied, discriminated against, segregated, isolated, and misunderstood. Students have been attacked and killed for living out a gender different from their sex assigned at birth, which is in turn pathologized. More recently, students and parents have formed movements to help the integration of transgender students, facilitating the practice of gender bending, which has historically been reprimanded. With regard to the role of race and ethnicity by sex, racial/ethnic young males report feeling isolated and marginalized in education. They have the highest suspension and expulsion rates, although they do not constitute the majority in schools. In comparison, Latinas and African American females show better academic performance, but they also report cultural incongruity, disconnection, and cultural invalidation. Limited research has examined the roles of first-generation racial/ethnic minorities, family values, and gender expectations placed on students throughout their educational pathways. With this general overview of the different student realities, a more thorough examination of student experiences and the psychological, social, and cultural factors contributing to their educational progress is warranted.

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Psychological, Social, and Cultural Factors Although a significant amount of the literature emphasizes educational statistics and outcomes, limited research highlights the multidimensionality of educational processes. Specifically, a significant amount of research examines the unique contributions of psychological, social, and cultural factors to students’ educational processes, but a large portion of the literature fails to approach the analysis holistically and does not account for the collective contributions of these constructs and their variables. This section provides an overview of important factors to consider in an attempt to understand the role of gender, class, race, and ethnicity in education. The following subsections highlight the intersectionality of student identities and the influence of various factors on educational outcomes. Although cognitive processes are critical to the outcome of educational success, numerous noncognitive processes must also be considered in studying educational experiences. Psychological Factors

In understanding the process of education and race, sex, gender, and ethnicity, it is critical to examine the factors that address self-beliefs, which include student motivation, academic self-efficacy, validation, self-esteem, and the means by which the education system serves students to promote these personal dimensions. Although the factors noted are not all inclusive, they provide an understanding of how psychological processes of the student must be considered to promote student satisfaction, retention, and graduation. As the ­system strives to shape students to become excellent scholars seeking educational achievement, the individual and personal dimensions of the process cannot be minimized. For example, at the high school level, it is imperative for students to feel that they have a strong base to consider continuing their education. Moreover, validation and academic self-efficacy work in tandem to facilitate academic involvement and confidence in one’s work. In current times, racial/ethnic minority male youth report feeling misjudged and discriminated against. They have limited racial/ ethnic minority figures who validate their realities and reinforce

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their identity as scholars. Instead, the media perpetuate negative stereotypes of men of color as criminals who are unable to navigate the educational curriculum. With stereotype threat and other identities consistently presented, young racial/ethnic minority males must counter the internalization of the stereotypes and the psychological distress that accompanies being labeled and dismissed by the authorities. In contrast, when students find the means to overcome these ­challenges and achieve educational success, many students doubt their abilities and experience a sense of phoniness (i.e., imposter syndrome), as they are unable to own their strengths, accept their competence, and internalize their success. Another significant element in understanding educational outcomes is coping. As students report experiencing invalidation and microaggressions (conscious and unconscious discriminatory behaviors, subtle forms of prejudice—e.g., “You don’t sound Black; you sound smart”), the way in which students navigate their challenges and negate the negative psychological impressions (e.g., stress, anxiety, depression) of these unique cultural experiences affects outcomes. Examining these coping processes by sex and gender in education, studies evidence differences between males and females. Specifically, males and females respond to challenge and stress differently, and gender adherence also has an impact on responses to the environment. For example, Latina strengths have been noted as protective factors to buffer educational perceptions, limiting gender expectations and resulting in greater academic success and the pursuit of nontraditional disciplines. Similarly, African American male strengths of spirituality and family ties have assisted students in retention and persistence. Social Factors

There is an array of social factors that contribute to students’ (of multiple identities) educational success. Specific social factors that contribute to educational attainment include perceived family support, peer social support, mentorship, teacher expectations, and family expectations. Although there is substantial literature that supports the role and value of parents in their children’s education, the examination of subgroups of parents and their

realities (e.g., ethnic; racial; immigrant; lesbian, gay, bisexual, transgender [LGBT]; male/female; and class) is less evident. Little is understood or explored about parents’ challenges if they are of a minority race (e.g., African American), ethnicity (e.g., Mexican American), sexual orientation (e.g., lesbian), or gender (e.g., transgendered). Limited research focuses on “minority status” parental concerns about the education system, their view of teacher interaction and the campus climate, or their access to educational resources. Less research investigates ways to serve parents, integrate their voices, and encourage their involvement with their children’s education. In examining students and their realities, parental support has been noted as critical for educational progress. Of course, parental educational background and academic understanding are an important factor in enabling students to navigate the curriculum and assignments. Yet it is well documented that emotional support and family cohesion are key factors in racial/ethnic minority students’ educational persistence and success. For example, while an immigrant Guatemalan mother may know little about the system, she can provide emotional support for educational sustenance and success. Limited in financial resources, the single mother may have limited money for school but sees education as important and finds means to enhance her son’s educational opportunities, understanding the direct correlation between educational success, future job placement, and upward mobility. Equally, teacher and counselor support and mentorship are critical for students to feel connected to school. As schools become more affected by high enrollments and experience greater disciplinary issues, there is less quality interaction between teachers and their students. Clearly, the literature underscores the role of disciplinary sanctions for racial/ethnic minority males in negatively affecting the student-teacher bond and students’ connection to learning. Similarly, racial/ethnic minority males report feeling lower expectations from their teachers and feeling a need to prove their interest in education while countering biases. Racial/ethnic minority students also report attending schools with few counselors and receiving little direction and guidance. In previous studies, counselors admittedly reported that their job was not to

Education and Gender: Overview

help students to go to college but simply to get their degree. Counselors suggested that getting a high school degree was a big accomplishment for racial/ethnic minority families and sharing college knowledge and helping place students at a university were not part of their duties. Such attitudes limit students’ potential and promise while creating another barrier for college preparation and admissions. In essence, counselors can serve as gatekeepers to the ivory tower, and their assistance can be critical to the final educational outcome of many students (particularly those whose parents have limited educational or financial resources). Finally, peer influence and support have been noted as a highly influential factor in persistence, school interest, and academic involvement. Examining peers by race and sex, African American male peers have been noted to make fun of students who study and other males who perform well academically. Specifically, peer expectations are intertwined with gender coding, discouraging males from expressing their academic achievement to others, positioning and reinforcing their masculinity, while aligning to a “cool pose” by demonstrating aloofness toward education or teachers. For example, in some research, Latinos report hiding their books in their baggy pants, leaving their books in their lockers, and not bragging about their academic performance to preserve their coolness. In contrast, peer support is positively ­ correlated with educational attitudes. If students receive support from their peers, peer modeling, peer mentorship, and collaborative learning are a few of the benefits they gain from these interactions. Specifically, research suggests that students can create cohesive learning communities, support spaces to help navigate their common realities, and create a family-like system (e.g., an academic family) to rely on for reference, guidance, and perspective. Cultural Factors

In understanding the role of intersectionality of students’ identities, cultural congruity, the ­university environment, the campus climate, and cultural validation provide an important dimension to ­better understanding of educational processes. Cultural congruity is the process by which students feel culturally validated, celebrated, and

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understood in an educational setting. Although there is a movement to be more culturally inclusive in schools via monthly programming (e.g., African American month, Latina/Latino/Hispanic month, LGBT month), many students still do not feel that they are properly understood, and they believe that their values are often not validated. For example, the literature suggests that Latinas are sometimes labeled “too Latina” if they align with their culture too closely and are marginalized by their peers if they seem “too Anglo.” Other students report that their peers are partially accepting of their gender and sexuality but they keep hearing messages such as “He is too feminine and so gay.” Another important component of student ­academic integration and success is the campus climate or school environment. A good campus climate and positive school environment offer a welcoming atmosphere for all students, allowing them to feel positive, affecting their perceptions of the environment, and increasing persistence. In contrast, if students experience microagressions, minority stress, or discrimination, these experiences negatively affect their perceptions of the environment, their affiliation to the institution, and their educational progress. Another dimension of the literature highlights first-generation racial/ethnic minority students as having a more difficult time adapting to college and acquiring university values than second-generation racial/ ethnic minority students. With regard to gender and sexual orientation, LGBT/LGBTQQ (queer and questioning) students (or gender nonconforming students) report a “chilly climate” contending harassment, perceived limited safety, exclusionary policies and spaces, and unwelcoming environments. In sum, educators, practitioners, and educational advocates must take into account the multidimensionality of educational processes while recognizing the complexity of the role of sex, ­ ­gender, race, ethnicity, and class in everyday educational experiences. Specifically, not recognizing the power of the various identities (and their intersectionality) can result in further exclusion, discrimination, and marginalization. Equally, avoiding addressing one of the dimensions or minimizing their ­influence (uniquely and collectively) can lead to misinterpreting student narratives and realities.

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Strategies for Improved Educational Experiences Across Identities As the field attempts to include students of all identities, it is critical that practitioners become informed about the dimensionality of student differences, the impact of background variables, ­ the context, and the multiple other noncognitive processes that influence educational outcomes. As educators pride themselves in becoming more inclusive and celebrative of different groups, there remains the question of whether teachers, counselors, and other educational personnel have a deepstructured understanding of students’ cultural realities, history, and life circumstances. The ­following recommendations are synthesized directives from the literature and educational reports leading the field. In practice, educators and counselors must work with parents to better integrate families into education and facilitate safe and validating spaces for all students. Professionals in education must become culturally aware and knowledgeable about different cultures, and subgroups or subcultures within these cultures (African American, Asian American, Latina/Latino, LGBT, immigrant vs. nonimmigrant, documented vs. undocumented, and female vs. male) and their values. Furthermore, viewing all racial/ethnic minority groups as one can be harmful, and dismissing ethnic subgroup differences could lead to misinterpreting student realities. In time, with greater exposure and understanding (through reading biographies and attending cultural training), exchanges can lead to better cultural skills and competency. Schools must reexamine policies to not exclude or discriminate against students of nonconforming gender or LGBQQ students. Campus climate and school environments must welcome all students and help integrate students regardless of their ethnicity, sex, race, class, or sexuality. Curriculum and educational programs must attend to the multitude of student identities and the dimensionality ­(psychological, social, and cultural) of their experiences. Specifically, school officials must intentionally offer a campus setting that celebrates various cultures, fosters social support and peer ties, validates different student experiences, and facilitates the academic integration of all students. Campus assessments will be useful for students to report

their perceptions of the environment, studentteacher experiences, and peer exchanges. Last, educational success must not be viewed solely as an outcome (grade point average, graduation or college admission) but as a process composed of microsuccesses offering an array of complexities to attend to throughout the duration of students’ stay in the system. In research, scholars must further examine the role of sex, gender, sexuality, race, ethnicity, and class in education. As the current literature provides insight into dimensions of student experiences and their multiple identities, a plethora of research still controls for background variables, minimally examines sex differences, and often discounts gender and sexual identity. Scholars must account for the power of intersectionality in educational experiences, the role of multiple identities in educational success, the value of contextualization, and the importance of psychological, social, and cultural factors in educational processes and outcomes. Jeanett Castellanos See also Gender and Society: Overview; Gender Balance in Education; Gender Bias in Research; Gender Equality; Gender Segregation; Government and Gender

Further Readings American Association of University Women. (2010). Why so few? Women in science, technology, engineering, and mathematics. Washington, DC: Catherine Hill. Banks, C. A. (2009). Black women undergraduates, cultural capital, and college success. New York, NY: Peter Lang. Bowman, N. A. (2010). The development of psychological well-being among first-year college students. Journal of College Student Development, 51(2), 180–200. doi:10.1353/csd.0.0118 Carnevale, A. P., & Strohl, J. (2013). Separate and unequal: How higher education reinforces intergenerational reproduction of White privilege. Washington DC: Georgetown Public Policy Institute, Center on Education and the Workforce. Castellanos, J., Gloria, A. M., & Kamimura, M. (2006). The Latina/o pathway to the Ph.D.: Abriendo caminos. Sterling, VA: Stylus. Gloria, A. M., Castellanos, J., Scull, N. C., & Villegas, F. J. (2009). Psychological coping and well-being of

Egg Donation male Latino undergraduates: Sobreviviendo la universidad. Hispanic Journal of Behavioral Sciences, 31, 317–341. doi:10.1177/0739986309336845 Harper, S. R., & Associates. (2014). Succeeding in the city: A report from the New York City Black and Latino Male High School Achievement Study. Philadelphia: University of Pennsylvania, Center for the Study of Race and Equity in Education. Harper, S. R., & Nichols, A. H. (2008). Are they not all the same? Racial heterogeneity among Black male undergraduates. Journal of College Student Development, 49(3), 199–214. Retrieved from http:// repository.upenn.edu/cgi/viewcontent.cgi?article= 1156&context=gse_pubs Harwood, S. A., Huntt, M. B., Mendenhall, R., & Lewis, J. A. (2012). Racial microaggressions in the residence halls: Experiences of students of color at a predominantly White university. Journal of Diversity in Higher Education, 5(3), 159–173. doi:10.1037/ a0028956 Haskings, R., Isaacs, B., & Sawhill, V. (2008). Getting ahead or losing ground: Economic mobility in America (Economic Mobility Project: An initiative of the Pew Charitable Trusts). Washington, DC: Brookings Institution. Herndon, M. K., & Hirt, J. B. (2004). Black students and their families: What leads to success in college. Journal of Black Studies, 34(4), 489–513. doi:10.1177/​ 0021934703258762 Hoggard, L. S., Byrd, C. M., & Sellers, R. M. (2012, January 1). Comparison of African American college students’ coping with racially and nonracially stressful events. Cultural Diversity & Ethnic Minority Psychology, 18(4), 329–339. doi:10.1037/a0029437 Madigan, J. C. (2009). The education of girls and women in the United States: A historical perspective. Advances in Gender and Education, 1, 11–13. Retrieved from http://www.mcrcad.org/Web_Madigan.pdf Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association. doi:10.1080/1550428X.2014.897919 Nadal, K. L., Mazzula, S. L., Rivera, D. P., & Fujii-Doe, W. (2014). Microaggressions and Latina/o Americans: An analysis of nativity, gender, and ethnicity. Journal of Latina/o Psychology, 2(2), 67–78. doi:10.1037/ lat0000013 National Center for Education Statistics. (2013). Digest of education statistics, 2012 (NCES 2014–2015). Washington, DC: U.S. Department of Education. Retrieved from http://nces.ed.gov/pubs2014/2014015.pdf

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National Center for Science and Engineering Statistics. (2012). Gender equity in education: A data snapshot (NSB 12-01). Washington, DC: U.S. Department of Education. Parham, T. A., Ajamu, A., & White, J. L. (2010). Psychology of Blacks: Centering our perspectives in the African conscious. New York, NY: Pearson. Perez-Felkner, L., McDonald, S. K., Schneider, B., & Grogan, E. (2012). Female and male adolescents’ subjective orientations to mathematics and the influence of those orientations on postsecondary majors. Developmental Psychology, 48, 1658–1673. doi:10.1037/a0027020 Pew Global Attitudes Project. (2010). Gender equality universally embraced, but inequalities acknowledged. Washington, DC: Pew Research Center. Saenz, V. B., & Ponjuan, L. (2011). Men of color: Ensuring the academic success of Latino males in higher education. Washington, DC: Institute from Higher Education Policy. Solorzano, D., Villalpando, O., & Oseguera, L. (2005). Educational inequities and Latina/o undergraduate students in the United States: A critical race analysis of their educational progress. Journal of Hispanic Higher Education, 4(3), 272–294. doi:10.1177/​ 1538192705276550 Turner, C. S. V., & Garcia, E. E. (2005). Latina and Latino students in higher education: Enhancing access, participation, and achievement. Journal of Hispanic Higher Education, 4(3), 178–180. doi:10.1177/​ 1538192705277029 Windmeyer, S. (2010, September 13). Release: First-ever national report chronicles the LGBT experience at U.S. colleges and universities. Washington, DC: American Association for Access, Equity, and Diversity. Retrieved from http://affirmact.blogspot .in/2010/09/release-first-ever-national-report.html

Egg Donation Egg donation, as a treatment for infertility, has existed for more than 30 years. Since 2005, the practice has increased 74%, both nationally and internationally, with people traveling around the world for reproductive services. Women between the ages of 18 and 30 years are recruited by egg donation agencies and infertility clinics to provide eggs in order to help other people create their

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families. In the United States alone, there are more than 18,000 in vitro fertilization cycles per year using fresh donor eggs. Egg retrieval involves surgery under anesthesia, in which a surgeon, guided by ultrasound, inserts a needle through the vagina and pierces through the vaginal wall to reach the ovary. Using suction, the surgeon retrieves each individual follicle from one ovary and then repeats the process on the other ovary. According to ­American Society for Reproductive Medicine guidelines, women should undergo no more than 6 egg donation cycles and be paid no more than $10,000 per cycle. People who need donor eggs include women whose own ovaries no longer produce quality eggs (due to age, chemotherapy, or premature ovarian failure), same-sex male couples, and single men. When a woman starts the egg donation process, she will usually go through medical tests and psychological and genetic screening. Once selected, egg providers must self-inject hormones for several weeks, first to time their cycles with those of the intended mother or surrogate and then to stimulate the ovaries to produce more mature follicles than a woman normally produces in a nonstimulated cycle. To date, there is very limited and conflicting information on the potential risks of both the hormones used to stimulate oocyte production and the complications brought about by surgery, as well as on the psychological and emotional impact on egg donation women’s lives over time.

policies regarding compensated egg donation, but these became more restrictive amid international scandals. Still, India is the number one destination for egg donation and surrogacy. The United States is largely unregulated; as such, the United States is a top destination for infertility treatment using donor eggs, and for fertility travel more broadly, for people from all around the world. Egg providers are often flown from ­countries where compensated egg donation is prohibited to countries with more permissive policies, such as the United States, Cyprus, and Mexico. Global economic inequalities influence who becomes an egg provider and who is able to pay for donor eggs. In the United States, donors are often college students or low-income women. Highly attractive women and educated women are in high demand and are often paid higher sums for their eggs than women who do not possess traits considered highly valuable to a wide array of intended parents. Internationally, egg providers may come from low-socioeconomic backgrounds or from poor countries. In the United States, egg provider payment ranges from $2,500 to $10,000 on average. However, “elite donors,” from top ­universities, are often paid substantially more. The United States has the highest-paid donors in the world.

Global Dynamics of Commercial Egg Donation

Increasing numbers of young women are providing eggs for pay, yet little is known about egg provider decision making and experiences, the short- and long-term risks, and whether paid and unpaid donors experience egg donation differently. According to Rene Almeling, women who provide eggs are often motivated by a combination of the desire to help others create families and financial compensation. According to the Institute of Medicine report on oocyte donation for stem cell research, one of the most striking facts about in vitro fertilization is just how little is known about the long-term health outcomes for women who undergo controlled ovarian stimulation and oocyte retrieval—the process used in egg donation. Studies addressing risks associated with ovulation induction and oocyte retrieval have been conducted primarily with women undergoing procedures for their own

Different countries have different policies regarding commercial egg donation. Most western ­European countries, such as Switzerland, G ­ ermany, and France, ban compensated egg donation. The United Kingdom, Australia, and South Africa have very restrictive policies surrounding egg donation, including limits on compensation, age limits, and varying policies on mandatory donor identity release. In Spain, regulations include a monetary cap on donor compensation at €1,000, mandatory donor anonymity, and selection of donors by physicians based on phenotypic similarity to the intended parents. Gay couples currently cannot use egg donors in Spain to create their families as Spanish law bans surrogacy. Until recently, Thailand and India had relatively permissive ­

Risks and Benefits

Emotional Abuse

infertility treatment. The short- and long-term impact of egg donation on egg donors’ physical and mental health is understudied. One of the most common complications with ovulation induction and oocyte retrieval is ovarian hyperstimulation syndrome (OHSS). This complication is connected to the body’s reaction to the follicle-stimulating hormones used in the process and usually occurs after eggs have been retrieved from the body and the empty follicular sacs fill with fluid. OHSS can result in excessive abdominal swelling, difficulty breathing, and other complications. Left untreated, it can be life threatening. Most of the existing medical literature reports that this is a rare complication; however, this has not been well studied, and OHSS is likely underreported. There is also some concern that the ­injectable hormones used to stimulate oocyte production could increase risk for certain cancers and exacerbate endometriosis. Positive psychological impacts include both the satisfaction a donor feels when helping other ­people bring children into their lives and the possibility of having identity release donations, which could enable a donor to meet the intended parents and the children born from their eggs. Negative psychological effects can occur if a donor ­experiences her own infertility after helping other people have children, if a woman has health complications associated with the process, or after a former donor has children of her own and then views her parenthood and her biological material differently. Diane Tober See also Hormone Therapy for Cisgender Men and Women; In Vitro Fertilization; Infertility; Lesbians and Health; Reproductive Rights Movement; Sperm Donor

Further Readings Almeling, R. (2011). Sex cells: The medical market for eggs and sperm. Berkeley: University of California Press. ASRM Ethics Committee Report. (2007). Financial compensation of oocyte donors. Fertility and Sterility, 88(2), 305–309. Kalfoglou, A. L., & Gittelsohn, J. (2000). A qualitative follow-up study of women’s experiences with oocyte donation. Human Reproduction, 15(4), 798–805.

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Tober, D. (Producer/Director). (2015). The perfect donor [Documentary film]. Retrieved from http:// perfectdonormovie.com/

Emasculation See Masculinity Threats

Emotional Abuse Emotional abuse, which is also known as psychological maltreatment, is a form of abuse characterized by a person subjecting or exposing another person to behavior that may result in the psychological distress of the victim. Emotional abuse is the least studied of all the forms of maltreatment (generally, physical abuse, sexual abuse, emotional/ psychological abuse, and neglect). Such abuse is often associated with situations of power imbalance, such as abusive romantic relationships, abusive caregivers, or bullying. Emotional abuse can be perpetrated in childhood or adolescence by caregivers or peers; in adulthood by romantic ­partners, colleagues, or peers; and in elderly populations as well by caregivers. Therefore, the risk for psychological maltreatment persists throughout the life span. Although this entry touches on domestic violence, the focus is on the nature of childhood psychological maltreatment and the differences in the experience and effects of emotional abuse by gender. There is considerable overlap between different types of abuse. Historically, research and prevention programs have focused on the consequences of physical or sexual abuse. Despite increased attention given to psychological maltreatment, research on other types of abuse predominates in the literature. The American Professional Society of the Abuse of Children defines psychological maltreatment of children as a repeated pattern of caregiver behavior or extreme incidents in which a caregiver conveys to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting someone else’s needs. The major components of psychological maltreatment

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include spurning, terrorizing, isolating, exploiting/ corrupting, denying emotional responsiveness, as well as mental health, medical, and educational neglect. Modern technology has provided new venues for emotional abuse, such as online ­ cyberbullying.

Passive Versus Active Emotional Abuse Five categories of “passive” emotional abuse of children have been identified in the literature. This subtype of emotional abuse may be harder for people to identify. The first area to consider is emotional unavailability, when a parent, or caregiver, is not connected with the person and ­ cannot give them the love that they deserve and need. The second category is negative attitudes, such as having a low opinion of the child and/or denying any praise or encouragement. Third, the developmentally inappropriate interaction with the child category refers to either expecting the child to perform tasks that they are not emotionally mature enough to do or speaking or acting in an inappropriate way in front of a child. Another type of passive emotional abuse is failure to recognize a child’s individuality. This can mean an adult relying on a child to fulfill their emotional needs and not recognizing that the child has their own needs. Finally, failure to promote social adaptation refers to the failure to encourage a child to make friends and mix among their own social peers. When someone intentionally scares, demeans, or verbally abuses a child, it is known as “active” abuse. This requires a premeditated intention to harm a child. Active emotional abuse has been defined as spurning (rejecting), terrorizing, purposely ignoring, isolating, exploiting, or corrupting. In this type of abuse, a child may be exposed to domestic violence between the parents. The child may then learn to walk on eggshells to protect a family member from another family ­ member, which could have a profound negative psychological effect. This exposure is a terrorizing experience.

Domestic Violence Emotional abuse is a major component in the maintenance of domestic violence. The Duluth Model Power and Control Wheel, developed by

the Domestic Abuse Intervention Project in the 1980s, demonstrates how integral aspects of emotional abuse, including using isolation and using children, threats, intimidation, and insults, are in the maintenance of domestic violence. This wheel emphasizes that the goal of the abuse is to gain power and control over another person, even another adult. Research has suggested that men and women emotionally abuse each other at equal rates. ­Murray Straus and colleagues found that female intimate partners in heterosexual relationships were more likely than males to use psychological aggression, including threats to hit the victim or throw an object. Numerous studies report that lesbian relationships have higher overall rates of emotional abuse than heterosexual or gay male relationships. However, studies have also found that double standards exist in how people tend to view emotional abuse perpetrated by men as opposed to emotional abuse perpetrated by women. For example, one study found that when rating hypothetical descriptions of psychological abuse in marriages, psychologists tend to rate male abuse of females as more serious than identical vignettes of female abuse of males. Similarly, a group of Los Angeles, California, residents were randomly ­surveyed for their opinions on hypothetical descriptions of abuse in heterosexual relationships. This study found that emotional abuse committed by women was typically viewed as less serious or detrimental than identical abuse committed by men. It has also been found that men who are emotionally abused often encounter victim blaming that ­erroneously presumes the man either provoked or warranted the maltreatment of his female partner.

Gender Differences and Emotional Abuse The relationship between emotional abuse in childhood and gender can be examined from ­several different perspectives. Are there inborn differences between girls and boys in how they express and process emotion? Can it be discerned whether there are sexual variations in whether emotional experience, in this case psychological maltreatment, is internalized or externalized? Given that boys are socialized differently than girls, are they also mistreated psychologically in distinct ways? The answers to these questions will

Emotional Abuse

then affect significantly the long-term effects of emotional abuse by gender and also the types of interventions that can be utilized to treat and prevent maltreatment. Research that would assist in obtaining such answers is very sparse overall, in that only since the 1980s has emotional abuse been formally investigated separately from sexual and physical abuse. Much of the research that does exist examines the impact of psychological maltreatment on adult outcomes. Little is known about the differences in frequency, duration, and intensity of emotional abuse by gender or the particulars of the family socialization contexts in which it occurs. Emotional Expression

With respect to differences in how each gender expresses and processes emotions, women are considered to be more emotionally expressive. ­ ­Stereotypes exist across multiple cultures that specifically view women as more capable of sending and receiving nonverbal cues, smiling, laughing, gazing, and expressing emotions in general, and better at expressing sadness and fear, whereas men are seen to be more logical and express more anger than women. Self-report studies confirm many aspects of these stereotypes. However, with respect to anger, gender differences do not stand up well; both men and women express anger, albeit differently. Research confirms that men do tend to be “internalizers,” meaning that they show physiological arousal without noticeable emotional ­expression, whereas women are more frequently “externalizers,” displaying clear emotional expressions without corresponding physiological arousal. More recent findings suggest that women are “generalizers,” capable of expressing various emotions in a variety of modalities at the same time. The implications of these differences for effects of emotional abuse by gender are not necessarily clear. Although it would make sense that boys would be at greater risk of developing externalizing behavior problems and girls, of later internalizing behavior problems, research has not ­confirmed such a direct causal link. Some studies indicate that boys do demonstrate problematic externalizing behaviors more than girls, whereas others show no differences by gender. Girls do tend to show more problematic internalizing behaviors

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than boys, but these tend to not become evident until late childhood or early adolescence. A study from 2014 that included children who were maltreated at an early age found distinct trajectories by gender for the development of these behaviors. Boys and girls were assessed every 2 years beginning at the age of 4 years until the age of 12 years. Findings showed that for boys the effects of ­maltreatment on behaviors were noticeable during the early assessment periods but decreased and then diminished with time. However, for girls, the effects were weakest at the first assessment point and then increased over time. This study included all types of abuse, not just psychological maltreatment. Neurological and Psychiatric Differences

Researchers also examined sex differences in the effects of childhood emotional abuse on the brain. The volume of the hippocampus, a brain organ that is very susceptible to stress, was studied. ­Previous studies have shown that an association exists between decreased hippocampal volume and psychiatric illness. One study found that childhood emotional abuse was associated with reduced ­volume of the hippocampus in males but not in females. However, among these nonclinical participants, both males and females who were emotionally abused showed higher levels of subclinical psychopathology. The authors suggested that while women may have been more resilient to the neurological effects of psychological maltreatment, they were no more resilient than men to the psychiatric symptoms that are associated with this maltreatment. Research that looked at whether gender moderated the relationship between childhood maltreatment and adult depression indicated that both men and women who had experienced any type of childhood abuse were equally at risk of experiencing major depression in adulthood. In addition, participants who had experienced emotional abuse were more likely to experience depression as adults than those who had experienced either physical or sexual abuse. Other research found that experiencing emotional abuse in childhood was related to the presence in adulthood of social phobia, as well as major depression. These research findings indicate that the effects of emotional abuse vary by gender. In childhood

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and adolescence, effects have been measured in terms of externalizing behaviors, whereas in adulthood, they are viewed in terms of increased risk for major depression, posttraumatic stress, and other mental and health-related symptoms. Overall, the psychological effects are negative and long lasting for both sexes. In addition, the effects of emotional abuse may be greater than those of other forms of abuse, such as physical and sexual abuse. Future research is needed to discern whether there are variations in how each sex tends to be emotionally mistreated by caregivers. The perceptions and evaluations of emotional abuse ­ according to gender should also be studied. Finally, attention should be paid to discern the relevant variables that affect the family context in which emotional abuse occurs. Aileen Torres and Carol Quintana See also Child Neglect; Physical Abuse; Psychological Abuse

Further Readings Barlow, J., & McMillan, A. S. (2010). Safeguarding children from emotional maltreatment: What works. London, England: Jessica Kingsley. Dutton, D. G. (2006). Rethinking domestic violence. Vancouver, British Columbia, Canada: University of British Columbia Press. Godinet, M. T., Li, F., & Berg, T. (2014). Early childhood maltreatment and trajectories of behavioral problems: Exploring gender and racial differences. Child Abuse & Neglect, 38, 544–556. doi:10.1016/j.chiabu.2013 .07.018 Hamel, J. (2005). Gender inclusive treatment of intimate partner abuse. New York, NY: Springer. Hart, S. N., Brassard, M. R., Binggeli, N. J., & Davidson, H. A. (2002). Psychological maltreatment. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 79–103). Thousand Oaks, CA: Sage. Higgins, D. J., & McCabe, M. P. (2003). Maltreatment and family dysfunction in childhood and the subsequent adjustment of children and adults. Journal of Family Violence, 18, 107–120. Teicher, M. H., Samson, J. A., Polcari, A., & McGreenery, C. E. (2006). Sticks, stones, and hurtful words: Relative effects of various forms of childhood maltreatment. American Journal of Psychiatry, 163, 993–1000.

Emotions in Adolescence and Gender Adolescence marks a crucial period of emotional development. During this period, boys and girls not only display many similarities in the development of emotional expression and regulation but also follow particularly distinct paths in their emotional development. This entry examines adolescent emotional development by gender, reviews the biological and social explanations for gender differences, and discusses future directions for ­ research.

Emotional Expression in Adolescent Boys and Girls Adolescence and the onset of puberty is a unique and salient period for emotional development, regardless of gender. First, major changes are seen in the brain’s emotional and social networks. These changes include stronger reactions to positive and negative events, as well as the release of hormones, specifically oxytocin, which contributes to increased self-consciousness and sensitivity to social feedback. During this time, the “imaginary audience” developmental state can be observed, during which adolescents believe that many people are carefully listening to or watching them and that their thoughts and feelings are extremely unique or novel (known as “personal fable”). In addition, the brain’s frontal lobe, an area responsible for decision making and impulse control, remains underdeveloped until adulthood. Because of this, adolescents still lack the fully formed impulse control of adults and may be quicker to anger or may make hasty decisions. Changes in brain development also bring about transformations in role and identity during adolescence. As the body and mind develop, adolescents feel conflict between their diminishing roles as children and their emerging roles as adults. Erik Erikson termed this identity versus role confusion. This describes a process of exploration of one’s traits, capacities, interests, and beliefs. This process is informed by a number of factors, including personality, family, peers, community, education, and culture. Many facets of identity development may

Emotions in Adolescence and Gender

result in emotional conflict that evokes a variety of expression and regulation strategies (e.g., conflicts of autonomy with parents or emerging political views that may clash with peers). In addition, a major facet of identity formation involves gender roles and expectations, including rejection or embracing the gender assigned at birth and its attendant rituals, rules, and expectations. This may occur with changes in social and interpersonal relationships, which tend to become deeper and more intimate in adolescence, often begin to focus on mixed-sex groupings, and evolve to include romantic relationships. The process of identity formation both influences and is influenced by ­ emotional development. Lawrence Kohlberg further identified adolescence as a period of moral development, during which adolescents may form advanced ways of thinking about abstract concepts of justice, fairness, and social order. Kohlberg believed that by early adolescence, most children have achieved the conventional level of moral reasoning, in which morality is determined by social rules and conventions. An adolescent at this stage might determine whether something is right or wrong based on how they think others will judge it. This belief may influence an adolescent’s emotional expression or regulation; for example, a girl might believe that her peers will judge physical aggression negatively and thus refrain from using physical aggression to express anger. Both moral and identity development comprise significant facets of emotional growth during adolescence. Finally, the physical and emotional changes that both boys and girls experience during adolescence prompt gender intensification, an increase in stereotyping attitudes and behavior based on gender identity. Physical pubertal changes may prompt this gender intensification and may evoke gendertyped expectations from family and friends. Changes in cognition that result in increased selfscrutiny also make adolescents more responsive to gender role expectations, which may be either adaptive or distressing depending on the adolescent’s personality, family, peers, culture, community, and sexual orientation. For example, a child whose sexual identity does not conform to their assigned sex at birth may feel distress at the pressure to conform to gender norms. Conversely, a child who feels that gender norms suit their sexual

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identity may find security in having their identity reinforced through gender intensification.

Gender Differences in Emotional Development Although both boys and girls share many physical, cognitive, and social changes during adolescence, different emotional responses to these forces are seen in boys and girls. The first of these differences lies in emotional expression. Boys are more likely to externalize their negative emotions than girls, meaning that boys tend to express emotions in outwardly visible ways, such as displaying anger or aggression. Although girls are likely to outwardly express positive emotions, they are more prone than boys to internalizing negative emotions. This means that girls tend to direct negative feelings, such as sadness or anger, toward the self. It is theorized that because girls are more likely to internalize negative emotions, the reasons for which are discussed in more depth later in this entry, they experience higher rates of mood disorders, such as depression and anxiety, than boys during adolescence. Notably, rates of depression are approximately equal in boys and girls prior to puberty but dramatically increase in girls at the onset of puberty. Children who experience gender dysphoria (i.e., children who strongly wish to be a gender that is not their assigned gender) are at an increased risk of both internalizing and externalizing problems compared with gender conforming children. However, natal boys (children who are assigned to the male gender at birth) who experience gender dysphoria also experience greater rejection by same-sex peers than natal girls with gender dysphoria, which may relate to greater emotional pathology for dysphoric boys versus girls. In addition to differences in emotional expression and disorders, gender differences in emotional regulation are also seen. Emotional regulation is the ability to process and respond to emotions in a way that is both healthy and socially acceptable. Although both boys and girls grapple with emotional regulation during adolescence, they do so in different ways. Girls are more likely to engage in dysfunctional rumination, a maladaptive and excessive focus on negative feelings and symptoms of distress. Boys are more likely to engage in

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avoidance and suppression of negative emotions. Excessive use of either of these strategies is associated with emotional dysfunction and disorders, such as depression and anxiety in girls and conduct disorder in boys.

Explanations for Gender-Based Differences in Emotional Development Both biological and social factors account for the gender differences in emotional expression, regulation, and disorder during adolescence. No one ­factor is responsible for the gender differences in emotional development. Rather, the differences between boys’ and girls’ emotional expression, processing, and disorders are the result of many factors interacting together. Moreover, not all boys or girls fall perfectly into any developmental ­pattern based on gender; rather, the patterns reflect tendencies by gender, not inevitable outcomes for adolescents of either gender. The following subsections aim to describe the underlying factors that contribute to divergent emotional development between girls and boys in adolescence. Biological Explanations

Biologically speaking, research has uncovered differences in both brain structure and hormones that partially explain the differences in emotional development in boys and girls. Structurally, neural imaging of adult women reveals that emotional response primarily occurs in the subcallosal ­anterior cingulate cortex, the thalamus, and the midbrain, whereas for men, emotional response occurs in the inferior frontal cortex and posterior areas. When adult men and women are asked to regulate their emotions, rather than simply responding to emotional stimuli, neural imaging reveals less activity in the orbitofrontal cortex, anterior cingulate, and dorsolateral prefrontal cortex for women as compared with men. However, these structural differences do not necessarily cause differential emotional development between boys and girls and may simply reflect differences in neuronal processing that are influenced by other factors. Hormonal differences are another potential influence on emotional development in boys and girls. Oxytocin, which causes relaxation, sedation,

and reduced fearfulness, is present in greater quantities in women, and estrogen has been found to enhance its effects. The effects of vasopressin, a hormone that is present during the fight-or-flight response, are enhanced by testosterone. Thus, gender-based predispositions to reduce the fightor-flight response in women and enhance it in men may be related to the interactive effects of hormones. However, as with structural brain ­ ­differences, gonadal hormones alone cannot fully explain the gender differences in emotional expression and response. Social Developmental Explanations

A number of social explanations exist to explain the relationship between gender and emotional development, some of which are considered social developmental. These theories explain how gender role behavior, including the expression and regulation of emotions, is learned from explicit teaching and modeling. Girls’ gender roles are often defined in relation to an expected role of a caregiver, and they are often expected and encouraged to internalize negativity and instead display sympathy, empathy, and positivity. Boys’ gender role expectations follow an assertive, protective role. Thus, boys are more often expected and encouraged to express aggression, assertiveness, and other dominance behaviors, while internalizing behaviors that are expected of girls. Children may learn these gender roles through many sources, including family, peers, media, the community, and school. An example of a source of learned emotional expression may be seen in commercials for children’s toys, where toys that encourage empathy and emotional nurturance, such as baby dolls, are marketed toward girls, whereas toys that encourage action play, such as trucks, are marketed toward boys. Although emotion in gender roles can be absorbed passively through these types of media, more explicit forms of instruction can also account for learned differences in emotional expression and regulation, such as when a child is told that “boys don’t cry” or “girls must keep sweet.” Experiencing these directives may be especially distressing for a gender nonconforming child, particularly natal boys, resulting in the observed increases in internalizing and externalizing problems.

Emotions in Adolescence and Gender

Social-Constructionist Explanations

Although learned and modeled behavior accounts for some influence on emotions in adolescence, it is crucial to remember that children are not “blank slates” and also exert their own agency on development. Thus, social-constructionist theories also help account for differences in emotional development beyond the imposition of roles on a child. For example, an adolescent may reject gender norms of emotional expression or may act in more or less gender-normed ways with peers or strangers than when at home. Thus, a boy who would not express distress at school during his parents’ divorce may cry at home, or a girl may engage in physical aggression to prove herself to peers. A child who rejects an assigned identity of “male” may express more emotion around a trusted peer or adult to signify her chosen gender identity but may suppress these qualities around someone who may disapprove. Components of each of the reviewed influences on emotional development—biological, social, and child driven—help explain the gender differences in adolescent emotional development. However, no one theory is sufficient on its own, and causality is difficult to prove. For example, a girl who expresses negative emotions through physical aggression may have higher testosterone levels than average, but these hormonal levels may be influenced by early-life experiences of living with a physically aggressive family. Or perhaps differences in her brain structure during emotional processing reflect an inherited trait that also accounts for the high levels of familial aggressive behavior. Behaviors have multiple influences, and their causes are difficult to disentangle from one another. Therefore, the general differences between boys’ and girls’ emotional expression, regulation, and identification cannot be attributed to just one source.

Future Research In addition to uncertainty about the causal mechanisms of gender differences in emotional development during adolescence, there remains much to study about this dynamic. For example, a large meta-analysis of emotional expression finds that gender differences between boys and girls are not as robust as expected, that many studies primarily

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focus on White children, and that few studies have examined how emerging differences in emotional expression may coincide with the development of gender-typed personality traits. Ethnicity and personality are two factors that may provide insight into the dynamics of emotional development, particularly if social-developmental and -constructionist traits stem more from these factors than from gender alone. In addition, research has shown that there is just as much variance within genders as there is between them; thus, it may be valuable to focus future study on the variance within gender. That is, researchers may gather more valuable information comparing boys who internalize emotions with other boys, or girls who externalize emotions with other girls, rather than comparing boys with girls. The value in understanding the root of gender differences in emotional development, rather than simply ascribing the differences to gender alone, is extremely high for children and caregivers navigating the road of adolescent emotional development. Leighann Starkey and Angela M. Crossman See also Behavioral Disorders and Gender; Biological Sex and Mental Health Outcomes; Gender Identity and Adolescence; Gender Norms and Adolescence; Gender Socialization in Adolescence

Further Readings Chaplin, T., & Aldao, A. (2013). Gender differences in emotion expression in children: A meta-analytic review. Psychological Bulletin, 139(4), 735–765. doi:10.1037/a0030737 Cole, P. (2014). Moving ahead in the study of the development of emotion regulation. International Journal of Behavioral Development, 38(2), 203–207. Deaux, K., & Major, B. (1987). Putting gender into context: An interactive model of gender-related behavior. Psychological Review, 94, 369–389. Domes, G., Schulze, L., Bottger, M., Grossmann, A., Hauenstein, K., Wirtz, P., & Herpertz, S. C. (2010). Neural correlates of sex differences in emotional reactivity and emotion regulation. Human Brain Mapping, 31, 758–769. doi:10.1002/hbm.20903 Kret, M., & de Gelder, B. (2012). A review on sex differences in processing emotional signals. Neuropsychologia, 50(7), 1211–1221. doi:10.1016/ j.neuropsychologia.2011.12.022

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End-of-Life and Existential Issues

Liben, L. S., & Bigler, R. S. (2002). The developmental course of gender differentiation: Conceptualizing, measuring, and evaluating constructs and pathways. Monographs of the Society for Research in Child Development, 67, 1–147. Noval-Aldaco, E., Ruiz-Torres, M., López-Gil, J., & Payá-González, B. (2015). Adolescent depression. In M. Sáenz-Herrero & M. Sáenz-Herrero (Eds.), Psychopathology in women: Incorporating gender perspective into descriptive psychopathology (pp. 409–421). Cham, Switzerland: Springer International. doi:10.1007/978-3-319-05870-2_17 Zimmerman, P., & Iwansi, A. (2014). Emotion regulation from early adolescence to emerging adulthood and middle adulthood: Age differences, gender differences, and emotion-specific variations. International Journal of Behavioral Development, 38(2), 182–194.

End-of-Life

and

Existential Issues

Existential psychologists consider universal ­concerns, including death, alienation, freedom, and meaninglessness. Such concerns often emerge alongside illness, loss, and end-of-life issues, particularly surrounding the management of life’s final stages, often serving as catalysts toward a confrontation with one’s mortality and meaning in the world. Variables such as gender shape how individuals navigate aging, illness, and issues of mortality. This entry examines variables and ­experiences related to existential concerns and end of life, the meaning-making process, diversity ­factors, and the role of psychologists.

Importance of Gender Gender figures prominently in the experience of existential encounters and aging, as sex-specific health concerns, such as breast, gynecological, or penile cancers, and social mores for coping with physiological changes, grief, and meaning making are situated within a gendered cultural context. Typically, women outlive men, face old age and death unpartnered, and vary in their perceptions of suicide, euthanasia, and life-sustaining treatments as compared with men. Men more often request life-sustaining measures, with masculine-typed men more likely avoiding existential issues. Women,

by contrast, frequently express concerns of becoming a burden, fear continuing life with physical or cognitive impairments, and reject invasive or heroic measures that may compromise their appearance. It is important to note that while the focus of this entry is on gender, all diversity variables, such as race/ethnicity, socioeconomic status, and religious views, similarly intersect with existential and endof-life issues.

Variables Related to Existential Issues and Common Experiences Experiencing loss or grief can raise existential concerns, including both physical and symbolic loss. Although the predominant emotion accompanying abortion is relief, some women experience feelings of anxiety, guilt, and shame, often in response to gendered and cultural expectations of mothering. Women who experience a stillbirth or miscarriage report a sense of helplessness, anxiety, and betrayal by their bodies or a higher power. The experience of stillbirth, for example, also presents physical reminders of the loss, such as milk production following delivery. Old age often provides an opportunity for reflection, as death is inevitably closer than during any other period of the life span. The aging process raises concerns about the ephemeral nature of the human body and the end of one’s existence. Chronic, life-threatening illnesses such as HIV/ AIDS, renal and other degenerative diseases, or the loss of a loved one can also trigger death anxiety. Not only do individuals facing illness contend with the threat of death, but many also experience a threat to their gender and sexual identities or are prematurely launched into physiological/biological stages, such as menopause, as a result of medical intervention. Individuals who experience the death of a loved one typically experience a range of emotions, with some reporting relief if their loved one was previously suffering. Individuals can grieve the perceived loss of their former selves, as occurs in aging or with changes in health status or reproductive ability. Facing illness or the death of a loved one can result in a loss of sexual desire, identity as a sexual being, or life roles. Existential issues are often triggered by fear of impending death, recurring diagnoses, additional loss of loved ones, pregnancies, health problems,

Equal Employment Opportunity

loss of quality of life, loss of self, or loss of immortality. Many report a sense of anticipatory grief, engaging in fantasizing or brooding behavior, prompted by upcoming medical examinations or reminders of their previous loss. Fear of a painful death and of the unknown process of dying is similarly a common experience. Many individuals report a sense of desperation, anxiety, hopelessness, loneliness, or isolation from others, their higher power, or parts of their internal experience. Individuals may avoid existential issues, increasing involvement in their daily activities as a distraction, or confront their existence through a process of reevaluation. Conversely, many embark on an existential flight or search for meaning through transcendence, involving personal exploration of roles, identity, and values, reevaluating one’s ­existence within a broad context of time, seeking personal growth, and shifting values.

Meaning Making Meaning making involves pursuing the meaning of life, exploring the experience of suffering, establishing one’s role in the universe, and assimilating painful experiences into one’s life story. Individuals can establish practices or rituals as special acts to commemorate an event or to achieve closure, such as lighting a candle or holding a service or vigil. Meaning making can facilitate coping skills and survival after existential crises; a deeper understanding of the world, others, and self; personal growth; gratitude for living; and a reorganization of values. Some individuals experience barriers, including an inability to carry out traditional practices, such as the baptism of a stillborn child or burial and religious acknowledgement of a loved one who has completed suicide. Some experiences have little or no formal cultural practices or recognition, such as rituals for aborted or miscarried fetuses. The stigma of changes associated with sexuality due to illness or the aging process, such as a mastectomy or orchidectomy, can hinder a public grieving process. Individuals who are disenfranchised, such as incarcerated persons, are often unable to attend ceremonies for loved ones. Similarly, those in nursing/hospice homes or in prisons can experience a fear of dying alone and concerns about the legacy they are leaving, while receiving few resources to find closure at the end of life.

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Psychologists can facilitate the meaning-making process by highlighting the universality of existential issues, promoting legacy-building activities at the end of life, conducting grief support groups, and facilitating exploration of clients’ inner experience. A willingness to explore existential concerns, in the context of their gendered and cultural beliefs, can enhance psychological well-being and foster resilience. Noelany Pelc and Debra Mollen See also Grieving and Gender

Further Readings Brody, C. M. (2002). An existential approach: End-of-life issues for women. In F. K. Trotman, C. M. Brody, F. K. Trotman, & C. M. Brody (Eds.), Psychotherapy and counseling with older women: Cross-cultural, family, and end-of-life issues (pp. 239–250). New York, NY: Springer. Cacciatore, J. (2010). The unique experiences of women and their families after the death of a baby. Social Work in Health Care, 49, 134–148. doi:10.1080/ 00981380903158078

Equal Employment Opportunity Equal employment opportunity refers to all individuals who are qualified for a given job having equal opportunity to be hired, regardless of gender, race, age, disability, or any other factor that has no bearing on potential job performance. The concept of equal employment opportunity is based on ­antidiscrimination laws and practices, which state that a person should not be treated differently because of a demographic characteristic. This entry reviews the history of equal employment and defines hiring discrimination; then, the entry discusses remedies for violations as well as continuing issues ­specifically with women’s equal employment opportunity.

History and Sociological Perspective For much of modern history, employees have had very little power. It has been traditionally viewed as the employer’s prerogative to decide whom to

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hire and not hire. It is actually a defensible position, and still held by many employers today, that if one is buying something (labor), then one should be able to choose from whom to buy it. However, social activism and the rise of unions, beginning in the late 19th century, have steadily lessened the extent to which employers can discriminate. In addition, on the heels of civil rights legislation in the latter part of the 20th century, the United States has implemented several pieces of legislation banning workplace discrimination, beginning with Title VII of the Civil Rights Act of 1964 and continuing with legislation such as the Americans with Disabilities Act of 1990 and the Genetic Information Nondiscrimination Act of 2008. The idea of equal employment opportunity is part of the democratic ideal, which states that one person is as worthwhile as another. Because of this ideal and the robustness of the laws that have been put in place, the majority of Americans endorse equality in the workplace and in hiring. Not providing equal employment opportunity is a form of discrimination. The origin of discrimination is in the ancestral human tendency to form in-groups and out-groups. The result is viewing members of one’s own group as more capable, more worthy, and more desirable than others. Not seeing potential employees as members of one’s ingroup because they are of a different gender, race, ethnicity, or country of origin can lead to employment discrimination.

What Hiring Discrimination Is and Is Not It should be noted that equal employment opportunity does not mean that everyone who applies should be considered for a job. The ability to do the tasks involved can still legitimately be a ­criterion for employers; for instance, an employer could refuse to hire a blind person for a job driving a taxi and not violate equal employment ­opportunity laws by such refusal. Similarly, it is not gender-based hiring discrimination to refuse to hire someone for a job that is truly appropriate for only one gender, such as, for example, an attendant in a men’s bathhouse. However, this concept cannot be extended to prejudicial concepts of what is a “man’s job” or a “woman’s job.” For instance, one could not refuse to consider a man for a job selling women’s dresses

or a woman for a job as a firefighter. The sole criterion a potential employer can apply is ability to do the job. In point of fact, in recent years, women have made substantial inroads into traditionally male professions, and vice versa. It is permissible to have standards for physical ability and fitness for a given job, but it is not permissible to treat anyone who meets such standards differently in hiring decisions. The realization and proof that women can be just as strong, enduring, and physically capable as men is now evident with many women who work in police and fire departments, as emergency medical technicians and other emergency responders, and in the military, including frontline positions. Thus, it is not only against the law but also against ­common sense to refuse to hire a woman based on the perception that she will not be as physically capable as a man.

Remedies for Violation of Equal Employment Opportunity Most of the time, a person who feels that his or her employment rights have been violated will seek compensation by suing the employer in question. Employers who discriminate may also be subjected to criminal penalties, but generally, the issue is resolved in a civil, not criminal, court. The plaintiff has to show that he or she was not hired solely due to the characteristic discriminated against (e.g., gender, race, disability). This can be hard to prove as the employer can simply argue that another, more qualified candidate was chosen for the job. It is difficult to prove that discrimination was the reason why a person was not hired. This is not to say that lawsuits based on violation of equal employment opportunity laws have not been successful. Many such actions are and have been successfully brought against employers. This, in turn, has led to employers carefully documenting applications, interviews, and other ­prehiring procedures. It is a valid defense for an employer to point out that many qualified candidates were available and the applicant was not one of those selected; it is not a valid defense that the employment decision was made for subjective reasons. Even then, though, the burden falls on the plaintiff to prove that such a decision was discriminatory.

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Continuing Issues in Women’s Equal Employment Opportunity Women still face many obstacles in achieving fair hiring treatment. Many “old-school” male employers feel that hiring a young woman for an executive position is a mistake because she will not make a commitment to the position but, instead, will want to start a family. This impression, often used as an excuse for not putting women in positions of responsibility in the past, is not valid as many professional women can and do have families and careers, just as men have for millennia. Nonetheless, the impression that women cannot handle both career and family persists and is manifested in hiring discrimination; also, many believe that women should concentrate on the family and not on a career. A further issue is that of paid maternity leave. In western Europe, it is the norm; in the United States, it is slowly being adopted. Employers could refuse to hire women based on their perception that they will have to provide such paid leave, which is expensive. However, it is becoming more and more common for men to be granted paternity leave as well when their spouses are expecting and/or have given birth. This policy recognizes that pregnancy and having a child are family events, not just something that happens to a woman alone. William G. McDonald See also Gender Bias in Hiring Practices; Workplace and Gender: Overview

Further Readings Bielby, W. T. (2000). Minimizing workplace gender and racial bias. Contemporary Sociology, 29(1), 120–129. Burstein, P. (1998). Discrimination, jobs, and politics: The struggle for equal employment opportunity in the United States since the New Deal. Chicago, IL: University of Chicago Press. Chacko, T. I. (1982). Women and equal employment opportunity: Some unintended effects. Journal of Applied Psychology, 67(1), 119–123. England, P. (2010). The gender revolution uneven and stalled. Gender & Society, 24(2), 149–166. Krieger, L. H. (1995). The content of our categories: A cognitive bias approach to discrimination and equal employment opportunity. Stanford Law Review, 47(6), 1161–1248.

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During the Industrial Revolution, women were often paid less than their male counterparts for similar jobs. As the first wave of feminism gained traction and popularity, the demand for equal pay for equal work became an important movement. In the 1830s, women began to be unionized, and they used their new power to make their voices heard. In this period, there were a series of strikes organized and promoted by unionized women in the United Kingdom. Following World War II, trade unions and legislation in many countries began to slowly embrace the “equal pay for equal work” platform. Despite the laws enacted throughout the world, women still struggle with being paid less than their male counterparts for the same work. Although the gender pay gap has narrowed significantly since the 1970s, the average woman is paid about 23% less than the average man. These figures vary based on large-scale factors such as geography and local industry. For example, Washington, D.C., maintains the smallest wage gap in the United States, with the median woman earning 90% of the median man. Women of Wyoming, on the other hand, are paid merely 64% of the earnings of an average man for similar work. Other major factors that come into play are more individual in nature, such as race, ethnicity, age, and education level. For example, Asian American women have the largest gender wage gap, whereas Hispanic women’s earnings are the most similar to those of their male counterparts. In terms of education, although greater education tends to increase women’s overall earnings, it does not adequately explain or close the gender wage gap. At every level of academic achievement, women’s salaries are less than men’s by at least 21%. The gap is also associated with factors such as college major and type of job, although there is still a significant part that cannot be explained by these factors. Even after controlling for industry, hours, work experience, religion, grade point average, education, number of children, marital status, college major, race, ethnicity, and type of job, women are still paid only 82% of what men earn 1 year after college graduation. Furthermore, the gap widens 10 years out of college, when women earn only 69% of what men earn.

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The gender pay gap is an issue that affects women across the world. Although exact figures on pay differentials vary based on the measures being studied, there are similar patterns among industrialized nations. According to a 2013 report by the Organisation for Economic Co-operation and Development, the gender pay gap among the top 25 industrialized countries ranges from 6.1% to 28.7%. Countries such as Spain, Belgium, H ­ ungary, New Zealand, Norway, and Belgium tend to have low percentages of pay differentials, whereas countries such as Japan and Germany have more significant wage gaps. Because the gender pay gap is so prevalent throughout the world, it is important to understand some of the possible mechanisms that may account for it. One popular theory, known as the human capital theory, posits that some workers are paid less because they lack the needed level of education, training, or work experience compared with their competitors. When applied to the gender gap, then, the theory suggests that women’s wages tend to be lower because they choose to work fewer hours and choose less demanding careers as a result of the demands of child care and family responsibilities. A second theory, known as discrimination ­theory, hypothesizes that prejudicial and discriminatory practices in the workplace are the main culprits of the pay gap. It suggests that discriminatory practices result in differential treatment, which eventually leads to unfair assessments and expectations of productivity, evaluation, and appraisal of women compared with men. Florence L. Denmark and Talia Zarbiv See also Career Choice and Gender; Equal Employment Opportunity; Equality Feminism; Socioeconomic Status and Gender

Further Readings Lips, H. M. (2013). The gender pay gap: Challenging the rationalizations. Perceived equity, discrimination, and the limits of human capital models. Sex Roles, 68, 169–185. U.S. Equal Employment Opportunity Commission. (2010). Equal pay and compensation discrimination. Washington, DC: Author. Retrieved from https://www .eeoc.gov/eeoc/publications/upload/fs-epa.pdf

Equality Feminism Equality feminism emphasizes similarities between men and women with the goal of equality across gender. The concept takes on the view that men and women are similar in intellect, reason, and cognitive ability. The term does not suggest that men and women should be treated the same entirely—especially because there are many ­differences between them. However, the concept purports that men and women be afforded the same rights and protections as human beings regardless of gender. In equality feminism, it is necessary that “normalcy” not be defined based on White, heterosexual, able-bodied, and economically privileged men.

Birth of Equality Feminism Equality feminism was highly influenced by Mary Wollstonecraft’s 1792 essay, A Vindication of the Rights of Women. In this essay, Wollstonecraft argued that men and women were born with the ability to reason and that women are only deemed inferior because society denies women access to education. Wollstonecraft’s writing facilitated ­feminist equality theory, which continued with the works of Sarah Grimke´, Letters on the Equality of the Sexes (1837); John Stuart Mill, Subjection of Women (1869); Simone de Beauvior, The Second Sex (1949); and Betty Friedan, The Feminine ­Mystique (1960). The birth of equality feminism in the United States occurred in 1848 in Seneca Falls, New York, which came to be known as first-wave feminism. The organizers of the event were Lucretia Mott and Elizabeth Cady Stanton—abolitionists who met in London, England, at the World Anti-Slavery Convention in 1940. The first Women’s Rights Convention in Seneca Falls attracted more than 200 men and women, including Frederick Douglass, an influential African American abolitionist. At the convention, Stanton read a document, Declaration of Sentiments, which she and Mott had authored. This document detailed the oppression women experienced at the hands of White men and government. Specifically, husbands owned women, and everything a woman wore, had, or bore, ­including clothing, wages, and children, respectively,

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belonged to her husband. The right to vote and have a voice in government also was a focus of the Declaration of Sentiments and would be a catalyst for the suffrage movement and women’s right to vote. Stanton and Mott continued their feminist work and later were joined by Susan B. Anthony. In 1866, Mott became the first president of the ­American Equal Rights Association, which supported equality for African Americans and women, while Stanton and Anthony worked together on establishing equal rights for women in New York by amending the Married Women’s Property Law in 1860 to allow shared child custody, property ownership, and ownership of wages and inheritance. With issues of the Civil War at the forefront, Stanton and Anthony established the National Women’s Loyal League to support the constitutional amendment to abolish slavery. In 1868 and 1870, when the Fourteenth Amendment, granting citizenship to persons born or naturalized in the United States, including former slaves, and the Fifteenth Amendment, which granted African ­ American men the right to vote, respectively, were ratified, Stanton and Anthony were critical of the Fourteenth and Fifteenth Amendments because they centered on the exclusion of women’s suffrage. Discontented with the American Equal Rights Association’s focus on the rights of African American men, the organization split, forming the National Woman Suffrage Association, which was led by Stanton, Anthony, and Matilda Joslyn Gage. The National Woman Suffrage Association focused on getting women the right to vote to facilitate social justice reform for women and other marginalized groups. Anthony traveled the country, while Stanton largely wrote speeches and other documents that expressed religious, reproductive, and voting reform for women. The fight for equality continued with the Women’s Suffrage Amendment, which was introduced in Congress in 1878 but took until 1920 to become law. Two women, Alice Paul and Lucy Burns, were feminists who worked tirelessly to obtain for women nationwide the right to vote. Many activists continued the quest for equality by introducing the Equal Rights Amendment (ERA) in Congress in 1923, which is yet to be ratified. Although women won the right to vote in 1920, there were battles yet to be fought for equality feminists. Women were still considered the “weaker

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sex,” and careers and education were limited. Within the sociocultural structure of the United States, men were still considered the “head of the household,” and women were relegated to be housewives and caretakers of children. This made women dependent financially on men, which gave them little room for refuge from marriages that were unhealthy or abusive.

Equality Feminism: A New Birth Friedan’s work and the publication of The Feminine Mystique in 1960 strongly influenced what would be known as second-wave feminism. Friedan noted that women were pigeonholed in their roles as wives and mothers and were limited in the careers they could enter because of societal expectations based on gender. Thus, second-wave feminism focused on increased opportunities for women, including workplace equality, passage of the ERA, and reproductive rights. Second-wave feminism met with some controversy because of the focus on issues that were specific to White, heterosexual women. However, the 1960s became the period in history when other oppressed groups fought for equality, including African Americans and the gay and lesbian community. The civil rights movement and the Civil Rights Act of 1964 changed the scope of women’s rights and equality feminism. Title VII of the act prohibits discrimination in employment based not only on race or color but also on religion, sex, or national origin. Thus, Title VII gave women the ability to seek legal recourse if denied equal treatment in the workplace. Since 1970, equality feminism continues toward the erasure of differential treatment on the basis of gender. Although much has been accomplished, including gaining reproductive rights, opportunities for equal education through Title IV, more career choices, and a reduction in sexism, overall, there are still battles to be fought for equality ­feminists, including equal pay for equal work, ratification of the ERA, heterosexism, racism, ableism, and the emergence of genderism, or the sociocultural belief that gender is binary and one is expected to be the gender assigned at birth. Catherine J. Massey See also First-Wave Feminism; Second-Wave Feminism

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Further Readings Rowland, D. (2004). The boundaries of her body: The troubling history of women’s rights in America. Naperville, IL: Sphinx. Stanton, E. C. (1876, July 4). Declaration of rights of women of the United States (Elizabeth Cady Stanton Collection, 111.00.01 [Digital ID# us0111_1]). Washington, DC: Library of Congress, Manuscripts Division.

Websites U.S. National Archives and Records Administration, Center for Legislative Archives: http://www.archives .gov/legislative/research/

Estrogen Estrogen is a sex hormone that is produced in the female ovaries, adrenal gland, placenta, fat tissue, and male testes. Estrogen is made up of a class of hormones consisting of estriol, estradiol, and estrone. Found in the largest amounts in a female’s ovaries, estrogen is responsible for the changes that occur during puberty, pregnancy, and menopause. Estrogen also affects the overall health of both females and males.

Estrogen and Puberty The first time many girls hear about hormones is right before they reach puberty. There are whispers about “raging hormones” and how this will affect behavior. However, few young girls actually know what hormones are or how they work inside the body. When puberty occurs in females, the ovaries begin to produce and release eggs (ova). The ability of the ovaries to do this is due in part to estrogen, specifically estradiol. Estrogen also plays a role in the health of the female reproductive organs and tissue, preparing them for menstruation and possible pregnancy. Estrogen is also partly responsible for the development of secondary sexual characteristics in females, which include the development of breasts and pubic hair. Estrogen is also given to transgender females to help their body transition into appearing more feminine.

Estrogen and Pregnancy When a woman becomes pregnant, her estrogen levels begin to greatly rise. This rise in estrogen

allows the placenta and uterus to support the growing baby. The lining of the uterus (uterine endometrium) thickens in preparation for implantation of a fertilized egg by way of estrogen. Throughout the pregnancy, the woman’s estrogen levels continue to escalate until they reach their highest levels during the third trimester. This increase in estrogen may be why many women experience pregnancy-related nausea or “morning sickness.” Estrogen also increases blood circulation, which is needed since the woman is now responsible for another being, living inside her. Estrogen also plays a role in the skin changes that can accompany pregnancy, such as dark spots, stretch marks, and darkening of the nipples. Another important role of estrogen is that it prepares the uterus to respond to oxytocin. This is essential because oxytocin stretches the cervix in preparation for labor and prepares the breasts for milk production. Estrogen also plays a role in fetal growth by aiding in the development of organs and bone density.

Estrogen and Menopause For the average woman in the United States, the end of menstruation, menopause, occurs sometime in her 50s, but it can occur earlier or later based on genetic and environmental factors. Menopause follows many years of perimenopause, a time of hormonal change in the female’s body. Once a woman has passed her optimal childbearing years, the body begins to shut down the process by which ova are produced, which involves a decrease in estrogen production. The levels of estrogen in the woman’s body can fluctuate greatly in the years of perimenopause. This can result in hot flashes, decreased lubrication in the vaginal area, night sweats, irritability, and irregular periods leading up to the complete end of menstruation. For most women, when they enter menopause and their estrogen levels are at a consistent low, many of the negative symptoms subside. However, if during perimenopause, the systems are too severe or bothersome for the woman, she does have the option of hormone replacement therapy (HRT). HRT is a synthetic version of estrogen, or estrogen and progestin, given to a woman to regulate her body as it transitions into menopause. The benefits of HRT are that it can help with hot flashes, night sweats, and vaginal dryness. The risks of HRT are that it can lead to a greater chance of heart disease,

Ethics in Gender Research

blood clots, and breast cancer. It is advised that women who choose HRT take the lowest dose that is helpful to them and only use HRT for the shortest amount of time possible to decrease the health risks associated with its use.

Estrogen and Males Although women have significantly higher levels of estrogen, men also produce the hormone, but in much smaller amounts. When boys hit puberty, their bodies begin producing high levels of testosterone, which aids in muscle development and sexual functioning. However, as a man ages, his body’s levels of testosterone begin to drop, and his levels of estrogen begin to rise. Estrogen and testosterone are very similar chemically but have very different effects on the body. When males produce high levels of estrogen, it can lead to erectile dysfunction, decreased muscle mass, and an increase in breast tissue. Low levels of testosterone and high levels of estrogen in men may also be linked to prostate cancer and stroke. Men are more likely to have an excess of estrogen if they are overweight and carry a high amount of fat in their midsection. However, a balanced amount of testosterone and estrogen in the male body contributes to bone health. Men, like women, can also benefit from hormone replacement when their testosterone levels get too low and estrogen levels rise. There are risks associated with hormone replacement in men, including sleep apnea, blood clots, and stroke. Tracy Meyer See also Hormone Therapy for Cisgender Men and Women; Menopause; Menstruation; Pregnancy; Puberty

Further Readings Maleskey, G. (2001). The hormone connection: Revolutionary discoveries linking hormones and women’s health problems. New York, NY: St. Martin’s Press. Neave, N. (2008). Hormones and behavior: A psychological approach. New York, NY: Cambridge University Press. Romoff, A. (1999). Estrogen: How and why it can save your life. New York, NY: Golden Books. Watkins, E. S. (2007). The estrogen elixir: A history of hormone replacement therapy in America. Baltimore, MD: Johns Hopkins University Press.

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Ethical considerations are a part of the foundation of any study in psychology. The American Psychological Association (APA) has specified guidelines that must be followed to ensure that human participants are protected from forms of distress such as breaches in confidentiality, deception, and undue physical or mental harm. In addition to APA guidelines, academic institutions also have an institutional review board that engages in a thorough review of a study’s data collection procedures, sample selection, and actions in which participants will be engaged. In most cases, certain participants are only excluded from a study with a justifiable scientific rationale (e.g., excluding participants not living in the United States when researching voting patterns of individuals in Nebraska). Despite the many safeguards in place for participants, some scholars have called for increased attention to research ethics in marginalized populations. One area that received attention is the ethics of gender research, as some studies have been found to completely omit women or misrepresent findings. In this entry, ethical issues in gender research are presented, followed by a description of research methods that attempt to reduce bias and share power. Finally, due to recent changes in research ethics in the APA code, research issues with transgender samples are explored.

Ethics as a Gendered Concept One widely used conceptualization of ethical decision making comes from Lawrence Kohlberg, a prominent psychologist who studied moral development in the mid-1900s. Kohlberg posited six stages of moral development within three distinct levels of development. In the first level, known as the preconventional stage, the individual would attempt to avoid punishment and seek out personal benefits. Individuals in the second level, the conventional stage, would use social norms to guide their behavior. For example, a greater understanding of relational consequences and the adherence to the golden rule are characteristic here. In the final level, the postconventional stage, abstract reasoning is used to determine if actions are just. Here, laws may even be broken if they are believed to be unjust. In addition, fairness and democracy are valued. Elements of Kohlberg’s theory of moral

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development are found in moral guidelines that range from government constitutions to university institutional review boards. Despite such widespread implementation of this theory of moral development, women frequently scored lower on Kohlberg’s scale of moral decision making. The reason for this, as some feminist researchers such as Judith Preissle point out, is that Kohlberg developed his theory based on the attitudes and behaviors of White, middle-class ­ men. Indeed, women were no less moral than their male counterparts but utilized a different method for decision making. Women were noted for their emphasis on caring rather than justice or fairness. For example, men often thought of morality as a vertical process, with specific hierarchies and levels of authority, whereas women thought horizontally, or how moral choices would affect networks and relationships. Preissle described how Carol ­Gilligan, a prominent feminist and ethicist, developed a model of women’s ethical decision making in contrast to the work of Kohlberg. Gilligan’s model illustrates how women navigate their perspectives on selfishness versus responsibility. In this model, the earliest stage of ethical decision making consists of actions that are good only for the self. This is followed by a stage of selflessness, where the primary concern is about the impact that decisions will have on an individual’s social network. The third and final stage describes how women make decisions that include implications for both the self and others. One can begin to see how an emphasis on the relational aspects of decision making may be just as important as a focus on justice and fairness.

Current Concerns in Gender Research Although many would likely agree that justice and fairness are important factors in ethical decision making, the lack of relational considerations and a generalization of the values and behaviors of privileged groups to marginalized groups have realworld implications. Sue Rosser, a researcher in women’s health and feminism, has noted that androcentric values have led to a number of limitations for women in science and medicine. Rosser stated that women and other marginalized groups are frequently ignored in studies. Instead, a focus is placed on those with social power. Furthermore,

Rosser noted that women are not sufficiently represented on peer review committees, which dictate how many studies are funded. As a result, Rosser noted several outcomes. One outcome was that gender is not used as a basis of a study’s hypothesis often enough. For example, a study in the mid1980s on drug effectiveness for cholesterol utilized almost 4,000 men but no women. Another outcome noted was that concerns that are specific to women tend to be less frequently studied or funded. According to Rosser, medical issues for men are commonly researched, whereas women’s health issues receive attention primarily when they are related directly to men’s issues, such as studies on contraception. In addition, studies generated from the personal narratives of women are also ignored, favoring data and “objective” measures. In this specific area of medical research, how decisions are made can at times literally mean life or death. Another debate between researchers concerns which groups should be able to research which groups. That is, what are the potential downfalls of groups with power and privilege conducting research with marginalized groups? It is clear that there are significant consequences for groups that are completely omitted from the discussion, but there are unique ethical concerns that must be considered when conducting research where differences in power and privilege exist. One issue is clear from previously listed examples: Results from research focused on men cannot be generalized to other populations. However, other ethical issues are oftentimes overlooked or are more difficult to recognize despite their deleterious nature. Researchers noted that one can be thought of as an “insider” or “outsider” when conducting research on gender. Regina Scheyvens and Helen Leslie, researchers of social responsibility and community empowerment, presented a noteworthy example of this. They noted that if a man were to attempt research with women in the Solomon Islands, it would be almost impossible unless he were to engage in activities such as bathing and eating with the women to gain their trust. Without doing so, the male researcher would be treated with suspicion by the participants and their husbands. Such a suspicion would not exist for researchers who were women, allowing for a greater engagement based on gender alone.

Ethics in Gender Research

Understudied Populations: Ethics in Research With Transgender Individuals Research with lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities often omits those within the T population. Why might this occur? As a whole, it is well documented that the LGBTQ population is marginalized and frequently discriminated against. In addition, subsets of the population can, at times, be ostracized within the LGBTQ community, and many transgender people may not feel as though they are actually a member of this wider group. Research that includes transgender populations is important not only for furthering the understanding of the population but also for assisting treatment providers or assessors with standards of care and assessment. According to some researchers, despite elevated risks related to physical and mental health concerns of the LGBTQ population, limited resources focus specifically on prevention programming for these individuals. Within the research, there are even further limitations on attention provided to the transgender population. While psychologists are aware that there is an elevated risk for suicide, and mental and physical health problems among this population, the research continues to omit transgender individuals. Although there are many hypotheses as to why this may occur, one may be related to the lack of ethical guidelines related to transgender-specific research. In August 2015, the APA created the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People to assist with psychologists’ therapeutic treatment and assessment of transgender individuals. There are 16 identified guidelines, one of which focuses on ethical considerations for research with individuals in the transgender community. The ethical standards are ­necessary to complete and facilitate therapy, assessment, and research with transgender individuals. However, these concerns are not new for this population, and the lack of ethical standards prior to August 2015 shows the continued lack of awareness and research concerning treatment for transgender people. Research with transgender populations may assist with the development of understanding and with eliminating the long-established stereotypes that often follow the trans community. The United

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States is a country where individuals are often socialized in a heteronormative environment. This type of socialization creates myths, stereotypes, and expectations related to sexual minorities, which in turn creates heterosexual bias. In facilitating research with transgender people, researchers must remain cognizant of potential bias or perpetuation of stereotypes and stigmas. When research is conducted with transgender people, researchers must also remain aware of factors related to the subjects’ gender identity, such as painful life experiences, which may include traumatic experiences directly related to their gender identity. As such, protective factors must be in place to conduct ethically sound research. Some of these protective factors may include a greater emphasis on “insider” research, whereby transgender researchers conduct research with transgender populations. Another method may be research that studies transgender communities with an actual member of the community, rather than conducting research on them. For example, considerations for ethically sound research with the transgender population can include an inclusive approach to the transgender community, while avoiding the creation or enforcement of hierarchies with transgender identities. Creating a research project that includes transgender people as collaborators with the researchers can assist with primary researchers’ questions, comments, or concerns that arise during the development of the research project. Often transgender individuals do not want to ­participate in research that is not being led by a transgender researcher, as they are potentially concerned about a cisgender bias toward transgender populations. Researchers should review their own cultural bias and make every effort to refrain from allowing their bias to play a role in affecting their study. While determining what type of study to complete, the researcher may choose a quantitative study; however, qualitative or participatory action research methods may at times be more appropriate, given that each transgender person’s ­experience is different. In the discussion section of the research paper, a note should be placed stating that the study of transgender communities attempts to be inclusive, noting that due to the diversity of experiences within the transgender community, this is not always possible.

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Ongoing Issues Of late, significant steps have been taken in the area of ethics in gender research. Yet there are still debates as to the most effective practices and how to ensure that studies meet a broader definition of what is ethical. Feminist scholars have taken significant strides to better capture the experience of women and other marginalized groups; however, ethical concerns with research involving individuals in the LGBTQ community continue to persist. Additional research might benefit from including more “insider” researchers who share similar social identities with those participating in the research, as well as allowing the participants to have a greater role in the data collection, analysis, and distribution of findings. Jacob S. Sawyer, Lindsey L. Wilner, and Melanie E. Brewster See also Ethics in Psychotherapy and Gender; Feminism: Overview; Gender Bias in Research; Heteronormative Bias in Research; Research Methodology and Gender; Research: Overview; Sexual Orientation as Research Variable; Transgender Research, Bias in

Further Readings Baum, F., MacDougall, C., & Smith, D. (2006). Participatory action research. Journal of Epidemiology and Community Health, 60(10), 854. doi:10.1136/ jech.2004.028662 Edwards, R., & Mauthner, M. (2002). Ethics and feminist research: Theory and practice. In T. Miller, M. Birch, M. Mauthner, & J. Jessop (Eds.), Ethics in qualitative research (2nd. ed., pp. 14–31). Thousand Oaks, CA: Sage. doi:10.4135/9781473913912.n2 Kohlberg, L. (1981). The philosophy of moral development. New York, NY: Harper & Row. Preissle, J. (2006). Envisioning qualitative inquiry: A view across four decades. International Journal of Qualitative Studies in Education, 19(6), 685–695. doi:10.1080/09518390600975701 Rosser, S. V. (1989). Re-visioning clinical research: Gender and the ethics of experimental design. Hypatia, 4(2), 125–139. doi:10.1111/j.1527-2001.1989.tb00577.x Scheyvens, R., & Leslie, H. (2000, February). Gender, ethics and empowerment: Dilemmas of development fieldwork. Women’s Studies International Forum, 23(1), 119–130.

Ethics in Psychotherapy and Gender Ethical codes of conduct governing professional psychotherapy and related services require practitioners to understand and appreciate the ways in which gender and gender identity (as well as a host of other client-related factors) may affect diagnosis and symptom identification, case conceptualization, and treatment selection and implementation. Failure to consider the ways in which gender affects these psychotherapeutic processes may result in harm to the client/patient and may be considered a violation of professional ethical standards. This entry focuses on the responsibilities of professional psychologists using the American Psychological Association’s Code of Ethics (hereafter, APA Ethics Code) and, specifically, ­ gender-related ethical standards and responsibilities relevant to psychologists who provide ­psychotherapy. It should be noted that, in addition to psychologists, these standards and responsibilities may be applicable to other professionals providing psychotherapy.

Relevant Ethical Guidelines and Standards Psychotherapists are bound to abide by the laws of practice within their jurisdiction and the ethics codes of the governing professional association of which they are a member, such as the National Association of Social Workers, the American Counseling Association, and the American ­Psychological Association. For example, the APA Ethics Code guides the work of psychologists in their various professional roles, including assessment, psychotherapy, research, consulting, and teaching. The APA Ethics Code includes two major sections: (1) aspirational ethical principles and (2) more than 100 enforceable standards. The aspirational principles represent the ­underlying moral pillars of the profession and are as follows: (A) Beneficence and Nonmaleficence, (B) Integrity, (C) Fidelity, (D) Justice, and (E) Respect for People’s Rights and Dignity. The enforceable standards include specific rules by which psychologists must abide in their professional work.

Ethics in Psychotherapy and Gender

Understanding and Respecting Individual Differences Respect for individual differences in the persons with whom psychologists work is a core ethical principle (Principle E: Respect for People’s Rights and Dignity). Psychologists are ethically obligated to consider the ways in which relevant client factors, including gender, race, ethnicity, age, sexual orientation, disability, and socioeconomic status, may affect the psychotherapeutic processes (Standard 2.01, Boundaries of Competence). For example, rather than relying on gender assumptions, competent psychologists are aware of the ways in which a person’s gender may not be captured by traditional binary “male” or “female” categories. In addition, psychologists also recognize the differences between sexual identity and gender expression, understanding that a person who identifies as transgender may also identify as lesbian, gay, bisexual, queer, or heterosexual.

Avoiding Harm One of the primary moral responsibilities of a psychologist is to maximize benefits and avoid harms to those with whom they work (Principle A: Beneficence and Nonmaleficence). Psychotherapists’ own prejudices, incorrect assumptions, ignorance, and biases about the gender, sexual orientation, ethnicity, religious beliefs, or other characteristics of the client/patient may inadvertently cause harm (Standard 3.04, Avoiding Harm). Examples include misunderstanding or misrepresenting the findings of psychological science with respect to gender and mental health, making professional recommendations that are based on the therapist’s personal beliefs rather than on sound psychological research or theory, and providing therapies that are not supported by evidence and/or pose potential harms to the client/patient, such as those meant to change sexual orientation. Bias or lack of proper training can also result in misdiagnosis, which may have serious implications for treatment planning and may result in incorrectly labeling a client/patient as having a more stigmatizing or severe disorder. To minimize the possibility of harm, psychologists are ethically required to critically evaluate their own skills and ability to provide effective professional services and to self-reflect on any personal beliefs

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or biases that may impede treatment and/or cause harm to the client/patient.

Competence Psychotherapists are prohibited from providing services that are considered outside the bounds of their competence, which generally refers to skills and knowledge related to particular psychotherapeutic techniques and approaches, mental health conditions, and individual populations (Standard 2.01, Boundaries of Competence). For example, in general, it would be considered unethical for a psychotherapist who has never received training or education in the treatment of posttraumatic stress disorder or sexual assault to agree to provide psychotherapy services to a client/patient seeking treatment related to an experience of sexual violence. Practicing outside the bounds of one’s competence raises the risk that clients/patients may be harmed through well-intentioned, but potentially damaging, techniques. In most cases in which a therapist lacks the necessary knowledge, training, and/or experience, the therapist is ethically required to give a referral to a professional who possesses the necessary competence to provide effective treatment. In addition to education, training, and experience, psychologists rely on professional and scientific guidelines to inform professional duties and work with specific populations. Psychologists working with women and girls are encouraged to consult the American Psychological Association’s Guidelines for Psychological Practice With Girls and Women, which presents recommendations regarding practices that are gender sensitive and empirically validated for use with girls and women. The guidelines also present research about genderrelated diagnostic and treatment disparities and stress the importance of recognizing the effects of oppression, socialization, bias, discrimination, and stereotyping on the development of girls and women, including mental health functioning. Other relevant professional guidelines published by the American Psychological Association and used by psychologists include Guidelines for ­Psychological Practice With Transgender and Gender Nonconforming People and Guidelines for Psychological Practice With Lesbian, Gay and Bisexual Clients.

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Multicultural Competence

Research suggests that mental health may be affected by a host of factors in addition to intrapsychic processes, including gender, age, race, sexual orientation, and socioeconomic status. Many leading psychologists argue that to provide effective services, psychologists must also possess multicultural ethical awareness and competence, ­ including an understanding of the impact of gender and other factors on mental health functioning. Multicultural ethical awareness requires that clinicians be sensitive to the ways in which gender, sexual, cultural, racial, religious, and other types of identity may affect the professional experience, as well as the clinician’s own values, biases, and prejudices. Multicultural competence also requires that when conceptualizing cases or making treatment recommendations, psychologists consider that a client/patient may present with multiple diverse identities. For example, a client/patient who identifies as gay or lesbian may also simultaneously voice deep religious beliefs and strongly value each identity. There has been a call for the field of psychology to move beyond an exclusive focus on individual psychological factors (e.g., personality constructs) to also include consideration of the ways in which sociopolitical factors, such as poverty, social class, racism, stigma, and oppression, may negatively affect mental health and well-being. Psychotherapists should consider the ways in which sexual and gender-based discrimination and harassment may affect the client’s/patient’s functioning and how an understanding of these factors affects the clinician’s conceptualization of the case. For example, research suggests that women who experience ­discrimination may be more likely to exhibit symptoms of depression. Maintaining Competence

Psychologists are also ethically mandated (by the APA Ethics Code and through continuingeducation requirements set forth by many state psychology licensing boards) to maintain competence by staying current with new developments in the science and practice of psychology, including new research findings, laws and regulations that affect the work of psychologists, and professional guidelines and recommendations (Standard 2.03, Maintaining Competence). For example,

psychologists are required to keep up with changes to diagnostic criteria and categories. The publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013 heralded major changes in diagnoses related to gender identity. Previous versions of the manual included the diagnosis of gender identity disorder, which many argued stigmatized transgender individuals by implying that nonconformity to one’s assigned gender was pathological. The latest edition of the manual did not include gender identity disorder but included a new diagnosis, gender identity dysphoria, which focuses on emotional discomfort associated with disparities between one’s identified gender and one’s assigned gender. The practice of psychology is continuously informed by new research and scholarship. Psychologists also maintain competence by keeping up with and applying empirical research findings to inform their professional services. For example, psychologists should be aware that although there may be an assumption that a match between the gender of the client and the therapist has an effect on psychotherapy outcome, in general there is no consistent empirical evidence to suggest that psychotherapy outcomes vary based on client gender. Psychologists should also be familiar with research that suggests that there are differences based on gender, ethnicity, and even socioeconomic status in how one understands and copes with psychological distress and how one demonstrates symptoms of disorders. When evaluating the findings of empirical research that may be used to inform professional practice, psychologists are cautioned to carefully consider the study’s methods and the demographic characteristics of the sample. Multicultural psychology scholars have pointed out that, historically, a great deal of psychological research has often been conducted on populations who lack diversity, raising questions as to the applicability of the findings to other populations. In addition, developmental theories and measures used in research may be based on heterosexist and/or gendered assumptions that may not reflect the experiences of those with whom the psychologist works.

Therapist Bias As reflected in the APA Ethics Code principles of Justice (Principle D) and Respect for People’s Rights and Dignity (Principle E), psychologists are

Ethics in Psychotherapy and Gender

urged to courageously and systematically examine the ways in which implicit or explicit assumptions and stereotypes related to client/patient gender and gender identity may affect the diagnosis, the ­development of a therapeutic relationship, and the selection and implementation of therapy ­techniques. Gendered assumptions about the roles and responsibilities of individuals may cause client/patient distress and may negatively affect the professional relationship. For example, a therapist who communicates personal beliefs to a client/patient that children whose mothers do not work outside the home fare significantly better than children whose mothers hold outside employment may unintentionally cause harm and emotional distress to the client/patient by providing inaccurate information that is not supported by empirical research. Moreover, a client/patient may conflate the personal opinions of the therapist with professional recommendations that are based on empirical research or established psychological principles. Research also suggests that gender biases may be at work when diagnosing clients with mental health disorders. For example, traditionally, men may be more likely to be diagnosed with certain disorders, such as antisocial personality disorder, whereas women may be more likely to be diagnosed with others, such as borderline personality disorder, depression, and somatization disorders. Biases also may result in pathologizing client/ patient behaviors simply because they do not conform to social or other expectations. Finally, therapist bias may be triggered by ­clients/patients who express statements that reflect intolerance and prejudice. Such interactions have the potential to negatively affect therapist judgment and decision making. Psychotherapists are encouraged to process negative personal reactions to clients/patients, for example, through consultation with colleagues or supervision.

Multiple Relationships and Sexual Intimacies With Clients The therapeutic relationship is based on trust and mutual respect between the therapist and the patient. Psychologists are prohibited from engaging in relationships with clients/patients that would reasonably be expected to impair their ability to perform their professional duties in a competent manner or that might lead to exploitation of the

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client/patient (Standard 3.05, Multiple Relationships; Standard 3.08, Exploitative Relationships). Examples include when a therapist asks a client/ patient to simultaneously serve as the therapist’s personal assistant or when a therapist and a client/ patient agree to invest in a business while maintaining the therapeutic relationship. Sexual relationships between therapists and patients/clients are prohibited by the APA Ethics Code (10.05 Sexual Intimacies With Current Therapy Clients/Patients). Research suggests that when sexual misconduct does occur between a psychotherapist and a patient, it is often male psychologists who engage with younger female clients. Sexual relationships exploit the already significant power differentials between the therapist and the client/patient and have the potential to cause considerable emotional harm. Sexual relationships also diminish the ability of the psychologist to remain objective and to provide competent care.

Conclusion Responsible practice of psychotherapy requires knowledge of and sensitivity to the ways in which gender and other factors can affect mental health and the therapy experience. Gender-related ethical challenges in psychotherapy include developing and maintaining competence (including multicultural competence), acknowledging personal biases and minimizing negative effects on professional services, and avoiding harmful multiple relationships and sexual intimacies between the therapist and the client/patient. Psychologists rely on numerous sources to navigate these challenges, including the APA Ethics Code, professional guidelines, and continuing scholarship and research. Adam L. Fried See also Ethics in Gender Research; Gender Dynamics in Clinical Training; Gender Dynamics in Group Therapy; Gender Dynamics in Psychotherapy; Sexual Orientation Dynamics in Clinical Training; Sexual Orientation Dynamics in Group Therapy; Sexual Orientation Dynamics in Psychotherapy

Further Readings American Psychological Association. (2007). Guidelines for psychological practice with girls and women. American Psychologist, 62, 949–979.

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American Psychological Association. (2010). Ethical principles of psychologists and code of conduct with the 2010 amendments. Retrieved July 30, 2015, from http://www.apa.org/ethics/code/index.aspx American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Retrieved from http://www .apa.org/practice/guidelines/transgender.pdf Fassinger, R., & Arsenau, J. R. (2007). “I’d rather get wet than be under that umbrella”: Differentiating the experiences and identities of lesbian, gay, bisexual and transgender people. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual and transgender clients (2nd ed., pp. 19–49). Washington, DC: American Psychological Association. Fisher, C. B. (2013). Decoding the ethics code (3rd ed.). Thousand Oaks, CA: Sage. Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (2001). Handbook of multicultural counseling (2nd ed.). Thousand Oaks, CA: Sage.

Ethics of Self-Care Psychologists

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The American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct (hereafter, APA Ethics Code) is the primary ethical resource for psychologists. Throughout the Ethics Code, it is clear that psychologists are expected to provide competent care for clients, students, and supervisees. However, guidelines for how psychologists are expected to care for themselves and their colleagues are much less clear. This entry examines the issue of self-care for psychologists, first providing the historical context and then discussing the self-care imperative.

Historical Context Psychology has been powerfully influenced by modern feminist theory. The current interest in selfcare for psychologists can be traced back to the tenets of the ethics of care as described by Carol Gilligan in her radical 1982 book In a ­Different Voice. In it, Gilligan challenged the prevailing patriarchal conceptualization of moral reasoning, which was that girls and women are less likely to

achieve “higher” levels of moral development and tend to get “stuck” in stages focused on relationships and caring. This unchallenged theory fostered the widely accepted notion that girls and women are inherently limited or flawed in their approach to moral decision making. However, this theory was rooted in the underlying assumption, well accepted at the time, that the highest level of moral development included universal and absolute ethical principles of individual rights and justice. In her work as Lawrence Kohlberg’s research assistant, Gilligan noted that girls and women tended to emphasize caring and interpersonal relationships in their approaches to moral reasoning, rather than the abstract notions of justice or individual rights valued in the Kohlberg model. Girls and women tended to conceptualize moral dilemmas as embedded within an interdependent social network. In Gilligan’s words, girls and women understood and resolved moral dilemmas in a different voice. Her work was revolutionary in that she used a feminist lens to challenge the unquestioned assumption that an individualistic and justice-based approach to dilemmas was the pinnacle of moral reasoning. By identifying this fundamental bias in Kohlberg’s model and through providing an alternate view, Gilligan was part of decades of work by feminist philosophers and psychologists that resulted in articulating an ethical and moral framework that values relational interdependence and care.

The Self-Care Imperative Coinciding with the publication of Gilligan’s book, in the early 1980s, psychologists were becoming increasingly aware that their work was stressful and that they were (and are) vulnerable human beings in addition to being highly trained professionals. Some of these tensions are reflected in the APA Ethics Code and what it says (and does not say) about self-care for psychologists. After briefly reviewing the APA Ethics Code, this section reviews research on the nature and scope of stress-related problems for psychologists and describes contemporary approaches to promoting a healthy and sustainable community for psychologists. It is not clear whether the APA Ethics Code applies at all to the private “self” of the psychologist. For example, in its section “Introduction and Applicability,” the APA Ethics Code states that the

Ethics of Self-Care for Psychologists

code does not apply to psychologists’ private lives. So what is meant by “private lives”? Presumably, anything that occurs when psychologists are not at work. However, the APA Ethics Code also encourages psychologists to be aware of their physical and mental health and to be conscious of the ways in which their physical and mental health can affect their ability to do their jobs competently and be helpful to others. As a result, the distinction between purely private and professional functioning is less clear; psychologists’ physical health and mental health are personal unless (or until) they affect their ability to help others. Common Stressors

Numerous surveys of practicing psychologists have uncovered common stressors, including working with challenging clients, keeping up with documentation and records, dealing with insurance companies, financial concerns, and the risk of ­ethical or licensing board complaints. Many psychologists also experience what has been termed vicarious trauma in their work with clients who have undergone traumatic events. Exposure to trauma is most likely for psychologists who work with refugee populations; in prison systems; with military service members, the police, the fire department, and other first responders; with survivors of natural disasters or domestic violence; and so on. As an essential aspect of treatment, psychologists encourage clients to share the story of the traumatic experience. As part of that process, the psychologist listens to and may absorb intense emotional pain, fear, and anger as clients tell their story and may, in fact, undergo a response similar to what the client has experienced. Compassion fatigue is similar and is believed to be a risk when psychologists treat psychologically distressed, but not necessarily traumatized, clients over time. In fact, even psychologists who do not work regularly with identified high-risk or highly distressed clients are susceptible to being profoundly affected by others’ pain and suffering. If not managed effectively, distress and burnout can be the result, which can lead to eventual problems of diminished professional competence. Distress and burnout can be compounded by the nature of the work; change is often gradual and can happen months after a client leaves therapy. Psychologists who work with clients with severe

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mental illness may see very little concrete change to let them know that they have been helpful. Even when change does occur, successful outcomes cannot be shared publicly, as confidentiality laws and related ethical principles limit the extent to which psychologists can discuss stressful (or even innocuous) work situations with friends or family. Other common stressors include personal vulnerabilities. Most psychologists feel very ­ responsible for the clients they serve. This sense of professional responsibility can interact with personal vulnerabilities such as an unrealistic wish to rescue others from pain and suffering. Some surveys have suggested that many psychologists were helpers or conflict mediators in their families of origin. In addition, psychologists may be susceptible to culturally related stressors. For example, not all organizations are inclusive environments and not all organizations are attentive to issues of diversity. Although this can be a stressor for any psychologist, regardless of minority or majority status, psychologists who are part of an underrepresented or marginalized group may experience significant stress and distress when working in an unsupportive or hostile environment. Furthermore, such stressors may increase or exacerbate the impact of some of the other stressors noted in this section. There are additional subtle aspects of work as a psychologist that can cause distress and reduce the relief from potential sources of support. For example, in a traditional private practice, long days of working one-on-one with clients can be isolating, and it may be difficult for the psychologist to leave the therapist role at the end of the day. What has been called the business of practice is also becoming more challenging as complex payment or reimbursement models become the norm. All of these potential stressors add up to make psychology a challenging profession. Several surveys have found that psychologists commonly experience emotional exhaustion, depression, social isolation, and anxiety. Also concerning is the survey finding that psychologists acknowledged working when they were too distressed to be effective, even though they knew that it was unethical to do so. Self-Care Approaches

Arguably, there is a uniquely important role for self-care for those involved in the practice of

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psychology. The term self-care seems to have originated with the 12-step self-help movement. In recent years, it has been much more widely adopted by psychologists, other health professionals, and many others. Stated broadly, self-care includes routine positive practices and regular mindful attention to one’s physical, emotional, relational, and spiritual selves. This includes activities and strategies that help establish and maintain wellness while minimizing the effects of stress. Self-care also includes avoiding (or at least not ­ overusing) negative coping behaviors such as substance use or distraction (e.g., excessive television watching), which will likely exacerbate difficulties over time. The goal is to soften the impact of professional stress and prevent loss of professional functioning. Research-Based Approach

Some researchers advocate for a research-based approach focused on positive psychology, cognitive behavioral therapy, and physical wellness, in which they emphasize psychologists valuing themselves and focusing on the rewards of their work. In this approach, psychologists are encouraged to acknowledge the hazards of psychological practice (described earlier) and the importance of focusing on the rewards of the work, especially when those rewards (e.g., helping people, seeing clients improve) are subtle. They also recommend setting boundaries and maintaining healthy relationships with colleagues, family members, friends, and mentors. Finally, they emphasize the importance of engaging in creative and diverse activities both in and out of work. Therapeutic Lifestyle Changes Approach

Another approach is the therapeutic lifestyle changes (TLCs) approach, in which psychologists are encouraged to develop lifestyle behaviors (e.g., nutrition, physical exercise, spiritual endeavors, attention to relationships) that positively affect mental health. The TLC approach builds on awareness of our evolutionary need to be in nature and the negative impact of overexposure to the media. Interestingly, the TLC approach was developed for use with clients, but it is highly applicable to psychologists themselves as well. In fact, most, if not

all, of the therapeutic techniques that are commonly recommended for clients are likely to also be beneficial to the psychologist. Communitarian Approaches

Several of the self-care strategies discussed in this entry allude to the importance of maintaining healthy personal and professional relationships. A more recent focus on communitarian care makes this point more explicit. In their review of the literature on professional competence and functioning, Brad Johnson and his colleagues noted that psychologists commonly expect themselves (and one another) to have a do-it-yourself approach to selfcare and a fix-it-yourself approach to addressing their problems. These authors emphasized developing a competent community, in which psychologists mindfully develop connections with several trusted colleagues and agree to provide one another with both constructive and nurturing feedback. These competent communities can serve as early warning systems for one another, helping psychologists recognize situations in which they risk becoming burned out, emotionally fatigued, vicariously traumatized, or otherwise too distressed to function well. Once there, they may take steps individually or with a colleague to address these concerns. Importantly, Johnson and colleagues pointed out that the competent community is not limited to harm prevention: This collection of carefully chosen colleagues can help psychologists achieve optimal functioning, working with their strengths to help one another achieve the best in themselves and in others. Throughout their work, they emphasize that rather than immediately asking the question “What shall we do?” when having concerns about a colleague, the first question might be “Who shall we be?” in relation to the colleague. Erica H. Wise and David S. Shen-Miller See also Caretakers, Experiences of; Gender Role Stress; Gender Self-Socialization; Gilligan’s Moral Development Theory; Humanistic Approaches and Gender

Further Readings American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://apa.org/ethics/code/index.aspx

Evolutionary Sex Differences Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press. Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J. (2012). The competent community: Toward a vital reformulation of professional ethics. American Psychologist, 67, 557–569. doi:10.1037/ a0027206 Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J. (2013). The competence constellation: A developmental network model for psychologists. Professional Psychology: Research and Practice, 44, 343–354. doi:10.1037/a0033131 Kohlberg, L. (1981). Essays on moral development: Vol. 1. The philosophy of moral development. San Francisco, CA: Harper & Row. Norcross, J. C., & Guy, J. D. (2007). Leaving it at the office: A guide to psychotherapist self-care. New York, NY: Guilford Press. Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66, 579–592. doi:10.1037/a0021769

Evolutionary Sex Differences According to evolutionary psychology, sex differences originate in dispositions that evolve as a result of natural and sexual selection. Evolutionary theory is a theory of origin in which distal causes—based on conditions in the past—are examined. In this entry, characteristics such as mating preferences, visual-spatial ability, aggression, and emotion are discussed from an evolutionary perspective. The entry concludes with a brief discussion of some of the criticisms of evolutionary explanations of psychological sex differences and alternative theories in which proximal causes are taken into account.

Natural and Sexual Selection In evolutionary theory, the origin of human sex differences is found in the solutions to problems successfully employed by our primitive ancestors. Males and females are genetically predisposed to behave differently because throughout the centuries, these differential behaviors permitted them to survive, to reproduce, and to pass their genes on to subsequent generations. The evolutionary approach is biological and deterministic. According to Charles Darwin, both

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natural selection and sexual selection have driven the development of physical and psychological sex differences. Natural selection is the gradual ­process by which heritable biological traits of organisms become more or less common in future populations, based on the differential reproductive ­success of organisms interacting with their environment. After Darwin was troubled by the inability of natural selection to explain extravagant male traits that did not appear to increase the survival of a species, such as the colorful tail of a peacock and the large rack of a moose, he expanded his theory of natural selection to include sexual selection. Sexual selection is composed of two separate types of selection process—intrasex and intersex selection. In intrasex selection, competition within a sex for opportunities to mate drives the selection of heritable traits of the successful competitors. Intersex selection results from the process in which members of one sex prefer to mate with some specific members of the other sex who are more attractive to them as mates. Heritable traits in the high-demand partners will then become more common in the offspring. It is these fundamental processes of evolution that have driven the development of sex differences.

Explaining Differences Reproductive strategies are an extremely important part of the evolutionary process and sexual selection. It is through having optimal reproductive strategies that genes proliferate in future ­generations. In 1972, Robert Trivers made a fundamental contribution to Darwinian thought with his parental investment theory. According to Trivers, differential levels of investment by males and females lead to differences in sexual selection. The sex that contributes most to the future offspring is sought after by the sex contributing less. In the ­history of the mammalian species, the female is typically limited in the number of potential offspring that she can produce because of her significantly larger contributions to parenting. Females are better able to maximize fitness by choosing the right male with whom to mate, as well as to increase the likelihood that the product of their union will have both resources and good genes. Males, on the other hand, are better able to maximize fitness by seeking to mate with many females,

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but in so doing, they have to possess features attractive to females, which will also help them compete with other males. These fundamental differences in early human ancestry are implicated in the development of many sex differences. In the review that follows, only some well-established sex differences with proposed evolutionary explanations are discussed. Mating Preferences

Because of the emphasis on reproductive strategies in the development of gender differences, this discussion begins with the differences between males and females in mating preferences. Researchers have documented a large sex difference in attitudes toward casual sex, with men being more in favor of it. Studies have found that men have more desire for casual sex partners, and in one study, 75% of the men but 0% of the women approached by an attractive stranger of the opposite sex consented to a request for sex. This is in accord with evolutionary psychological theory, because as Trivers noted, genetic success for males is attributable to having multiple sexual partners, while for females, genetic success involves having committed partners, who will aid in child rearing. In addition, men and women generally experience heightened sexual jealousy on the basis of different kinds of infidelities. Men are more distressed by imagining their partner being sexually active with another person, while women experience greater distress over emotional infidelity. These sex differences are precisely those that fit with evolutionary psychological theories based on sexual selection, because as women are searching for males who will give them resources and protection and participate in child rearing, men are more worried about sexual infidelities that may put their paternity into question. Mate selection is also based on physical appearance. Women prefer men whose skin is clear (indicating good health) and who have a muscular build and masculine features, because these are associated with higher levels of testosterone and therefore with fertility. Also attractive to women are men with the resources needed for commitment to a long-term relationship, in which support can be provided for children. These resources include intelligence, older age, social status, and stable finances. Men prefer younger women who have features suggestive of higher estrogen levels

(and therefore good fertility). These include curvaceous breasts and hips, smaller waists, clear skin, and full lips. Social status of potential mates, on the other hand, tends to be less important to men. Spatial Ability

Research findings indicate that men achieve better scores on tests of visual-spatial reasoning, whereas women appear to be better at tasks involving visual-spatial memory, remembering visual locations of a complex array of stimuli. Evolutionary psychological theories on spatial ability differences include theories that stem from both mating preferences and the differences in hunting and gathering roles the sexes had. According to the model based on mating preferences, fundamental differences in the need to range, or travel from place to place in search of mating opportunities, made it necessary for males to have superior spatial reasoning. This superior spatial, or “navigational,” reasoning can be seen as a male adaptation to the need to successfully navigate larger ranges. Because of the need for the primeval female to produce and care for children, women were generally restricted to relatively small home ranges. Thus, female adaptation resulted in higher levels of visual-spatial memory. A second, and more accepted, model of the development of visual-spatial sex differences rests on the observation that among hunting-and-gathering ­peoples, it was common for women to forage and men to hunt. Thus, tests of spatial ability that assess types of cognition related to important hunting skills, such as the ability to orient oneself in relation to objects or places that are either close or distant, tend to favor men. Men, historically the hunters, have needed the skill to maintain accurate orientations during the pursuit of prey across unfamiliar territory. However, women, who were gatherers, may have developed a superior visual-spatial location memory, because successful gathering depends on the ability to differentially encode the locations of stationary resources within a complex array of similar stimuli and to remember these locations at some later time. Aggression

There is agreement that on average, males are more likely to display aggression than females.

Evolutionary Sex Differences

Indeed, aggression is closely linked with cultural definitions of “masculine” and “feminine.” ­According to research by David Buss, different evolutionary functions of aggression exist, including ­co-opting the resources of others, defending against attack, inflicting costs on same-sex rivals, negotiating status and power hierarchies, deterring rivals from future aggression, and deterring mates from sexual infidelity to ensure paternity. Because of the differential role of men and women in society and the intersex competition between males for females with whom to mate, aggressive behaviors were important for the genetic success of males. Hence, it has been proposed that differences in aggressiveness between the two sexes emerged because of behaviors needed in the process of sexual selection. In addition, because of the female’s role in child rearing, it is adaptive for aggressive behavior to be suppressed, so that females may react patiently to children’s needs, misbehaviors, and demands. Emotion

Emotional differences between men and women can be considered in three domains: (1) expression, (2) recognition, and (3) experience. Women perform better than men on tests involving emotional interpretation (recognition), such as understanding facial expressions. Women have also been found to be more sensitive to nonverbal emotional cues. In terms of emotional expression, women are more adept at inhibiting potentially maladaptive emotional, social, and sexual responses than men. There are also many differences in the kinds of emotions with which men and women are associated in society. According to gender stereotypes, women are seen as more emotional and, therefore, more likely to experience happiness, sadness, and fear, whereas men are seen as more likely to experience anger. These differences are also captured by self-report measures of emotion in males and females. The question of whether there are actual sex differences in emotional experience as opposed to emotional expression is hotly contested and remains unclear. In understanding some of these emotional ­differences from an evolutionary perspective, some theorists propose that the importance of emotion differed for men and women in prehistoric society. For women, understanding, tracking, and reading others’ emotional states was particularly

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important for success in activities such as choosing mates, avoiding conflict, and caring for children. In addition, research has shown that mothers who raise securely attached children are typically emotionally warm and sensitive to emotional signals in others. According to evolutionary theory, because females have been more directly involved in child rearing, they were more likely to develop the warmth and sensitivity needed to successfully raise children to adulthood.

Criticisms There are several criticisms of the evolutionary psychological perspective on sex differences. One of the most widespread arguments against it is that these theories merely provide explanations of existing conditions but fall short of predicting differences. Furthermore, from a moral perspective, these deterministic evolutionary theories are often criticized for justifying male dominance and abuse of females and, therefore, sexual inequality. Proponents of the evolutionary psychological approach, such as Robert Wright, explain that a differentiation is necessary between what “is” by nature and what “ought to be.” They assert that even if we dislike the outcomes of evolutionary processes, by understanding natural inclinations and their historical roots, we may be better able to control behavioral tendencies that we believe to be morally reprehensible. In contrast to the emphasis on distal causes by evolutionary theorists, sociocultural theorists emphasize the importance of proximal forces on the development and expression of underlying traits and believe that social structure, societal norms, and stereotypes drive the sex differences that people perceive. These theorists have alternative explanations for expressed gender differences in mating preferences, spatial abilities, aggression, and emotion that do not rely on evolutionary ­theories, and they typically call into question the existence of many innate differences. In biosocial theory, an interactional approach is taken, wherein biological and sociocultural factors interact to create sex differences. Elizabeth Midlarsky and Cheskie Rosenzweig See also Biological Sex and Cognitive Development; Biological Sex and Health Outcomes; Biological Sex and Language and Communication; Biological Sex

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and Mental Health Outcomes; Biological Sex and Social Development; Biological Sex and the Brain; Biological Theories of Gender Development

Further Readings Archer, J. (2009). Does sexual selection explain human sex differences in aggression? Behavioral and Brain Sciences, 32(3/4), 249–266. Buss, D. M. (1995). Psychological sex differences: Origins through sexual selection. American Psychologist, 50(3), 164–168. Darwin, C. (2004). The descent of man. London, England: Penguin Classics. (Original work published 1871) Hyde, J. S. (2014). Gender similarities and differences. Annual Review of Psychology, 65, 373–398. McBurney, D. H., Gaulin, S. J., Devineni, T., & Adams, C. (1997). Superior spatial memory of women: Stronger evidence for the gathering hypothesis. Evolution and Human Behavior, 18(3), 165–174. Petersen, J. L., & Hyde, J. S. (2010). A meta-analytic review of research on gender differences in sexuality, 1993–2007. Psychological Bulletin, 136(1), 21–38. Trivers, R. L. (1972). Parental investment and sexual selection. In B. Campbell (Ed.), Sexual selection and the descent of man, 1871–1971 (pp. 136–179). Chicago, IL: Aldine. Wood, W., & Eagly, A. H. (2002). A cross-cultural analysis of the behavior of women and men: Implications for the origins of sex differences. Psychological Bulletin, 128(5), 699–727. Wright, R. (1994). The moral animal: Why we are, the way we are: The new science of evolutionary psychology. New York, NY: Vintage Books.

Exhibitionism

and

Gender

The term exhibitionism is generally credited to 19th-century French physician Charles Lasègue. At a clinical level, sexual exhibitionism is characterized by the experience of sexual arousal from exposing one’s genitals to a nonconsenting and unsuspecting person, typically a stranger. The arousal may be experienced in the form of urges and fantasies or from actual behavior. The overwhelming majority of perpetrators of reported exhibitionist acts are men, and the vast majority of victims are girls and women, so there is very little

research on female exhibitionism at this level of definition. As such, the forensic and clinical literature focuses on men. However, the research on fantasies and behavior in community samples suggests that exhibitionist tendencies are well established in women and that the motivations, response, development, and correlates may be quite different between genders.

Prevalence and Development of Exhibitionistic Disorder Sexual exhibitionism is categorized as a paraphilia by the American Psychiatric Association, along with fetishism, frotteurism, pedophilia, voyeurism, transvestic fetishism, sexual masochism, and sexual sadism. Exhibitionism, like frotteurism and voyeurism, has been conceptualized as a “courtship disorder” in that it appears to be a distortion of normative human courtship behavior, which includes searching for a partner, nonphysical interaction, physical interaction, and sexual intercourse. Exhibitionism is conceptualized as an extreme distortion of nonphysical interaction. The American Psychiatric Association suggests that the upper limit for the prevalence of exhibitionist disorder (characterized by having acted on one’s exhibitionist urges and/or being extremely distressed by these urges) is between 2% and 4% of the male population and it is extremely uncommon in females. In clinical samples, exhibitionism tends to be comorbid with other paraphilias, particularly voyeurism, frotteurism, and sadomasochism. In general, male exhibitionism seems to develop in adolescence. There is some evidence that childhood emotional abuse and family dysfunction are risk factors for male exhibitionism and other ­paraphilias, as are anger/hostility and sexual maladjustment/heterosexual relationship skills deficits. Sexual abuse, on the other hand, does not seem to be a risk factor for male exhibitionism. Given that research on clinical/forensic exhibitionism is generally conducted with male samples only, it seems likely that the risk factors for female exhibitionism are different.

Exhibitionism as a Crime Exhibitionist acts are one of the most common sexual offenses, with some research suggesting that

Exhibitionism and Gender

exhibitionism is involved in up to two thirds of reported sexual offenses. Furthermore, in victim surveys, approximately one third to one half of women indicate that they have been victims of exhibitionism. These offense rates are likely to substantially underrepresent actual rates of exhibitionism, given that these incidents are frequently unreported. The most common reaction to such an incident is shock and/or fear, followed by disgust and anger. Although many girls and women are not severely affected by the incident, some report being traumatized by the event. For example, women report avoiding the location of the incident, reduced feelings of safety in their community, and a more negative attitude toward men following the incident. Despite the fact that male exhibitionism is not uncommon, there has been a lack of research into this disorder, perhaps because it has been largely seen as a nuisance crime (although most victims perceive the offender as dangerous). This innocuous characterization may be misleading, as research with offender samples suggests many men convicted of exhibitionism have prior or subsequent convictions for “contact” (hands-on) sexual offenses, such as sexual assault. In one recent review, about 5% to 10% of convicted exhibitionists were subsequently convicted for contact sexual offenses during the study’s follow-up period (defined for the review as at least 5 years). In a Canadian clinical sample of male exhibitionists (offenders, self-referrals, and psychiatric referrals), more than 30% went on to commit sexual or violent crimes. It is possible that exhibitionism with motives to induce shock or fear may be a way of testing reactions to unsolicited aggressive sexual behavior, which may later escalate to more aggressive unsolicited physical sexual assault. Exhibitionistic crimes are characterized by very high rates of recidivism, with one review showing recidivism rates of 6% to 48%. These rates are particularly striking given how many of these offences go unreported. Risk factors for reoffending include lower education, sexual interest in children, alcohol abuse, and psychopathy (a personality disorder characterized by callousness, interpersonal manipulation, and reckless and socially deviant behavior). Because exhibitionistic disorder is rarely diagnosed in women and women are less likely to be

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arrested for such crimes, the characteristics of female perpetrators remain unknown.

Treatment Given the high rates of recidivism and the fact that female victims tend to perceive male exhibitionists as dangerous, effective treatment for offenders is essential. Cognitive behavioral therapy (CBT) has generally been shown to be the most effective treatment for exhibitionism. Many male perpetrators show deficits in relationship skills, and CBT may focus on appropriate ways of meeting i­ ntimacy and emotional needs. Because these offenders often fail to recognize that they have caused any harm, CBT may also incorporate empathy for victims, as well as identifying the thoughts and feelings that trigger exhibitionist behavior. Because women are rarely charged with crimes related to exhibitionism, they are rarely a focus of therapeutic intervention.

Assessment of Exhibitionism Assessment of exhibitionism can be conducted with interviews and self-report inventories. Research in subclinical sexual deviance has employed the Multidimensional Inventory of Development, Sex, and Aggression (MIDSA) scales, a measure developed to identify potential areas for intervention in treatment populations, with a focus on sexual offenders as a subpopulation. With items such as “I have had sexual thoughts about exposing myself” and “I have exposed my genitals to someone who did not know me,” the MIDSA is a useful and reliable source of data on behavior. Another method of assessing nonclinical exhibitionist interest is to ask people about their sexual fantasies. For example, one widely used sexual fantasy questionnaire includes the fantasy item “exposing yourself provocatively.” However, these methods may be limited by an individual’s unwillingness to disclose illegal or embarrassing information about exhibitionist fantasies and behavior. Thus, current or former partners of the individual may be able to provide valuable information about the individual’s exhibitionist tendencies. Somewhat surprisingly, physiological indices such as measuring changes in penile circumference in response to images of genital exposure have not been shown to

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be reliable indicators of exhibitionism disorder in men, despite the utility of phallometry in assessing other paraphilia, such as sexual sadism and pedophilia.

Nonclinical Exhibitionism There is evidence that the characteristics of exhibitionistic offenders may be different from those of nonoffending individuals with some paraphilic exhibitionist interest. Thus, although sexual ­exhibitionism in women rarely attracts clinical or legal attention, one psychoanalyst noted that when women discuss exhibitionism in therapy, it does not present as alarming or aggressive in its ­manifestation. Thus, there may be a greater gender balance in subclinical exhibitionistic tendencies. In one Swedish national survey, about 4% of men and 2% of women reported at least one occasion in which they had experienced sexual arousal by exposing their genitals to a stranger. In this sample, having reported an exhibitionistic incident was associated with greater sexual interest in general, more sexual activity and partners, and more frequent use of pornography, as well as being more likely to report other paraphilic behavior, such as voyeurism, sadomasochism, or transvestitism, for both men and women. In addition, exhibitionistic behavior was related to reporting more psychological problems, lower life satisfaction, and more drug and alcohol use in this sample. In research on sexually deviant behaviors in a sample recruited through social media sites to complete a survey on sexually deviant behavior as measured by the MIDSA, women (34.7%) were more likely than men (29.9%) to have engaged in exhibitionistic behavior, and women engaged in exhibitionistic behavior with greater frequency than men. In addition, while exhibitionism related to Machiavellianism in men, exhibitionism in women was associated with low conscientiousness and high narcissism. While the incidence of exhibitionist behavior is low, these are fascinating findings suggesting that in everyday sexual behavior, women may engage in more sexual exposure than men but they do so for entirely different reasons. It also raises questions of what individuals mean and the contexts they are imagining themselves in when answering questions such as “I have had sexual thoughts about exposing myself.”

Female Exhibitionism In keeping with these findings, sexual fantasy research demonstrates that women are even more apt than men to indicate that they fantasize about exposing themselves. This exhibitionism fantasy theme may relate to the greater tendency of women to become sexually aroused by the idea of being an object of someone else’s desire. Women, for example, may fantasize about being sexy or attractive to a potential partner, whereas men tend to fantasize about the sexiness or attractiveness of a potential partner. Qualitative research of interviews with six women, all of whom participated in amateur exhibitionist websites (i.e., providing nude images with no monetary exchange), provide further insights into female exhibitionism. Over the course of the interviews, while these women expressed awareness that their exhibitionism could be negatively evaluated as indecent or immoral, they rebutted these perceived criticisms with arguments that their behavior was positive and rewarding. The women suggested that their exhibitionism was personally fulfilling and emphasized their own confidence, agency, and self-worth. Furthermore, these female exhibitionists reported that their friends and/or loved ones were aware of and supported their exhibitionist activities, suggesting that their behavior was relatively normative. There is a substantial literature indicating that in Western societies, women are constantly subjected to media sexualization and feel objectified to a greater extent than men. Many female celebrities (e.g., Madonna, Ke$ha, Miley Cyrus, Britney Spears) incorporate self-sexualization into their performances or personas. Some feminists have embraced owning and exhibiting their sexuality and eschewing restrictive, modest female gender roles as empowering and a part of third-wave feminism, whereas others view self-sexualization as potentially harmful and oppressive. This apparent enjoyment of self-sexualization for an admiring public would seem theoretically relevant to female exhibitionism. In the literature on transvestitism, this is known as autogynephilia, or arousal at the thought of one’s femininity. While typically applied to men’s desire to dress as women, this motivation could conceivably apply to women’s exhibitionist behavior as well, though research is needed to corroborate this hypothesis.

Existential Approaches and Gender

Motivation and Reception Across the small volume of literature that exists to date, female exhibitionists tended to distinguish themselves from male exhibitionists on the basis that rather than inflicting themselves on vulnerable audiences who would be shocked or disgusted, they provided welcome entertainment or excitement to an appreciative audience while also fulfilling personal needs to be admired. Thus, one important difference between male and female exhibitionism may be around motivation. Although many male exhibitionists also imagine that their victims will admire their penis or become sexually aroused, others want to frighten or shock the unsuspecting victim. Some authors have suggested that it is the latter exhibitionists who go on to commit contact sexual offenses. The female exhibitionists, on the other hand, overwhelmingly reported that they were displaying their bodies in realistic anticipation of an excited response. Thus, another difference between male and female exhibitionists may be around the reception their exhibitionism receives, with a greater tolerance and appreciation for female exhibitionism, whether it is expressed in person or in the form of disseminating photographs and videos online. The male exhibitionist is unlikely to receive such a positive response. In addition to the generally negative response to male offenders described earlier, research suggests that even when women attend male strip clubs, they are not there for the same type of sexually arousing experience that men are when they attend female strip clubs. Instead, these women’s primary motivation seems to be about a shared experience with their friends. This finding suggests that even when heterosexual women seek out male nudity, it is not for the visual sexual stimulation that characterizes men’s heterosexual pursuit of female nudity. Research on male attendance at strip clubs, on the other hand, has suggested that men prioritize the sexual experience rather than bonding with friends. Beth A. Visser, Jennifer Lodi-Smith, and Samantha A. Wagner See also Fetishism and Gender; Frotteurism and Gender; Pedophilia and Gender; Sexual Disorders and Gender; Sexual Dysfunction; Sexual Offenders; Third-Wave Feminism

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Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Hugh-Jones, S., Gough, B., & Littlewood, A. (2005). Sexual exhibitionism as “sexuality and individuality”: A critique of psycho-medical discourse from the perspectives of women who exhibit. Sexualities, 8, 259–281. Lodi-Smith, J., Shepard, K., & Wagner, S. (2014). Personality and sexually deviant behavior. Personality and Individual Differences, 70, 39–44.

Existential Approaches and Gender Existential psychotherapy is a philosophical approach to therapeutic practice. This unique approach emphasizes the freedom of individuals to choose and act in response to their circumstances and create meaning, in contrast to traditional psychoanalytic theory, which stressed unconscious forces and instinctual drives. This school of thought is less concerned with identifying and classifying pathology and more with understanding individuals’ way of being in their world. Existential psychotherapists encourage their clients to consciously shape their own lives and create meaningful existences. For these reasons, existentialism is an excellent fit for addressing concerns of gender. For years, individuals have been both condemned by and confined to the binary experience of gender, expectations of polarizing, ill-fitting identities for many people whose gender identity falls within a diverse spectrum of genders. This entry briefly reviews the history of existential philosophy and existential psychotherapy, and their overlap. It concludes with a discussion of gender and existential therapy, as well as suggested readings.

Existentialism as a Philosophy Existentialism as a philosophy arose in late-19thcentury western Europe, making it a contemporary of Freudian psychoanalysis. The philosophy’s founders, including Søren Kierkegaard, Edmund Husserl, Martin Heidegger, Simone de Beauvoir, and Jean-Paul Sartre, were interested in the human condition in the face of an absurd world.

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Kierkegaard, a Christian philosopher from Denmark, wrote about topics such as free will, subjectivity, and emotions and took issue with historical proofs of God’s existence and the notion of objectivity. Like other existential philosophers who followed, he was reacting to, among other things, Marxism and Victorianism. Kierkegaard viewed math and science as the domains of objectivity but argued that a person’s experience was not objective. In response to Immanuel Kant’s categorical imperatives, Kierkegaard proposed the additional category of the absurd. This category was not meant to be pejorative but rather to distinguish those things that fall outside the purview of the rational. The historical context of the time evidenced the random nature of life and gave rise to the idea of meaninglessness in the world. Kierkegaard proposed the defining principle of existentialism, which contradicted earlier Platonic and Aristotelian philosophies, as the idea that existence precedes essence. Kierkegaard’s tenet posits that there is no human nature that precedes an individual’s presence in the world. Through acts of freedom, people individually create humanity at every moment. This line of thinking also contrasted with other strains of thought at the time that relied on systems of religion or government to determine meaning. In fact, Kierkegaard argued that individuals are the source of all authority and are completely responsible for all their decisions. From this framework, if existence precedes essence, there is no meaning past the one an individual determines that meaning to be. There is no factual state of affairs capable of motivating certain actions. Furthermore, no matter what interpretation is ascribed to an individual’s being, there can always be others. This belief supports the absence of objectivity of human experience. As a result of this thinking, existentialists emboldened the individual to determine life’s meaning in the face of the absurd. They believed that it was incumbent on individuals to determine their purpose and to live authentically via their will. Will, for existentialists, is a basic feature of existence. Individuals are isolated and alone and dread their freedom because of the overwhelming responsibility of creating a life of purpose and authenticity. Juxtaposed with the construct of freedom is the importance of responsibility, including

the mandate that we are responsible for initiating the creation and meaning of our lives. Two other important concepts of existentialism germane to this discussion are facticity and authenticity, both of which are concepts closely related to freedom. Individuals’ facticity consists mainly of things that cannot be chosen and on which a person’s values may depend. Examples might include race, place of birth, past experiences, and, according to some conceptualizations, sex and gender. Although a person’s facticity is static, the value individuals assign to their facticity is done so freely. Within existential freedom, the values assigned to facticity are fluid. For this reason, individuals are responsible for their own values, regardless of the values society as a whole outlines for them. Angst arises when freedom is limited by facticity. These concepts have many implications for gender specifically, and diversity more broadly, to be addressed later in this entry. Authenticity is addressed by many existential philosophers and, indeed, later by existential psychotherapists. Authentic existence is the value that one should act as oneself and not as a predetermined essence or, in a more modern conceptualization, a sequence of genes expressing themselves. Authenticity exists congruously alongside freedom and responsibility. Existentialists believe that we should make choices based on our values and take responsibility for those choices, actions, and values instead of choosing to, for example, make excuses based on facticity, thus living inauthentically or, according to Sartre, in bad faith. Existentialists crafted some of their theoretical tenets in reaction to the construct of determinism. Determinism, frequently espoused within psychoanalytic frameworks, is the idea that every event follows inevitably from a preceding event. If determinism were the comprehensive explanation, ­freedom would not exist. A common example of determinism is social mimicry, in which one plays a role of sorts and acts in the way one believes one should. Pursuant to a discussion of gender, biological determinism as dictated by social norms would offer that one is only either female or male and that this identity is static throughout an individual’s life. However, from an existential perspective, there is freedom to live authentically and in good faith in accordance with one’s individual experience of gender. Authenticity, then, is concerned

Existential Approaches and Gender

with the extent to which individuals act congruently with their freedom and the attitude they take toward their own freedom and responsibility. The existential perspective emboldens people to live in ways authentic to their own internal sense of themselves as women, men, both, or neither and, as such, represents an improvement over conceptualizations that rely on the gender binary. The information presented here is meant to provide a base and framework for understanding how the psychological school of thought emerged. Whereas empirically based psychology is born from atomism, objectivism, reductionism, determinism, and materialism, existential psychotherapy is situated within the perspectives of freedom, authenticity, will, self-awareness, and a constant search for meaning.

Existential Psychotherapy Existential psychotherapy arose as a philosophical approach to therapeutic practice in the 1940s, with Rollo May and Viktor Frankl regarded as its earliest contributors. Existential psychotherapy is considered a philosophical approach rather than a specific school or model of techniques and intervention. It is more concerned with themes within people’s lives and whether and how they are living authentically with freedom and responsibility. As a student of Sigmund Freud, Frankl was well versed in psychoanalysis and reacted against the deterministic nature of Freud’s conceptualization of people. In contrast to Freud, Frankl did not view individuals as subject to, and at the mercy of, unconscious forces. In his book Man’s Search for Meaning, Frankl not only detailed his experiences in Nazi concentration camps, but based on these experiences, he advanced a type of psychotherapy that he called logotherapy (“therapy through meaning”). The therapy focuses on identifying meaning as a core curative feature. Frankl was clear that there is no single meaning of life. Indeed, he stated that expecting one answer to this question is akin to asking, “What is the best chess move in the world?” What matters is the specific meaning of a person’s life at a given time. He also believed that suffering stops the moment it finds purpose or meaning. Thus, helping people find, ascribe, and understand the meaning of their suffering allows the suffering to evolve into something else. Relating

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back to the philosophical concept of facticity, people cannot change their past, and Frankl could not change the fact that he was incarcerated. He stated that when people are no longer able to change a situation, they are forced to change themselves, and he acknowledged that individuals have both the freedom and the responsibility to do so. He did not argue that people are free from the conditions of their lives but rather that individuals are free to take a stand regarding those conditions. Two Americans who contributed to the advancement of existential psychotherapy were May and Irvin Yalom. May is credited with bringing existentialism from Europe to the United States. He concerned himself with topics such as anxiety, ­ love, and will. Like Frankl, he believed that ­psychotherapy should be aimed at helping people discover meaning in their lives. May also saw value in exploring aloneness and death, and contributing to the greater good. Later, Yalom detailed the four ultimate concerns of (1) death, (2) freedom, (3) existential isolation, and (4) meaninglessness. These themes are frequently addressed in existential psychotherapy and can form the impetus for a number of interventions. All humans live with the knowledge of their mortality, and the existential school of thought believes that this causes ontological anxiety throughout life. The knowledge of finitude and the accompanying anxiety also provide an entrance point and the motivation toward living a meaningful life. Existentialists believe that people are fundamentally alone, or isolated, though they desire and pursue contact and relationships with others. Finally, the concept of freedom refers to the ultimate choice each person has in authoring their lives. All of these conflicts can result in anxiety. If this anxiety is not confronted or is ­ ignored, people live inauthentic lives, even as they simultaneously desire authenticity. According to existentialists, pathology results from inauthenticity. May proffered that failure to live an authentic life consistent with one’s true self would result in illness and that healing depends on the process of becoming wholly authentic. Thus, the goal of therapy from an existential perspective is to seek authenticity and maintain it while learning to coexist with cultural realities. There is a lack of emphasis on diagnosis or on following a specific series of steps toward treatment, but instead the psychologist engenders an appreciation of each

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client’s experience and journey. Therapists are not regarded as experts but rather as guides who have awareness of their own existential and ontological angst and work to maintain their authenticity. As an approach, existential psychotherapy is not concerned with the medical model of treatment, nor does it have a focus on pathology as determined by biology. Pathology, in the eyes of existential practitioners, is explained as living an inauthentic life and is an indication that the individual needs assistance to consider their current state of affairs and choose the path on which they would like to travel. Surely most practicing existentialists would not deny the existence of mood disorders, but the disorder’s development would be conceptualized differently than a practitioner approaching it from the medical model would, such that the existential psychologist would work with the client to make them aware of the meaning of the disorder, the responsibility to confront it, and the freedom to choose alternative perspectives on the mood disorder. Much like their philosophical predecessors, existential psychotherapists are not concerned with objectivity. Instead, they are invested in understanding the subjective, lived-world experience of their clients. Therapy is typically present focused and nonhierarchical, the latter being especially facilitative when working with clients from disenfranchised or marginalized groups, including women. Existential psychotherapists are not immune to the four ultimate concerns either and, as such, often adopt the stance of cotraveler. Because existential psychotherapy does not concern itself with the application of specific techniques, there is great freedom in the ways in which practitioners intervene. It is the role of the therapist to understand the subjectivity of the client and to actively challenge concerns such as avoiding authenticity or shirking responsibility. Often, practitioners will encourage clients to see their contribution to troublesome situations and to make changes to mitigate the resulting emotions. Clients are not passive recipients in existential psychotherapy but are active contributors to the therapeutic process. Clients are frequently challenged to increase self-awareness and insight. It then becomes their responsibility to take that awareness outside the therapy room and make decisions about how they will enact that change in their world. Because of what is expected of the

client, the relationship between the client and the therapist is very important. Existential psychotherapists are challenging and therapeutically confrontational and thus must convey integrity and honesty while cultivating and maintaining an environment of trust and safety in the room. Practitioners are meant to model authentic behavior to further assist clients in their journey toward their own authenticity. As with the previous section in this entry, this is in no way an exhaustive explanation of existential psychotherapy. Because there is little to no standardization of existential technique or intervention, practitioners may employ its application very differently. In fact, this lack of standardization is an excellent fit with the school as a whole, which values subjectivity and personal authenticity so highly.

Gender and Existentialism Although existential psychotherapy complements perspectives on gender, this entry would be remiss if it did not mention the gender imbalance among its founders. While women were not absent in the development and furthering of existentialism, they were certainly overshadowed by their male counterparts. It is also important to note that the school of thought’s founders were largely, if not entirely, cisgender. A number of the aforementioned topics are important to consider when working with an existential conception of gender. From the existential perspective, gender is a concept that must be determined by individuals in accordance with their freedom, facticity, and authenticity within the structures of the world into which they are thrown. While an argument may be made that biological sex assigned at birth is a part of one’s facticity, gender is not an existential given. The ways in which one chooses to engage with, make meaning of, and express one’s gender must be congruent with one’s sense of self to enable one to live authentically and in good faith. This conceptualization also favors a phenomenological understanding of a gendered individual. Gender expression varies widely even within those identifying with the same label; there are infinite ways to identify, experience, and live one’s authentic gendered self. Existential psychotherapists should approach individuals with an aim toward understanding their lived-world experience, to

Existential Theories of Gender Development

consider their facticity, the world into which they are thrown, and the individual’s understanding of it, and how their freedom may be restricted. Helping clients seek alternate meanings of specific situations can bring new meaning to those situations, ideally reducing suffering. De Beauvoir observed that one is not born a woman but one becomes a woman. In her estimation, one becomes a woman by adhering to the social expectations of the feminine. Modern existentialists might extend this observation to all ­genders. It is not women alone who are socialized toward specific thoughts, feelings, and behaviors. Anyone of any gender who lives within a society is subject to gender role expectations, for better or worse. Men, whether cisgender or transgender, are subject to similar ideas and expectations of masculinity. While some might say that this aspect of maleness is a part of men’s facticity, others would argue that it is a part of their thrownness into the world with preconceived ideas and expectations of what it means to be a man. When one identifies as male and does not adhere to traditionally masculine standards, angst can arise. When one identifies as male, does not agree with traditionally masculine standards, but attempts to live according to them anyway, bad faith results. Frankl never argued that people are free from the conditions of their lives. He argued that people are free to take a stand on those conditions. He also acknowledged that this would not be an easy stand to take or one free of strife. When the ontological angst of living incongruently with one’s experience of gender becomes too great, one may present for treatment. Diagnoses exist for this angst—for example, major depressive disorder, generalized anxiety disorder, and gender dysphoria. Regardless of how the presentation is labeled, existential therapists will seek to understand the subjectivity of their clients and, to the best of their ability, remain aware of their own subjectivity and existential struggles. The therapist should seek to understand the individual’s context and how that might contribute to limitations of freedom. Existential therapy is a particularly nonpathologizing and supportive approach when individuals identifying as transgender present for help. As mentioned previously, existentialism does not require the gender binary to understand gender. Furthermore, the idea of living in good faith and

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living authentically all but requires clinicians to affirm the experience of being trans identified. Indeed, whether gender is a biological determinant or is socially constructed is less important than whether or not individuals are responding in an authentic way for themselves. Ginny Maril and Debra Mollen See also Existential Theories of Gender Development; Gender Expression; Gender Fluidity; Gender Identity

Further Readings de Beauvoir, S. (1989). The second sex. New York, NY: Vintage Books. (Original work published 1953) Frankl, V. E. (1984). Man’s search for meaning (3rd ed.; I. Lasch, Trans.). New York, NY: Simon & Schuster. (Original work published 1942) Kass, S. A. (2014). Don’t fall into those stereotype traps: Women and the feminine in existential therapy. Journal of Humanistic Psychology, 54, 131–157. doi:10.1177/0022167813478836 Kierkegaard, S. (1995). Works of love (H. Hong & E. Hong, Trans.). Princeton, NJ: Princeton University Press. (Original work published 1847) Martin, L. L., Campbell, W. K., & Henry, C. D. (2005). The roar of awakening: Mortality acknowledgment as a call to authentic living. In J. Greenberg, S. L. Koole, & T. Pyszczynski (Eds.), Handbook of experimental existential psychology (pp. 431–448). New York, NY: Guilford Press. May, R. (1953). Man’s search for himself. New York, NY: Dell. Richards, C. (2011). Transsexualism and existentialism. Existential Analysis, 22, 272–279. Sartre, J.-P. (1956). Being and nothingness. New York, NY: Simon & Schuster. Tantam, D. (2015). The contribution of female existential philosophers to psychotherapy. Existential Analysis, 26, 36–48. Yalom, I. (1980). Existential psychotherapy. New York, NY: Basic Books.

Existential Theories of Gender Development Existentialism focuses on the ultimate question of the meaning of life and was exemplified in the 11th century in Omar Khayyam’s Rubaiyat.

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Existential Theories of Gender Development

Existentialism emerged as a major force in Europe in the 20th century due to the chaos created by the World Wars, the disarray in the social and political systems, the emergence of the mass society, and the alienation among people, all created by cultural upheaval and the movement away from an agrarian to an industrial society. Phenomenology and existential thinking in 20th-century psychiatry did not emerge from a single school of thought; there are many different and sometimes opposing views on existential thought. The commonality in these two lines of thinking is the rejection of reductionist thinking, which resulted in 19th-century materialism, and objectivism, which reduced humans to an abstraction. Existential philosophy focuses on humans, and the focus is on understanding the meaning of “being.” Existential philosophy has influenced the existential-humanistic theories of counseling, specifically the work of Abraham Maslow on human development and Carl R. Rogers’s emphasis on person-centered counseling and psychotherapy, and has led to the emergence of depth psychology as a representation of existential-humanistic and transpersonal psychology. The concept of gender development was not the specific focus in any of these perspectives; the focus was always on the concept of being and the human experience. To consider gender development, this entry focuses on how the humanistic-existential perspective as it has emerged in modern psychology has influenced human development and, consequently, led to the emergence of an emphasis on gender development. First, the core principles of existential thinking are examined to understand its influence on psychology, human development, and gender development.

anxiety essentially central to the human condition due to the fear of death or nonbeing. Since existential thinking did not address gender development, to understand the influence of this school of thought, it is important to analyze theoretical, philosophical, and research perspectives in order to make inferences about how this movement influenced theories of gender development. Primarily, the theoretical perspectives of existential theorists, such as Martin Buber, Martin Heidegger, Friedrich Nietzsche, and Michel Foucault, reinforce the idea that in modern times the individual must separate self from the conforming masses. Therefore, the focus is on individualism, and identifying oneself as a separate entity, independent of others, and having the ability to pursue one’s fullest potential. Simone de Beauvoir, an existential author and philosopher, considers herself the midwife of JeanPaul Sartre’s existential ethics. In her 1949 book The Second Sex, de Beauvoir provides the distinction between sex and gender by stating that being born a biological female does not mean that one is a woman and it is society that makes a baby into a woman. Theorists have noted that before The Second Sex, the sexed/gendered body was not an object of phenomenological investigation. De Beauvoir changed that. Her argument for sexual equality takes two directions. First, it exposes the ways in which masculine ideology exploits the sexual difference to create systems of inequality. Second, it identifies the ways in which arguments for equality erase the sexual difference to establish the ­masculine subject as the absolute human type. Her perspective brought to light the social construction of gender. She confronts the norm of masculinity as the standard for humans and belief that the inequality between the genders has created The Essential Core of Existential Theories systems of inequality. She insists on gender equalExistential philosophical theories focus on the ity, not by compromising female characteristics— ­concept of being and what that means in terms of that is, erasing femininity—but by validating and how humans understand being in a social-­ accepting the differences. cultural-political world. Theoretically, being has The existentialism contained in de Beauvoir’s always been considered from a generic human writing is a reflection of her own experience of perspective. Existential theorists addressed the self-discovery and what it means to be a woman, issue of “being” within a system or a social-­ and her identification with the experience of cultural world. Understanding being implies also being a woman. Existentialism is probably the understanding nonbeing, the reason for existenonly school of philosophical thought that allows tial anxiety and the fear of death or nothingness. for an in-depth examination of what it means to Existentialist psychologist Rollo May considers be a gendered being. Theorists note that the reason

Existential Theories of Gender Development

de Beauvoir’s work is highly respected is because she believed that humans must be respected first as ­living beings, regardless of gender. Some may erroneously see The Second Sex as a “feminist manifesto,” whereas de Beauvoir is simply commenting on being human. Her perceptions tend to be gender blind. Furthermore, theorists contend that de Beauvoir did not mean The Second Sex to provide a rationale for seeking liberation but to help women focus on their own potentiality and what it means, without accepting the definitions imposed on them by society.

Existential Psychotherapy Existential psychotherapy is defined as a dynamic approach that focuses on ontology, intentionality, freedom, choice/responsibility, phenomenology, individuality, and potentiality. Irwin D. Yalom considers existential psychotherapy a dynamic approach that focuses on concerns that are rooted in the individual’s existence. These definitions and perspectives elucidate the essence of existential psychotherapy. The key concepts or themes of existential psychotherapy are as follows: Ontology, or being or, more specifically, beingin-the-world, emphasizes social relationships. Intentionality refers to meaning making, a unique human characteristic. Intentionality signifies making meaning of one’s life, that is, the freedom of a person to define the self, in spite of the numerous restrictions imposed by the social-cultural environment. May views freedom as possibility, the ability to have several different options and the freedom to make a decision on the path one will follow. Choice and responsibility are the core of existential thinking, signified by the fact that humans have many options, making choices and taking responsibility for the outcome of their choices. Phenomenology refers to the immediacy of the experience to understand the meaning of existence. ­Existential psychotherapy focuses on the meaning of the experience for the individual; therapists use empathy to understand a client’s experience. Individuality in existential psychotherapy is concerned with the uniqueness of the individual and the individual’s experiences in the world.

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Authenticity refers to living one’s life with an accurate appraisal of one’s humanity and focusing on fulfilling one’s potential. The emphasis is on not accepting societal and cultural expectations and on staying true to oneself. Being authentic also implies not dominating others. Potentiality is the final theme of existential assumptions, and it implies that all humans have the ­potential to become authentic and to overcome and transcend their past.

The existential movement in psychotherapy comprises a diverse array of theorists and practitioners; it is considered a movement instead of a theoretical school of thought. Furthermore, due to the amorphous nature of the existential perspective, and its opposition to the empirical approach, it has experienced a decline in research and publications. Existential psychology has four primary themes: (1) each person has value and is unique, (2) human growth occurs in part due to suffering, (3) growth is facilitated by staying in the moment, and (4) a sense of commitment is a necessary element for personal growth. Considering suffering a necessary component for personal growth sets existential psychology apart from humanistic psychology. Existentialism has contributed significantly to the rise of humanistic psychology, based on the core assumptions of existential theories—that is, the uniqueness of each human and the goal of achieving one’s fullest potential.

Humanistic Psychology Two major theorists have contributed significantly to the existential-humanistic movement in psychotherapy: Maslow and Rogers. Both emphasized maximizing human potential for self-direction, and freedom of choice. Maslow proposed the hierarchy of needs; he believed that all humans have certain basic needs that must be fulfilled before other developmental needs could be addressed. At the bottom of the pyramid of human needs are the physiological and safety needs. Once these are s­ atisfied, he believed, people will focus on their psychological needs for belonging and self-esteem. The need to achieve one’s fullest potential (i.e., self-actualization) is at the top of the hierarchy. A self-actualized person is

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autonomous and independent, with a clear perception of reality, possessing self-acceptance and accepting of others, and is able to transcend the ­ environment instead of merely coping with it. Furthermore, self-actualized people focus on the ­problem instead of being self-centered and have sympathy for the conditions that others face. They establish deep meaningful relationships with a few people rather than having superficial relationships with many people; they have a sense of detachment and a need for privacy, and they work to promote the common good. The term positive psychology is ascribed to Maslow. This is now a recent branch of psychology; it focuses on strengths and on promoting optimal functioning of humans and communities. Rogers was interested in studying the capacity of humans to change in therapeutic relationships. He believed that humans had great internal resources for self-understanding and self-directed behavior; he emphasized the dignity and worth of each individual and presented the necessary interpersonal conditions to bring about change (i.e., empathy, warmth, and genuineness) that would facilitate fuller functioning of each individual. Both Maslow and Rogers were leaders in establishing the Society for Humanistic Psychology. Although the third force or humanistic orientation to psychology movement was created by men, several women also worked to make the Society for Humanistic Psychology viable. They included female presidents of the Association of Humanistic Psychology, especially Jean Houston and Virginia Satir. Women who undertook leadership positions in the Society for Humanistic Psychology were ­significant in providing a voice for the female perspective in humanistic psychology. Within humanistic psychology, male and female perspectives varied. The female psychologists emphasized experiential, applied, and relational dimensions, and the male psychologists emphasized abstract, theoretical, analytical, and verbal dimensions. However, both genders in humanistic psychology focused on a strong somatic component and the mind-body connection.

Existential-Humanistic Perspective: Influence on Theories of Gender Development As noted previously, no mention of gender identity development exists in the existential-humanistic

perspective; therefore, it can be viewed as gender neutral. A theory that claims to be gender neutral, in essence, privileges males over females, genderqueer or gender ambiguous, intersex, and transgender. Humanistic psychology fails to note the obstacles faced by other genders, thereby colluding in the oppression of all nonmale genders. Theorists argue that a perspective that maintains gender neutrality fails to consider the impact of -isms on the person, such as, sexism, racism, ableism, classism, and islamophobia. The gender neutrality exhibited by humanistic theories essentially exhibits male hegemony and privileges male experience and rights at the expense of other genders. Although, the humanistic perspective emphasizes the commonality of human beings, and focuses on human needs as the common ground for understanding all humans regardless of race, culture, gender, or ability, humanists tend to overlook the influence of social-cultural conditions and the effect these have on self-actualization, the ultimate goal of human development. Both Rogers and Maslow prioritized self-actualization for the isolated, privileged, middle-class, m ­ id-20th-century American individual, with no consideration of power dynamics and oppression. Social environments can help or hinder self-actualization as perceived by humanists. Theorists note that to achieve self-actualization, one must possess qualities that include a democratic perspective with a spiritual (not necessarily religious) dimension, a concern for and commitment to the well-being of others, an interest in the arts, an ability to defer gratification, and respect for others and acceptance of divergent perspectives, while maintaining a personal sense of integrity. These characteristics do not take into account power, privilege, and social positioning and are in essence meaningless for understanding social-cultural development and self-actualization in any system. However, women as humanistic psychologists in emphasizing the centrality of personal experience and the holistic and tacit ways of knowing have much in common with feminist theorists of intersubjectivity, the importance of one’s voice. Humanistic psychology has been challenged by feminist theorists, who consider the assumptions inherent in humanistic psychology as privileging the sole, self-evolving individual on a solitary and heroic journey of self-discovery. Carol GustafsonWolter offers a meaningful perspective, noting the

Exoticization of LGBTQ People of Color

influence of Rogers’s theory, which activated research and theory on gender development ­specifically for women, transgender, and intersex individuals. The concept of self-actualization, and understanding the lived experience of being human, ignited the liberation of overlooked, gendered beings. She considers Rogers a visionary and notes that his revolutionary perspective, which included the core conditions of unconditional positive regard, empathy, and congruence necessary for psychotherapy, led to the creation and development of an integrative, postpatriarchal, postdualistic paradigm for human development and related areas of study and research. Other theorists influenced by existential humanistic perspectives, such as Carol Gilligan, focused on understanding the lived experience of girls and women, with the rationale that it would expand understanding of human development by emphasizing the experience of a group that was left out in the construction of the theory of human development. This perspective became the basis for generating new theories to explain human and, eventually, gender development. The core and essential conditions of existential-humanistic thinking have led to accepting the lived experience of humans as essential to understanding identity and gender development, and respecting the unique voice of gendered beings to decipher and identify their developmental processes. Farah A. Ibrahim and Jianna R. Heuer See also Gilligan’s Moral Development Theory; Hegemonic Masculinity; Humanistic Approaches and Gender; Humanistic Theories of Gender Development

Further Readings de Beauvoir, S. (2010). The second sex (C. Borde & S. Malovany-Chevalier, Trans.). New York, NY: Alfred A. Knopf. (Original work published 1949) Gustafson-Wolter, C. (1999). The power of the premise: Reconstructing gender and human development with Rogers’ theory. In E. Fairhurst (Ed.), Women writing in the person-centered approach (pp. 199–214). Llangarron, England: PCCS Books. Maslow, A. H. (1962). Toward a psychology of being. New York, NY: Van Nostrand. Rogers, C. R. (2004). On becoming a person: A therapist’s view of psychotherapy. London, England: Constable & Robinson.

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Serlin, I. A., & Criswell, E. (2014). Humanistic psychology and women: A critical-historical perspective. In K. J. Schneider, J. Fraser-Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic psychology: Theory, research, and practice (2nd ed., pp. 29–36). Thousand Oaks, CA: Sage.

Exoticization of LGBTQ People of Color Exoticization is a process wherein people who are outside culturally dominant groups are marginalized and diminished to stereotypes for entertainment or consumption by people in privileged groups. For example, given the racially White majority in the United States, people of color are often exoticized and seen as ethnic/racial “Others.” Asians and Latinas/Latinos are often labeled “exotic” based on their ethnic/racial identity and also with regard to their sexuality (e.g., Asian people are seen as sexually passive; Latinas/­Latinos are seen as fiery). Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals can also be subjected to exoticization and seen as Others, given their marginalized status in a heteronormative U.S. society. One prominent example of this is the representation of women engaging in same-sex sexual behaviors for the purpose of arousing or satiating heterosexual male desire. The LGBTQ community is not a homogeneous group of individuals; and LGBTQ identity intersects with other identity categories, including gender, race/ethnicity, and socioeconomic status. Acknowledging these intersections of identities provides greater awareness of the differing degrees to which these individuals are seen as cultural ­Others. This entry highlights how the intersection of racial/ethnic identity and LGBTQ identity can affect exoticization processes and practices. Exoticization is often conflated with concepts such as appropriation and fetishization. However, exoticization can be viewed as a unique concept that may serve as a precursor resulting in appropriation and fetishization.

Exoticization as Process The central process of exoticization focuses on determining who, or what, lies within the cultural

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majority and has the most sociocultural power. Individuals or groups who are excluded from these constructed norms are deemed Other, are viewed as lesser than those who hold dominant/majority privilege and status, and are subject to being labeled as exotic. The label of “exotic” is most often related to cultural groups and communities who are foreign to the majority and allows cultural differences to be seen as commodities. In addition, individuals who are seen as deviant or as a threat to the majority may also be pegged as exotic to neutralize the threat they pose to established norms. In other words, if majority group members see these Other group members as something of interest (i.e., exotic), they do not feel as threatened by their presence in a given environment. In the United States, the term exotic is often associated with consumables from non-White cultures, such as tropical fruits and drinks, Asian and South American cuisines, African jewelry, and home decor using Native American objects or patterns. However, individuals tend to expand this label to the people for whom these “exotic” objects are the norm. That is, if things from Other cultural groups are labeled as exotic, then there is a greater tendency to also label people from those cultural groups as exotic. This can lead to greater objectification of these people and heavier reliance on ­stereotypes when determining attitudes and behaviors toward members of nonmajority groups.

Exoticization as Practice The remainder of this entry explores how individuals may exoticize LGBTQ people of color. It also explores how engaging in exoticization practices can psychologically affect the individuals or groups who are exoticized. An exhaustive description of how LGBTQ people of color are exoticized by the LGBTQ and non-LGBTQ community is beyond the scope of this entry. However, the examples described below attempt to provide a sampling of how LGBTQ people of color have been/may be exoticized. Cultural Expressions

Exoticization can operate as a function of stereotypes about marginalized groups and may take the form of microaggressions. Microaggressions

can be understood as everyday slights that express derogatory or negative messages to members of the marginalized groups. Comments or ideas about certain groups may not necessarily reflect negative intentions and may sometimes take the form of “celebrating” diversity and difference. However, the act of embracing these cultural Others may be limited to different cultural food, music, or dance practices. For example, in the United States, Cinco de Mayo (May 5) is marked to celebrate Mexican culture primarily through food and music; yet most people who are not of Mexican descent are not familiar with the history or significance of Cinco de Mayo, and the day is often used as an excuse to drink excessively. Individuals who engage in these types of celebrations often do so with no desire to understand the cultural practice of interest in greater depth. Engaging in these processes on a surface level does not allow for reflection on one’s possible privileged status, which in turn reifies the othering process these celebrations may inadvertently create. To understand how these practices and/or celebrations may constitute an exoticization process, it is critical to examine who organizes these events and what these events consist of, in order to identify whether they may just be a tool for indulging in the exotic or may serve a greater purpose of cultural awareness. One such example of exoticization of GBQ Black and Latino men by the larger LGBTQ and non-LGBTQ community is voguing. Voguing originated as part of the ballroom culture in the 1960s’ Harlem, as a way of creating community and finding a sense of belonging among Black gay men and Black trans* women. The ballroom scene had been an underground cultural phenomenon until director Jenni Livingston created the documentary Paris Is Burning, which explores the culture of vogue and features prominent figures from that community. Voguing was then brought into more mainstream discourse with Madonna’s recording Vogue, for which she contracted individuals who were a part of this culture (i.e., Black gay men) to choreograph the music video. This brought greater ­attention to the culture, but it also resulted in the perception by a mass LGBTQ and non-LGBTQ audience that this cultural practice was a product for consumption. In other words, this cultural expression has been exoticized as it had become

Exoticization of LGBTQ People of Color

something to be experienced as entertainment by others who are not part of the community from which this practice originated. As a result, when mainstream communities reference voguing or the ballroom culture, it is easily connected to Jenni Livingston and her film or to Madonna, while the actual members of that community (i.e., GBQ Black men) are minimized and are viewed only as performers for the enjoyment of people outside the ballroom culture. Sexuality

The exoticization of LGBTQ people of color often takes the form of sexual fascination, exploration, and/or conquest by the mainstream and White LGBTQ communities. This exoticization includes sex tourism, a popular industry involving trips to “exotic” locations (e.g., Mexico, Thailand) with the specific goal of engaging in sex acts with the Others of that country. Furthermore, the language used to describe White LGBTQ individuals who are interested in specific people of color (e.g., “Rice Queen” to refer to men who are attracted to Asian men) and media representations serve to exoticize LGBTQ people of color. Indeed, media portrayals tend to depict LGBTQ people of color as unknown sexual conquests, such as a White man expressing concern about the possibility of a Latino partner having an uncircumcised penis (see HBO’s Looking), and stereotypically (e.g., African Americans as more sexually voracious or dominant). Sexual encounters with members of the transgender community are particularly exoticized, as this community is viewed as taboo, which serves to increasingly dehumanize transgender individuals and positions them as something to “explore.” An increasing number of LGBTQ people of color use social media not only to find a sense of community but also to explore possible sexual encounters. At the same time, people of color who are looking for same-sex sexual encounters increasingly find messages explicitly rejecting their ethnic/ racial group (e.g., “No Asians”). These messages can be seen on profiles and personal ads on websites (e.g., Craigslist) and on mobile phone ­ applications such as Grindr, Scruff, and Her. ­Simultaneously, gay pornography websites create “Black,” “Latin,” and/or “Asian” specialty channels, which serve to frame ethnic/racial identity and

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sexuality as a commodity for viewers/consumers. The presence of these channels reproduces the idea that “featured” material contains predominantly White bodies, whereas the “specialty” content that requires navigating away from the main website features bodies of color. These channels contribute to the potential mixed messages LGBTQ people of color receive about how their race/ethnicity functions in the gay community. Seeing these channels fortifies the idea that their race/ethnicity is an object for consumption, because they are consistently and explicitly rejected in the gay world due to their differences. Their “Otherness” can be conceptualized as simultaneously a commodity for pleasure and a target for prejudice.

Psychological Impact of Exoticization What effects can exoticization have on the mental health and psychological well-being of those being exoticized? LGBTQ people of color are in a unique position of occupying a “double minority” space, which has the potential to create conflict within themselves and among members of their respective communities. As people of color, they may already be exoticized in mainstream U.S. society depending on their ethnic/racial/cultural identity. For example, as was previously noted, Latinas and Asian women are often deemed exotic given their perceived foreign status. As LGBTQ people of color, they may face high levels of heterosexism in their cultural community, which can create a need to seek social support in the LGBTQ community. However, if the LGBTQ community is understood to be majority White, then LGBTQ people of color are subjected to the same exoticization practices here as they are in the non-LGBTQ community. This can lead to feeling uncomfortable or unwelcome in both of the communities that reflect these two aspects of their identity, decreasing the possibility of helpful social support from either community. LGBTQ people of color may also receive messages and process stereotypes about what “being gay” means in a predominantly White LGBTQ community (e.g., external pride in gay identity) and may internalize the idea that they are not the “right” type of gay person. If these messages are constant and LGBTQ people of color want to participate in the LGBTQ community, this can create

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Exoticization of Women of Color

psychological strain and limit individuals from fully expressing themselves in a community that promotes itself as welcoming and accepting. Exoticization practices may also contribute to hypervigilance from LGBTQ people of color because they will be more cognizant of being seen as exotic and of the types of spaces, LGBTQ or not, that may foster exoticization processes. This hypervigilance may also develop as a safety strategy to survive in a society that consistently sees LGBTQ people of color as deviant or threatening. For example, between 2014 and 2015, approximately 16 transgender women of color were murdered in the United States, which highlights how exoticization processes can take a deadly turn if the “foreign” object cannot be neutralized in some way (e.g., through finding sexual pleasure). Ultimately, it can be seen how exoticization of LGBTQ people of color can contribute to negative perceptions of, and actions toward, members of this group. Such exoticization can serve as a precursor to more serious levels of discrimination and objectification. This can then create issues for the psychological (and physical) well-being of LGBTQ people of color, who are only trying to live an authentic life in the midst of occupying multiple marginalized spaces. Tania Israel and Kevin Delucio See also Intersectional Identities; Intersectional Theories; LGBTQ People of Color and Discrimination

Further Readings Alimahomed, S. (2010). Thinking outside the rainbow: Women of color redefining queer politics and identity. Social Identities, 16(2), 151–168. Han, C. (2007). They don’t want to cruise your type: Gay men of color and the racial politics of exclusion. Social Identities, 13, 51–67. Han, S. (2001). There’s something about being gay and Asian . . . that’s special. International Examiner, 28(19), 12. Hom, A. Y. (1991). In the mind of an/other. Amerasia Journal, 17(2), 51–54. Martinez, D. G., & Sullivan, S. C. (1998). African American gay men and lesbians: Examining the complexity of gay identity development. Journal of Human Behavior in the Social Environment, 1, 243–264.

Exoticization

of

Women

of

Color

Exoticization is a type of stereotype often directed at women of color in the United States that objectifies and glamorizes them. Here, women of color are considered “Other,” or alien to the dominant majority group (i.e., White Americans in the United States). For women of color, exoticization is a racial and gendered experience that often causes psychological distress. The following entry discusses how exoticization affects the lives of women of color in the United States.

Women of Color: Double Minorities In this entry, women of color are defined as all nonWhite women in the United States. Historically, women of color have been subjected to themes of exoticization for several centuries. As with other racial/ethnic minority stereotypes, exoticization can range from subtle to overt exoticization. When encountering exoticization stereotypes, women of color must contend with the dual experience of being treated as inferior due to their perceived race while also being treated as inferior due to their perceived gender. In this way, women of color are subject to a “double minority” status. Such themes of “racialized sexism” degrade women based on both racial and gender hierarchies that privilege White Americans over people of color and men over other-gendered people. This section provides a brief overview of how themes of exoticization are applied to various racial/ethnic minority women. It is important to note that each of these groups comprises several subgroups, with various ethnic, cultural, and racial differences, and should not be considered as a monolithic entity. Asian American/Pacific Islander

Despite a multicentury history of living in the United States, Asian American/Pacific Islander (AAPI) people have long endured stereotypes of being foreign born and, thus, non-American. White American culture has historically regarded native Asian cultures as alien, mysterious, and exotic. AAPI women are often associated with themes of both hypersexuality and asexuality, as well as

Exoticization of Women of Color

subservience to men. For example, AAPI women are often thought to be sexually subservient (e.g., Thai sex workers, Japanese geishas, Chinese concubines), hypersexual (e.g., Asian Indian Kama Sutra experts, Hawaiian hula dancers), or asexual (e.g., achievement-obsessed students). AAPI women are thus exoticized and devalued as having easily generalized, and bluntly one-dimensional, sexual identities that depict two poles of sexuality. They are additionally exoticized as being un-American and, thus, stereotyped as eating foreign foods, having exotic physical features, and having thick accents. Black/African American Women

Black/African American women are saddled with the unique history of institutionalized enslavement in the United States, informing exoticization themes for Black women. Black women’s bodies have also been historically regarded as physically exotic as compared with women of other racial groups. Specifically, Black women’s bodies are thought to be hypersexual, aggressively curvy, and “savage” compared with those of other women, specific to their hair texture, their body types, and their dark skin. One salient example of public exoticization of Black women’s bodies occurred during the 19th century, when a South African Black woman named Saartjie Baartman was brought throughout Europe as part of a freak show, a type of circus displaying people whose physical features were judged as abnormal. White European tourists would come and stare at Saartjie’s body. Saartjie, on display for her curvaceous body shape, different-textured hair, and dark skin, was judged to be hypersexual, aggressive, and animalistic as compared with White Europeans. Black women have continued to contend with physical and psychological stereotypes that exoticize and dehumanize their bodies and their identities throughout the 20th and 21st centuries. Indigenous/Native American Women

Indigenous/Native American women are exoticized through two specific stereotypes: (1) the “noble savage” and (2) the “squaw.” The noble savage is a stereotype conveying Indigenous Americans as honorable, spiritual, and controlled, while simultaneously being uncivilized, animalistic, and

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less human than White Americans. Thus, Indigenous women are generalized as exotic “Native American princesses.” This image is characterized by traits of virginity and purity, and subservience to men. The squaw represents an opposite exotic image—an Indigenous woman characterized by ugliness, weakness and humiliation, and immorality, who is often discarded by men, both Indigenous and White American. Latinas

Latinas are exoticized through physical stereotypes about their bodies and psychological stereotypes about their character. Latinas are stereotyped as foreign and non-American, having curvaceous bodies, thick accents, voluptuous bosoms, and seductive clothing. Psychologically and sexually, they are stereotyped as being promiscuous, hyperfertile, sensual, passionate, dramatic, and impulsive. Latinas also contend with contrasting nonsexual stereotypes, that of being good domestic workers (e.g., nannies, housekeepers), devoutly Catholic, subservient to men, good cooks, and maternal. Arab American Women

Arab American women are an increasingly visible racial/ethnic minority in the United States, particularly after the terrorist attacks on September 11, 2001. Since then, Arab Americans have generally been stereotyped as dangerous, religiously conservative, and anti-American. Arab American women are exoticized as being subservient, quiet and mysterious, and highly restricted within their patriarchal, Islamic religious communities. Arab American women are also exoticized for wearing easily identifiable, foreign, religious clothing. For example, Arab American women are often assumed to be always covered by hijabs (i.e., a scarf/veil covering the head and chest) or fullbody burqas (i.e., a full-body garment worn in public). Moreover, they are viewed as having no voice in their households, deferring to their husbands, and having no independent identities. Multiracial Women

Multiracial women are defined as women of multiple racial/ethnic identifications. Multiracial

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Americans have historically been regarded as more attractive than monoracial people (i.e., people who identify as a single racial/ethnic group). White American culture has historically considered multiracial women to be physically exotic, in that their appearance is deemed to be physically appealing but also foreign, unusual, and not easily racially identifiable. As a result, multiracial women are often asked, “What are you?”—a question that reduces their personhood to their physical appearance. Such stereotypes convey to multiracial women that their worth is supremely tied to their physical bodies rather than their psychological, spiritual, intellectual, and relational selves. Sexual and Gender Minorities

Women of color who also identify as sexual minorities and/or gender minorities face the additional challenge of being minorities within their racial and gender groups, thus constituting a “triple minority” status. For women of color who identify as lesbian, bi/pansexual, queer, asexual, intersex, genderqueer, gender nonconforming, or transgender, these additional identities necessarily create additional opportunities for exoticization by the dominant cisgender, heterosexual, White American culture in the United States, as well as by their own racial/ethnic communities. White Americans and people of color identifying with ­ any sexual or gender minority group are exoticized as being restrictively defined by their sexual behaviors and interests, their novel and foreign ­ bodies, and their easily generalizable personalities, identities, and life experiences. Thus, these restrictive stereotypes are also directed at sexual and gender minorities who identify as women of color.

Experiences of Exoticization For all women of color, experiences of racism can cause significant psychological and physical distress. This section discusses ways in which exoticized stereotypes are directed toward women of color. Cultural Racism

Exoticized images of women of color often appear in symbols, creative works, and other

images that are commonplace within White American culture. For example, Black women are depicted as exoticized and hypersexual women with curvy bodies in music videos. AAPI women are depicted in American movies as foreign born and submissive to their male counterparts. Latinas are depicted on television as feisty, aggressive, and hypersexual. Indigenous women are depicted through retail Halloween costumes as timid and spiritual, as well as hypersexual and scantily clad. Arab American women are portrayed through television shows as submissive, religiously conservative, and lacking in identity. And multiracial women are portrayed as exotically beautiful and physically unusual on Internet websites and in magazine articles discussing the beauty of multiracial celebrities, as well as in articles promoting multiracial women’s bodies as futuristic. Such examples of cultural racism are psychologically distressing because they highlight the extent to which racist images of exoticized women of color are embedded and tolerated in White American culture. In particular, girls of color who are raised in the United States are subjected to these images throughout their childhoods, which contributes to decreased self-esteem, identity confusion, and pressure to act in ways that both fulfill and actively reject such cultural images. Individual Racism: Microaggressions

Women of color are also exoticized in somewhat subtle, ambiguous manners during interpersonal interactions that are confusing and difficult to identify. These experiences are commonly referred to as racial microaggressions. For example, a person might say to a Black woman, “I love what you’ve done with your hair; can I touch it?” Here, the person speaking to the Black woman may think she or he is paying a compliment to the Black woman, while actually the comment ­highlights how the Black woman’s hair is “not normal” and is available for exhibition and wonderment. Such a comment thus brings up the history of Black women’s bodies being exhibits for others’ perusal due to their inherently exotic qualities. Microaggressions, however, remain a particularly challenging form of racism for women of color to contend with. They are subtler than overtly racist comments, and they can be disguised

Exoticization of Women of Color

by the perceived good intentions of the perpetrator. Moreover, when women of color confront microaggression perpetrators about the racist and sexist nature of their words, these women of color are often accused of being overly sensitive or defensive. For women of color whose exoticization is typified by stereotypes of aggression (e.g., Black and Latinas), confronting the perpetrator can be used as evidence to support the stereotype further. At the same time, choosing not to confront the perpetrator can feel like tacit approval of the perpetrator’s behavior. Exoticization microaggressions thus present a psychologically distressing conundrum for women of color. Over time, repeated microaggressions can lead to chronic anxiety, depression, hypervigilance, and other forms of psychological distress. Internalized Racism of Women of Color

Women of color must also contend with internalized exoticized stereotypes about their own racial/ethnic features. People of color consistently defend against buying into stereotypes about themselves. As a result, women of color may accept, struggle with, and/or resist exoticized stereotypes about themselves, depending on how they think of themselves as women of color, what they think about their racial/ethnic groups, and what they think about White Americans (i.e., depending on their racial identities). One particular example of internalized racism distress is stereotype threat. Stereotype threat is an internal fear that minority individuals experience, that others will judge their behavior as supporting a stereotype about their minority group. For example, AAPI women may fear being judged by others as submissive, whereas Black women may fear being judged by others as aggressive. These women may attempt to adjust their behavior in order to defy the stereotype and present a more dimensional representation of their group. This fear can cause deep anxiety and depression for women of color, as well as identity conflict and confusion as to how to behave.

Exoticization: Future Directions For clinicians working with women of color, it is important to assess how their racial identities

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inform their experiences. Women of color vary in their awareness of exoticized stereotypes, and it may be powerful to name and discuss the impact of such images in psychotherapy, classroom settings, and prevention and intervention programs. Furthermore, experiences of race-related stress are linked to physical symptoms including chronic pain, heart disease, respiratory infections, and substance abuse. It is important for researchers to continue to assess how women of color can protect themselves from such race-related symptoms. Finally, it is also imperative that social justice activists continue to advocate for antiracist images of women of color in the media and broader society, to showcase a more humanizing and dimensional portrayal of these women. Marcia M. Liu See also Dual Minority Status; Gender Stereotypes; Microaggressions; Stereotype Threat and Gender

Further Readings Aoki, G., & Mio, J. S. (2009). Stereotypes and media images. In N. Tewari & A. Alvarez (Eds.), Asian American psychology: Current perspectives (pp. 421–439). New York, NY: Routledge/Taylor & Francis. Brooks, S. (201). Hypersexualization and the dark body: Race and inequality among Black and Latina women in the exotic dance industry. Sexuality Research and Social Policy, 7, 70–80. doi:10.1007/s13178-0100010-5 Ghavami, N., & Peplau, L. A. (2012). An intersectional analysis of gender and ethnic stereotypes: Testing three hypotheses. Psychology of Women Quarterly, 37, 113–127. doi:10.1177/0361684312464203 Helms, J. E. (1997). An update of Helms’ White and people of color racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 181–198). Thousand Oaks, CA: Sage. Merskin, D. (2007). Three faces of Eva: Perpetuation of the hot-Latina stereotype in Desperate Housewives. Howard Journal of Communications, 18, 133–151. doi:10.1080/10646170701309890 Merskin, D. (2010). The S-word: Discourse, stereotypes and the American Indian woman. Howard Journal of Communications, 21, 345–366. doi:10.1080/10646175 .2010.519616

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Root, M. P. P. (2004). From exotic to a dime a dozen. Women in Therapy, 27, 19–31. doi:10.1300/J015v27n01_02 Steele, C. M., & Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69, 797–811. doi:10.1037/0022-3514.69.5.797

Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2003). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62, 271–286. doi:10.1037/0003066X.62.4.271

F Family Relationships Adolescence

and females have similar developmental experiences during adolescence and are treated similarly by their parents, it is useful to consider how gender affects family-teen relationships, the influence of parents and siblings on teens’ ongoing gender development, and the impact of interactions between gender and family relationships on ­adolescents’ mental health, risk-taking behaviors, and other factors associated with health and well-being.

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Adolescence, the developmental period typically associated with the teenage years (though sometimes thought to extend into the early 20s), is a time of significant biological, cognitive, and social changes that have profound effects on an ­individual’s psychological experience and gender development. With the onset of puberty comes new hormonal influences on a child’s appearance, self-image, and behavior. Adolescence is also a period of great cognitive development as the brain matures and teens become capable of more complex and sophisticated reasoning. Socially, peer relationships become more important, and teens begin to seek greater autonomy from their parents and distance from siblings. From the family systems theory perspective, children and parents are separate but interconnected subunits of the larger system (the family) and are perpetually influencing and reacting to each other. Therefore, an adolescent’s experience of these transitions will ­ necessarily affect the rest of the family system. Likewise, family members’ personal and life course transitions, such as reaching middle age for parents and leaving home for siblings, will affect the individual teenager’s development. Throughout all of these transitions and experiences, gender is an important factor. This entry examines the ways in which gender and family relationships interact to affect adolescent development and psychosocial outcomes. Although males

Parent-Child Relationships Parent-child relationships are the interactions between individual parents and their individual children, including things such as communication, conflict, the amount and quality of time spent together, and support. Irrespective of gender, adolescence has traditionally been thought of as a time of “storm and stress” caused by hormonal changes during puberty and characterized by personal angst and conflict in close relationships. Psychoanalytic theorists Sigmund Freud and, later, Anna Freud believed that hormonal changes during puberty led to Oedipal urges that set the stage for unstable familial relationships. Later theory focused on the teen’s quest for autonomy and ego identity as central to adolescent development and relationships. Contemporary researchers and theorists have pulled back from the assumption that conflict is primary to family relationships with teens and, instead, have found that adolescents report generally positive relationships with their parents. Certainly, parent-child relationships tend 537

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to decrease in closeness and increase in conflict during the teen years, but these changes are relatively short-lived and well negotiated by families. Studies have found that strife tends to be focused on day-to-day issues, like curfews and rules, rather than on differences in core values and beliefs. In fact, teens’ values tend to be more closely aligned with those of their parents than with those of their peers. Parents and teens also report positive changes in their relationships during this time as teens’ cognitive growth enables them to have more “adult” conversations and interactions. Few differences have been found to exist between adolescent boys and girls with regard to the quality or types of parent-child relationships. There are more similarities than differences in male and female adolescents’ conflict, quality of relationship, and connectedness with their parents. In general, parents appear to treat adolescent girls and boys similarly. Some exceptions have been found in studies looking at changes in parent-child relationships across the substages of adolescence (early, middle, and late), such that girls in late adolescence tend to report more communication, interdependence, and connectedness with parents than their male counterparts. For late-adolescent boys and their parents, the relationship seems to center on the teens’ desire for independence, whereas girls appear to interact with their parents to find a balance between independence and connectedness. Greater differences are found when examining the gender of the parent, and it has become clear that mothers and fathers have distinct influences on their children. Studies have shown that teens tend to have more intense relationships with mothers than with fathers. This intensity manifests in positive ways, such as emotional closeness, comfort in discussing personal matters, and greater amounts of time spent together, as well as in ­negative ways, like more frequent fighting and the perception by teens that mothers are more controlling. This is seen most strongly in mother-daughter relationships. Conversely, adolescents perceive their fathers as more emotionally distant and less involved in their day-to-day lives. Consistent with gender role socialization, in which males are encouraged to be less emotionally expressive, fathers and sons express less affection for each other than mothers and daughters. Father-daughter

relationships are the least connected among the four parent-child dyads. The literature is filled with data supporting the importance of father involvement and with evaluations of interventions to increase such ­ involvement. When fathers are more directly and intimately involved in their male or female teenagers’ lives and show greater warmth and connectedness, an abundance of studies have found positive academic, behavioral, and emotional outcomes among the youth. There is a clear trend toward increasing father involvement in play and caregiving activities with young children, but with adolescents, fathers spend more time in recreational activities with their children, whereas mothers spend more time in caregiving work. As traditional parental roles continue to evolve, it will be interesting to see if, over time, fathers take on a greater share of caregiving responsibilities as their children progress through adolescence.

Sibling Relationships Less extensive work has been done in understanding sibling relationships during adolescence, particularly in the context of gender. It is known that the adolescent’s push to establish independence and autonomy affects sibling relationships as well as parent-child relationships. In particular, some studies find that the closeness and intensity of sibling relationships decrease as they spend more time with peers and less time at home. Other studies have found that, in spite of less time spent together, the emotional attachment between siblings remains relatively stable across adolescence and into early adulthood. Whereas parents and teenagers experience some increase in conflict during adolescence, siblings appear to have less conflictive relationships as they move in different directions. Sister relationships tend to have higher levels of intimacy than brother-sister or brother-brother relationships. In looking at sibling relationships across adolescence, it has been found that brothersister dyads increase in intimacy from early to late adolescence, sister-sister intimacy remains stable, and brother-brother intimacy decreases. This ­supports the theory that female siblings act in a “kin-keeper” role, promoting and protecting familial relationships, whereas male family members play a less active role.

Family Relationships in Adolescence

Gender Role and Sexual Orientation Identity Development and Family Relationships Because children are exposed to society’s expectations of how boys and girls “should” behave (known as gender stereotyped behaviors) from very early ages, gender socialization and development begin long before adolescence. Some parents may explicitly teach these gendered expectations, for example, with remarks like “Football is for boys,” but research shows that differential treatment of boys and girls by parents does not account for many other sex differences in children’s gender development. Children and adolescents learn about gender and what it means in their own lives by observing sex-typed interactions between their mothers and fathers. For example, by watching their mothers do much of the work of developing and managing family relationships, girls may learn that they ought to develop traits and skills that will enable them to do the same, whereas boys may receive the message that the male has less responsibility in being emotionally active and available in the family context. As cognitive development progresses and adolescents become capable of more nuanced and flexible ways of thinking about the world, one might assume that their understanding of gender would also become more flexible. While this is true for some individuals, one theory suggests that teenagers (both male and female) begin to adhere more rigidly to gender role expectations during adolescence, perhaps because of the pressures of peers and dating. They begin to look more closely at their identities in terms of how closely they fit with gender role expectations and what it means to be masculine or feminine. This is called the gender intensification hypothesis. Some researchers have found that gender intensification may be affected by parental attitudes and sibling relationships. For example, a father’s traditional attitudes about gender role conformity are likely to affect a teenage boy’s views, but so might the boy’s older sister’s rejection of gender stereotyped expectations. More research in this area is needed to understand how these variables interact to influence adolescent gender development. Many factors affect sexual orientation identity development in children and adolescents, including

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genetic and hormonal influences. Some early psychoanalytic theorists suggested that homosexuality and bisexuality resulted from dysfunctional ­parent-child relationships, but research does not support this. Nor do data support the idea that children raised by same-sex couples will be socialized to develop same-sex attractions or LGBTQ identities. What is clear is that children who are raised in families that model acceptance of samesex relationships are more likely than others to act on feelings of same-sex attraction.

Family Relationships and Adolescent Psychosocial Outcomes Family relationship quality, including factors such as parental support, acceptance, and good communication, can protect adolescents from many negative outcomes. Risks for delinquency, mental health problems, substance abuse, and low selfesteem are lower in families in which teens and parents report strong, healthy relationships. Supportive and open family relationships can help mediate the stress that accompanies the many physical, social, and emotional transitions that take place during adolescence. It is important for teens to feel that they are not “going it alone” or being stifled by overprotection as they attempt to move toward greater independence. The dominant thinking in child development is that the authoritative parenting style, characterized by a balance of warmth and age-appropriate limit setting, leads to the best psychological, social, emotional, and academic outcomes for adolescents. Although girls and boys go through similar experiences and transitions during adolescence, they are prone to different types of emotional, social, and behavioral issues. Adolescent girls are significantly more likely than boys to experience what is known as internalizing problems, such as low-esteem, sadness, and low energy—symptoms often associated with depression. In fact, teen girls are twice as likely as boys to experience depression. While the exact causes of this gender difference is not known, some research shows that girls experience greater interpersonal stressors such as conflicts with family members and peers, and such interpersonal stressors, as opposed to those related to achievement, for example, are closely linked to depression. Positive interactions with family

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members, both parents and siblings, can help protect adolescent girls from internalizing symptoms. Boys may also experience depression, though at lower rates than girls, and high-quality relationships with parents help protect adolescents of both genders from depression. Boys tend to experience more externalizing problems as adolescents, though there is some evidence that delinquency and substance abuse among teen girls are increasing. Strong relationships and positive parenting practices such as warmth and involvement in the child’s life can be protective against externalizing problems like delinquency, defiance, and aggression, for both male and female adolescents. For LGBTQ youth, family acceptance and ­support around issues of sexual orientation and gender identity are especially important. Family support is predictive of a variety of positive psychosocial outcomes, including higher self-esteem and better general health status, and is protective against depression, substance abuse, and suicidal ideation and behavior.

Adolescent Family Relationships and Culture Developmental theorists have been criticized for failing to acknowledge cultural variations in family relationships across racial, ethnic, and other cultural lines. In response, researchers have paid more attention to the cultural contexts of child development and family relationships. Certainly, cultural groups differ in their views of concepts such as traditional gender roles and effective parenting styles. In immigrant families, parent­ adolescent conflict can be high as the older generation seeks to preserve traditional ethnic and ­cultural traditions while teens face peer pressure to acculturate. However, in spite of differences in the perceived qualities of family relationships, several studies show that particular relationship characteristics are correlated with positive youth outcomes across cultural groups: In general, family environments that emphasize mutuality between parents and teens, respect for the child’s opinion, and training for maturity appear to best prepare youth for success in their social and cultural environments. Rebecca Bonanno

See also Adolescence and Gender: Overview; Gender Development, Theories of

Further Readings Ackard, D. M., Neumark-Sztainter, D., Story, M., & Perry, C. (2006) Parent-child connectedness and behavioral and emotional health among adolescents. American Journal of Preventive Medicine, 30(1), 59–66. Clemans, K. H., DeRose, L. M., Graber, J. A., & ­ Brooks-Gunn, J. (2010). Gender in adolescence: Applying a person-in-context approach to gender identity and roles. In J. C. Chrisler & D. R. McCreary (Eds.), Handbook of gender research in psychology (pp. 527–557). New York, NY: Springer. Collins, W. A., & Laursen, B. (2004). Parent-adolescent relationships and influences. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology (2nd ed., pp. 331–362). Hoboken, NJ: Wiley. McHale, S. M., Crouter, A. C., & Whiteman, S. D. (2003). The family contexts of gender development in childhood and adolescence. Social Development, 12(1), 125–148. Steinberg, L. (2001). We know some things: Parentadolescent relationships in retrospect and prospect. Journal of Research on Adolescence, 11(1), 1–19. Telzer, E. H., & Fuligni, A. J. (2013). Positive daily family interactions eliminate gender differences in internalizing symptoms among adolescents. Journal of Youth and Adolescence, 42(10), 1498–1511. doi:10.1007/s10964013-9964-y

Fat Shaming Fat shaming is the perceived or actual stigmatizing of someone for being overweight. It can be an intentionally unkind comment, like pairing fat with ugly and referencing an individual (e.g., “You are fat and ugly”), or it can be just mentioning a person’s body size or making disparaging remarks about another person’s body or one’s own body (e.g., “It looks like you have gained weight” or “I look so fat; I need to lose weight”). Even if the comment is not directed at a particular individual, the “policing” of anyone’s body communicates that all individuals must fear becoming fat. Fat shaming communicates the fear of fat and often leads to feelings of lower self-esteem.

Fat Shaming

Fat shaming may lead to body image disorders (i.e., dissatisfaction with one’s own body) and eating disorders, which are behavioral attempts to minimize the stigma and shame related to one’s body (by both others and oneself), and one of the leading causes of death from mental illness. There is also considerable research pointing to stigma and the limited life chances and unfair treatment in employment, medical care, and social life that affect fat peoples’ longevity and health. This entry discusses how and where people experience fat shaming, the history of the concept, and its r­ elation to identity.

Experiences Learning fear and disgust of fat through fat shaming often begins in the home. If a child is fat, ­parents and siblings may make negative comments about that child’s body. The comments may be rooted in love or in an effort to help the child understand that they need to change their body so that they do not have the medical and social disadvantages that fat people are perceived to have as adults. Family members’ concern may migrate to a medicalization of prejudice and shame. Fat shaming may also be experienced in medical offices or hospitals, from one’s physician or other practitioners. A focus on weight and body mass index by medical practitioners communicates that if a person is not in the “normal” range, they should be changing their body to move into the normal range, lest they be considered “abnormal.” As a result of such messages, by the time children enter school, they are commenting on others’ appearance and body size. In addition to schools, the doctor’s office, and the home, fat shaming is frequently reinforced in the media, internalized by children at a young age, and carried into adulthood.

History The concept of fat shaming goes back centuries in the United States and Europe. A look at the history of fat shaming and the demeaning of fat bodies reveals a conflation with racism and sexism in the United States, beginning in the latter part of the 19th century. Prejudices against fat bodies coincided with discrimination against ethnic minorities. It was a time when the prevailing medical

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science still looked at the human race as divided into subspecies, with northern Europeans at the top and southern Europeans often seen as inferior. People of African and indigenous descent were viewed more like animals, incapable of civilization. Fat bodies, thus, were often deemed primitive and disgusting, associated with the lowest classes. Fat shaming was also associated with sexism during this time period, used in the media to delegitimize the movement for women’s suffrage. Much of the propaganda used against the passage of the Nineteenth Amendment featured fat-bodied women, often with Eastern European or African features, to caricaturize suffragettes and their agenda. Ever since, the shaming of women through fear of fat has been a cultural force subjugating women. Not just being fat, but the fear of becoming fat, continues to enslave the psyches of many women in the United States and, increasingly, worldwide. The prejudice against fat bodies took on a medical frame in the early 20th century. It is during this time period that medical professionals introduced the first weight loss diets. Before this, family doctors promoted fat bodies and prescribed weight gain. Fat shaming evolved as another way of separating minority individuals and communities from participating in public life and the dominant culture, via shaming through the medical lens. It became okay to ostracize persons with fat bodies because the shaming and stigma were “for their own good.” Fat bodies came to be considered “unhealthy” and therefore undesirable. Although one may report that one’s concern is health related, it is very difficult for many people to recognize the difference between one’s aesthetic concerns, one’s medical concerns, and one’s own self-loathing from internalizing fat shame. In the 21st century, many people associate being fat with being unhealthy. Some suggest that improving people’s health (e.g., improving food quality, encouraging exercise) should be emphasized rather than addressing medical issues (e.g., ending childhood obesity). It has been argued that if exercise were play rather than work, everyone would want to participate.

Fat Shaming and Identity Fatness has been treated as a stigmatized or “spoiled” identity, a concept developed in the social

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Fatherhood

sciences by sociologist Erving Goffman. Goffman, in his work on stigma, talks about how a spoiled identity can manifest itself in appearance—that it can essentially be “worn.” Such is the case with fatness. Simply by being fat, fat people possess a spoiled identity, one nobody would want. However, many fat-bodied people, like thin people, tall people, short people, or people with green eyes, are in the bodies that are right for them. Michael I. Loewy and Nathaniel C. Pyle See also Body Image; Bullying in Childhood; Health at Every Size; Stigma of Aging

Further Readings Farrell, A. E. (2011). Fat shame: Stigma and the fat body in American culture. New York, NY: New York University Press. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York, NY: Simon & Schuster. Saguy, A. C. (2013). What’s wrong with fat? New York, NY: Oxford University Press. Wann, M. (1998). Fat! So? Because you don’t have to apologize for your size. Berkeley, CA: Bicycle Press.

Fatherhood There are a variety of terms used to characterize fatherhood. Unwed fathers are men with children who have never been married, absent fathers are unmarried or married fathers who live away from their children, resident fathers live with all their children, and absent and resident fathers live with some of their children and away from others. The term fatherhood has two associated but different definitions in the social sciences: Fatherhood can be seen as a fertility status or as the behavior and character endorsed by men who have children. This entry focuses on the latter definition.

History of Fatherhood The role of fathers has changed drastically over the past 400 years. In the colonial era, fathers were seen as primary, and irreplaceable, caregivers. They were the ones in charge of child rearing but

delegated many tasks to the mother. They taught their children religious and moral values at home and how to work hard out in the field to provide for their family. In the 17th and 18th centuries, fathers were predominantly perceived as breadwinners and teachers of moral standards and ­religious instruction. As the economy progressed toward urbanization and industrialization in the 19th century, fathers’ roles changed from farming and working at home to working at factories, which removed them from their household and family duties. During the 20th century, men generally were no longer taking part in household activities. In the 21st century, the term fatherhood has expanded to include many gay and bisexual men, same-sex couples, and transgender fathers raising children.

Importance of Fathers Fathers play an imperative role in the development of their child. According to research, it is important to position fathers within the larger framework of family relationships. Children develop better when they are allowed the opportunity to have a warm, continuous, intimate, and enduring relationship with their father. There are three components of father involvement: (1) en­­ gagement, (2) accessibility, and (3) responsibility. Engagement incorporates all methods of direct contact among fathers and children, such as care and play. It is strongly associated with monitoring, closeness, and warmth, demonstrating that engagement time is a respectable gauge of positive in­­ volvement. Accessibility includes the father’s availability to the child, regardless of the nature or intensity of the relations between father and child. Responsibility includes understanding and meeting the needs of the child by providing economic resources to the child and planning for the child’s future. Cultural wisdom ascribes five components to fatherhood. The first is that fathers have an exclusive and matchless role to play in child development. Fathers are not simply would-be mothers. Mothers and fathers are different, and each is essential for the prime development of a human being. Second, children with both parents are more often successful in life. Not only should fatherhood be promoted, parenthood should be too. Third,

Fatherhood

marriage and parenthood are strongly interlinked, especially for men. When men are married, they are more likely to stay involved with their children. Fourth, the most important aspect of fathering has to do with a child’s feelings. Children need to feel recognized and accepted by their fathers; they need to feel that they are special. Fathers need to ­understand that being a father is more than just providing the essentials; they need to be engaged with their children. Fifth, biological fathers are more likely to be dedicated to the upbringing of their own children than nonbiological fathers; being a father is much more than simply playing a social role.

Attachment Figures John Bowlby developed the theory of attachment. Initially, he stated that attachment relationships were between a child and his or her mother. Over the years, he added fathers as significant attachment figures as well. There are two distinct but equally important roles in a child’s development: (1) to deliver love and security and (2) to participate in exciting and challenging practices. The bond of attachment between children and parents is more than keeping the children safe from danger (often seen as the mother’s role); it also promotes exploration and provides the confidence to do so (often seen as the father’s role). For children to grow into proficient adults, they need to develop psychological security, which consists of both secure attachment and secure exploration. Secure exploration is defined as confident, attentive, eager, and resourceful exploration of materials or tasks, especially in the face of disappointment. It implies a social orientation, particularly when help is needed. Secure attachment and secure exploration help explain how fathers make a distinctive impact on the raising of children: Fathers’ stimulating behavior, when linked with sensitivity, instills in children a sense of safety while exploring new understandings. Bowlby considered play to be an important aspect of the child-father relationship. He posited that father-child play is critical for child development and adds to the expansion of attachment relationships. Often, though, a father’s role becomes noticeable later in the child’s development; consequently, the impact of a father’s involvement may

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be progressively important and more observable as the child grows older. A father’s awareness of his children’s exploratory behaviors can contribute to the children’s sense of safety during difficult tasks and increase the chance for his children to focus, follow their curiosity, and master new talents in an emotionally unhindered way.

Promoting Effective Fathering Suggestions offered to promote effective fathering include embracing a broader definition of father involvement (interactions with the child, psychological and physical accessibility to the child, responsibility for the care of the child), implementing culturally sensitive interventions, and utilizing a holistic, multiservice approach. Additional suggestions involve promoting support for a father’s parenting identity (a divorce or separation should not change the role of a father), enfranchising fathers as parents by making them feel that they still have rights even after separation or a divorce, encouraging a cooperative parental relationship with the mother (or secondary parent), and involving fathers in assuming child-raising responsibilities in a timely way (adopting a cooperative parenting plan immediately). Legal approaches ­ include emphasizing cooperative strategies in the family court by giving greater consideration to the father’s parental rights and responsibilities in court matters (e.g., joint custody arrangements) and establishing legal paternity as early as possible if the father is not married. Last, but not least, ­helping fathers become effective economic providers has been suggested as facilitating effective fathering. Ashley R. Cosentino See also Gender Roles: Overview; Parental Expectations; Parental Messages About Gender; Parental Stressors; Parenting Styles, Gender Differences in

Further Readings Allen, W., & Doherty, W. (1996). The responsiblities of fatherhood as perceived by African American teenage fathers. Families in Society: The Journal of Contemporary Social Services, 77(3), 142–155. Diekman, A. B., & Eagly, A. H. (2000). Stereotypes as dynamic constructs: Women and men of the past,

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present, and future. Personality and Social Psychology Bulletin, 26, 1171–1188. Marsiglio, W. (1995). Fathers’ diverse life course patterns and roles: Theory and social interventions. In W. Marsiglio (Ed.), Fatherhood: Contemporary theory, research, and social policy (pp. 78–101). Thousand Oaks: CA: Sage. Parke, R. (1996). Fatherhood. Cambridge, MA: Harvard University Press. Parke, R., & Brott, A. (1999). Throwaway dads: The myths and barriers that keep men from being the father they want to be. New York, NY: Houghton Mifflin. Pleck, E., & Pleck, J. H. (1997). Fatherhood ideals in the United States: Historical dimensions. In M. Lamb (Ed.), The role of the father in child development (3rd ed., pp. 33–48). Hoboken, NJ: Wiley. Sylvester, K., & Reich, K. (2002). Making fathers count. Assessing the progress of responsible fatherhood efforts. Baltimore, MD: Annie E. Casey Foundation.

Female Sex Offenders When the public thinks of sex offenders, the image that comes to their mind is almost certainly that of a male. Research has traditionally mirrored this idea and has only just recently started to turn its focus to the issue of female sex offenders (FSOs). Although women constitute only 1% to 4% of reported sex offenders, they account for a substantial number of actual offenses. Of individuals who have been abused sexually, the percentage ­asserting abuse from a female ranges from 2% to nearly 40%. Many women have co-offenders, or are coerced into offending by a male partner, but most offend on their own. Although FSOs engage in behaviors similar to those of male perpetrators, including rape, sexual assault, forced sodomy, exposure, forced prostitution, and genital fondling, to name a few, there are some significant differences between men and women with regard to victim and offender characteristics and rates of re-offending.

Victim Characteristics Females most frequently offend against young males, whereas male sex offenders tend to offend

against a broader range of victim types. This is important to note because male victims of sexual offenses tend to avoid reporting. Social expectations of males and widely held myths about the inability of women to abuse men make it difficult for boys and young men to recognize and report victimization. In addition, engaging in sexual relations with teachers may be perceived by many to be a conquest rather than a victimization that the young man has actually experienced. If the gender roles of offender and victim are reversed, it is much easier for many people to understand the victim status of a young girl who has been abused by an older male teacher. When the public is alerted to issues with FSOs, it is usually because the offender is taking advantage of a caregiver role or position of authority. For example, the most notorious cases of FSOs tend to be teachers, as was the case with the sixthgrade teacher Mary Kay Letourneau, who engaged in sexual activities with her student. Women are also disproportionately represented in samples of day care workers who offend children. FSOs most often have some prior relationship with their victim, including that of mother and child. The ­ caregiver relationship provides the access and ­isolation necessary for victimization to occur.

Offender Characteristics The typical first-time FSO is in her 20s or 30s, victimizes males 12 years of age or younger, does not have an extensive criminal history, and uses coercive techniques to facilitate the abuse. The most prevalent characteristic of FSOs identified in the literature is a history of childhood trauma. Trauma includes emotional abuse, physical abuse, and, most commonly, sexual abuse. FSOs have consistently experienced higher rates of sexual abuse as children and adults than both male sex offenders and female nonsexual offenders. Prior abuse has been attributed to sex offending, as the abuse has long-lasting effects, which contribute to difficulties engaging in social interactions and maintaining relationships as adults. It is hypothesized that this social ineptitude is rectified through engaging in, albeit inappropriate, sexual relationships. Although it is natural to assume that FSOs have some sort of mental illness or personality disorder, the research does not seem to support this

Femininity

idea. There are no consistent findings with regard to differences in the mental health of FSOs versus nonsexual offenders. While there are common features among FSOs, it is important to remember that this is a heterogeneous group in several ways. Awareness of these differences has led to the creation of typologies of FSOs that help describe and explain the characteristics of offenders, offending patterns, victim choice, and the propensity to re-offend. The most widely accepted typology, developed by Donna Vandiver and Glen Kercher in 2004, in­­ cludes six categories: (1) heterosexual nurturers, (2) noncriminal homosexual offenders, (3) female sexual predators, (4) young adult child exploiters, (5) homosexual criminals, and (6) aggressive homosexual offenders. Heterosexual nurturers are those who engage in sexual offending with males younger than 12 years of age and typically see their behaviors as those that teach young men about sexual relationships. These offenders seek emotional comfort in their victims and often do not consider their behavior to be abusive or criminal. Noncriminal homosexual offenders have minimal criminal histories and tend to victimize young adolescent women. Female sexual predators usually have engaged in other prior criminal behaviors and are likely to re-offend in the future. Young adult or adolescent offenders who abuse younger victims with whom they had a prior relationship fall into the young adult child exploiters typology. Homosexual criminals also tend to have more extensive criminal histories, are older, and have older victims of the same sex. These offenders engage in crimes such as forced prostitution and are not typically assaultive. Finally, aggressive homosexual offenders are also older and violently assault adult females. The most frequently occurring group of FSOs is the heterosexual nurturer, which supports the idea of the “typical” FSO as someone ranging in age from 20 to 30 years who offends males about 12 years of age with whom they have some sort of relationship. Often, this relationship can be an authoritative one, such as that of a caregiver or teacher. The purpose behind identifying characteristics unique to FSOs goes beyond simple description. FSOs face very different histories of trauma, which affect their offending. When attention is paid to these differences, better programming can be

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developed that can help address the needs of FSOs and their victims. FSOs are also less likely than males to re-offend, so it is important to keep in mind that a “one-size-fits-all” approach is not appropriate when addressing the issue of sex offenders more broadly. Randa Embry Matusiak See also Physical Abuse; Rape; Sexual Abuse; Sexual Assault; Sexual Assault, Child Survivors of; Sexual Assault, Female Survivors of; Sexual Offenders

Further Readings Sandler, J. C., & Freeman, N. J. (2007). Typology of female sex offenders: A test of Vandiver and Kercher. Sexual Abuse: A Journal of Research and Treatment, 19, 73–89. doi:10.1007/s11194-007-9037-4 Vandiver, D. M., & Kercher, G. (2004). Offender and victim characteristics of registered female sex offenders in Texas: A proposed typology of female sex offenders. Sexual Abuse: A Journal of Research and Treatment, 16(2), 121–137. doi:10.1177/107906320401600203

Femininity Femininity is a descriptive gender term associated with the culturally defined characteristics ascribed to females, women and girls. Femininity as a construct includes ideas of physical appearance, ­ mannerisms, ways of relating, and all-encompassing ideas of a female gendered self. Gender is considered a social construct, separate from the biological state of being assigned the female sex at birth, which is determined by external physical characteristics and chromosomal status. Although feminine gender is separate from biological sex, they are interrelated and often interplay with one’s sense of gender identity. Femininity is not inherently linked to femaleness, although in dominant cultures, gender and sex are seen as analogous parallel binary constructs—meaning that femaleness typically equals femininity and maleness equals masculinity. Although gender and sex are often conflated, femininity is accepted as a construct that can exist irrespective of someone’s birth-assigned sex—across cultures and subcultures—in definitive traits. In addition, gender identity is also separate from

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femininity in that gender identity refers to someone’s internal felt sense of themselves as male or female—which may or may not correlate to their level of femininity or masculinity.

Traits of Femininity Although there are variations in femininity across race, class, ethnic, and subcultural lines, overall femininity can be identified across several domains. Commonly defined features of femininity include physical attributes such as having long hair, wearing makeup and jewelry, wearing clothing ­ culturally defined as feminine, and culturally associated feminine physical traits. In Western cultures, this is often defined as being thin, hairless, and finer featured. In addition, other physical attributes can include having a higher pitched voice and being physically smaller than men. Mannerisms can also be defined as feminine, including being soft-spoken, gentle, polite, deferential to men, and nurturing. Personality characteristics associated with femininity can include being warm, empathic, and caring. Behaviors and personality characteristics that are deemed feminine can include being more expressive, emotional, relationship oriented, friendly, and demure. What is defined as feminine can vary within different cultures, but clear lines are drawn between what are considered feminine and masculine traits in most cultures. Femininity has historically been defined as part of a binary system of gender and as such is seen as the “opposite” of masculinity and associated with femaleness.

Cross-Cultural Variations in Femininity Norms The measure of femininity varies among different cultures. Western norms of femininity are based in White European ideals of feminine beauty and behavior, including pale skin, thinness, and a submissive demeanor. Other cultures can have specific ideals of feminine beauty. These can include body modifications that amplify traits thought to represent one’s femininity—for example, large ­ breasts, small feet, and long necks. Cosmetics use also can vary cross-culturally, with some cultures seeing makeup as ideal feminine expression and expecting women to present themselves in a

stereotypically feminine appearance, using makeup to enhance the eyes, the lips, and other facial features. What is considered feminine in body shape and size varies within cultures as well, with some cultures emphasizing thin, small body shapes and others emphasizing heavier, rounder features. In Western cultures, the feminine ideal of long, straight hair, thin bodies, and pale skin has affected expected norms of what is “appropriate” feminine presentation and is based in White supremacist ideals of beauty. For example, Black women with curly hair are expected to straighten their hair, and their bodies are seen as not meeting the feminine thin ideal. In this way, femininity is often bound to race, class, and ethnic values and, given the dominant western European ideals, often produces a specific feminine expectation that is reproduced through the media and enforced across multiple areas of life. Femininity, within patriarchal societies, often carries mannerisms, behaviors, and ways of being that are rigidly enforced to maintain sexual difference and sexual inequality between men and women.

Femininity and Sexuality Within binary heteronormative sexuality, femininity can include being sexually available to men, physically appealing to men, and submissive and receptive to men’s sexual advances. Women have been referred to as “the weaker sex,” and this phrase typifies core beliefs about feminine ­sexuality. Feminine sexuality is associated with receptivity, with being a passive agent in a sexual dynamic. To be feminine when sexual is to be the object, rather than the subject, of desire, to be desired rather than to be active in expressing desire. Feminine women are supposed to engender desire from men and to not possess their own sexual desires but instead receive and reflect men’s desires. Femininity is also associated with sexual purity. Women who exhibit clear, articulated desire are often seen as unfeminine or deviant, or even dangerous (sluts, lesbians, femme fatales). Femininity within a patriarchal context positions feminine sexuality, women, and f­ eminine-presenting people as sexually available to men. Feminists have posited that this can create a culture of sexual violence toward women and f­eminine-presenting people in that feminine-presenting people do not have

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sexual agency and are seen as sexual possessions of men. Feminine sexuality in this sense has often been defined in contrast to men’s desires and sexuality. As discussed in the next section, feminists have argued for reclaiming femininity and for defining women’s sexuality outside of the male gaze. ­Writers, activists, and theorists have all put forward alternative models of feminine sexuality. Among these are models of sexual response based on women’s physiology and taking into account different models of sexuality, desire, and arousal that can be defined as distinctively feminine.

Feminist Critique With the advent of second-wave feminists in ­Western cultures in the 1960s, there was a rising ­critique of femininity norms and corollary sexism. Feminists argued that femininity was a social construct and not inherent to women and that, instead, most people embodied traits along a continuum of masculinity-androgyny-femininity. Feminists argued that society was responsible for socializing women to norms of femininity that kept women in an inferior position and that, if given the opportunity to develop other interests and ways of presentation, all people would express themselves more fully on the gender continuum. Feminists also argued that feminine traits are devalued within the patriarchal system and are rigidly enforced to maintain male supremacy. This led to an expansion of women having access to more traditionally defined masculine interests and presentations yet did not lead to femininity being more embraced by men. Subsequently, more recent feminist critiques have used the term misogyny as inherent in the system of patriarchy—the valuation of men and masculinity and the devaluation of women and femininity. Thus, women can express masculinity (up to a point), and this is acceptable because masculinity is more valued. Men are still punished, however, for embodying femininity because it is seen as “less than”—less desirable, less powerful, and degrading. This is based in ­misogyny—hatred of women and femininity, which is the basis of a patriarchal system that places masculinity, maleness, and men above women, ­ femininity, and femaleness. The social construction feminist critique of gender has been challenged in recent years by scholars

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who problematize the idea of gender being completely socially constructed with no inherent basis. Scholars have pointed to the possible reactionary pendulum swing of social constructionism to the biological determinant gender hypothesis preceding it. Theorists argue that social-constructionist views of gender oversimplify the complex interactions of personality, gender identity, socialization, and gender expression in the sociocultural context. Debate still exists among theorists and academicians about how inherent gender expression and role are versus how much socialization affects gendered traits, roles, and behaviors. Transgender theorists and activists, in particular, have challenged the unilateral social construction of gender critique as not acknowledging the transsexual, transgender, and gender nonconforming experiences of an internally felt gendered self. If gender is wholly a consequence of socialization, then theoretically one would not have discomfort or distress in taking on a masculine or feminine role. This is counter to many people’s experience of discomfort in the pressure to conform to feminine or masculine gender norms when that does not fit their internal experience. Femininity as a social construction within a patriarchal framework carries with it the meaning ascribed to femininity within a heteronormative gender framework created to support the power and dominance of men. Feminine traits are thus given meaning that places them as inferior to masculine traits. Feminine traits may be inherent or socially mediated, but in any case, the meaning attached to them, and their association with women, places them in a less powerful position within patriarchal society.

Femininity Outside the Binary Femininity is pathologized outside of its expression by birth-assigned women who meet the cultural standards of appropriate femininity. A ­ commonly held stereotype is that being a feminineacting man or a masculine-acting woman is being gay or lesbian, respectively. Femininity in malebodied people is, within many cultures, seen as a subversive act and, paired with homophobia, can put people at risk for violence. Expressions of femininity place a person within a framework of targeted violence at feminine-appearing people due

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to misogyny. This is evidenced by higher rates of violence against women and against gender nonconforming people, typically male-bodied people who express feminine gender. Men and transfeminine people who express femininity and feminine sexuality are seen as ­perverts, deviants, and threats to binary normative sexuality. Men who express femininity have traditionally been the focus of jokes in the media and are seen as failing in their masculinity. It is considered insulting to tell a man he is acting feminine, and it can be a source of teasing, shaming, and violence. A man dressing in feminine clothing is seen as deviant. Transfeminine people are often a target of violence for their expression of femininity as male-assigned-at-birth people. Femininity is strictly regulated in dominant normative culture, and as such, femininity is strictly the purview of the appropriately bodied people (cisgender women) and seen as only appropriately exhibited in accordance with heteronormative, cisnormative, gender binary norms. It is common in many cultures for femininity to be regulated not just by men but also by women, who internalize gender normative value systems based in misogyny and patriarchy. Homosexuality and transsexuality, especially the expression of femininity by malebodied people, are seen as deviancies and are punished in many cultures through stigma, dis­ crimination, and violence.

Psychology and Femininity Psychologists have attempted to measure femininity through a variety of assessments over time, and the measurement of femininity has shifted with the times. Femininity was first thought to be understood as a reflection of one’s womanhood and ­correlated with biological sex. Early measures of femininity focused on gender role congruence, listing norms of feminine roles (based in Western understandings of femininity). With the advent of feminist psychology, more nuanced understandings of femininity expanded ideas of feminine identification of the meaning of femininity to the individual within society. Critiques of social sex role expectations and the introduction of terms such as gender expression and gender socialization ­influenced how femininity was measured within psychology and began to investigate how femininity is defined

within society. Current psychological measurement of femininity is inclusive of different gender identities and explores how femininity can be related to mental health outcomes, relationships, gender identity, and sexuality. Katherine G. Spencer See also Androgyny; Bem Sex Role Inventory; Cultural Gender Role Norms; Doing Gender; Gender and Society: Overview; Gender Equality; Gender Expression; Gender Role Behavior; Gender Role Socialization; Gender Socialization in Women; Gender Stereotypes; Measuring Gender Roles; Sexuality and Women; Women’s Issues: Overview

Further Readings Brownmiller, S. (2013). Femininity. New York, NY: Open Road Media. Butler, J. (2002). Gender trouble. New York, NY: Routledge. Fausto-Sterling, A. (2000). Sexing the body: Gender politics and the construction of sexuality. New York, NY: Basic Books. Mahalik, J. R., Morray, E. B., Coonerty-Femiano, A., Ludlow, L. H., Slattery, S. M., & Smiler, A. (2005). Development of the conformity to feminine norms inventory. Sex Roles, 52, 417–435. Pedhazur, E. J., & Tetenbaum, T. J. (1979). Bem Sex Role Inventory: A theoretical and methodological critique. Journal of Personality and Social Psychology, 37, 996–1016. Serano, J. (2007). Whipping girl: A transsexual woman on sexism and the scapegoating of femininity. Berkeley, CA: Seal Press. Spence, J. T., & Helmreich, R. L. (2014). Masculinity and femininity: Their psychological dimensions, correlates, and antecedents. Austin: University of Texas Press.

Feminism: Overview Feminism emerged as a response to the long-­ standing consequences of women being considered inferior to men and the oppression by the structures and rules created by men and the larger ­society. The definition of feminism has been varied and contested across history. In general, it has been described as a political, social, cultural, economic,

Feminism: Overview

and educational movement to establish equal rights and legal protections for women. Its ideologies and theories are concerned with differences based on sex and gender and the inequalities and inequities due to these differences, including but not limited to issues such as family roles, sexual harassment and assault, violence against women, human trafficking, exploitation, equal pay, employment opportunities, equality in the workplace, education, child care, contraception, ­abortion, prostitution, and equal political representation. Advocacy, activism, consciousness or awareness raising, writings, and campaigns are some strategies used by feminists and the feminist movement to address the inequalities and inequities of sex and gender and to bring about change until the oppression of women is eradicated. There is debate over when feminism began, but there were examples of feminism and feminist writings early on. Some scholars believe that the roots of feminism date back to ancient Greece with Sappho, or to Hildegard of Bingen in medieval times. One of the earliest known feminist writings was by Christine de Pizan. In her book The Book of the City of Ladies (written in 1405), she highlighted the great accomplishments of notable women of the past and of her time and how misogynists were wrong in their belief that there were inherent weaknesses and evils in females. Following her, there were numerous other writers, such as Heinrich Cornelius Agrippa, Modesta di Pozzo di Forzi, Olympes de Gouge, Marie Le Jars de Gournay, Anne Bradstreet, Francois Poullain de la Barre, and Jane Austen, who also advocated for respect, dignity, intelligence, and equality for females through their writings. One of the most influential of them, considered the “grandmother of British feminism,” was Mary Wollstonecraft. From her 1790 pamphlet, she extended her work with A Vindication of the Rights of Woman (1792), which advocated for the social and moral equality of females and males. Her later writings discussed women’s sexual desires. The aforementioned women and activities were all part of the creation and evolution of feminism and the feminist movement.

Waves of Feminism Generally, the chronological timeline of modern feminism is considered to be in three waves.

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However, there is no agreement about what constitutes these three waves. First-Wave Feminism

First-wave feminism is generally designated to the time period of the 19th and 20th centuries. Activities during the first wave took place throughout the world, but particularly in the United ­Kingdom, the United States, the Netherlands, and Canada, and emerged from urban industrialism ­ and liberal and socialist politics. It initially focused on property rights and equal contract for women, as well as opposing chattel marriage and the ownership of women and children by husbands and fathers, respectively. By the end of the 19th century, the focus of the first wave turned to political inequalities and women’s access to political power, particularly women’s suffrage and the right to vote. The Suffragettes and Suffragists campaigned successfully in Britain with the passage of the Representation of the People Act of 1918—which granted women over the age of 30 years who owned houses the right to vote. This was extended in 1928 to all women over the age of 21 years. In the United States, first-wave feminists initially fought for the abolition of slavery with the efforts of African American abolitionist and feminist Sojourner Truth, who led this fight along with other U.S. feminists. Their energies then turned toward women’s right to vote. The leaders of the movement included Lucretia Coffin Mott, Lucy Stone, Elizabeth Cady Stanton, and Susan B. Anthony. The end of first-wave feminism is considered to be the passage of the Nineteenth Amendment to the U.S. Constitution in 1920, granting women in all states the right to vote. Marsha Lear is credited with coining the term first wave in March 1968, when she used the term second-wave feminism in an article in The New York Times Magazine. The latter term was used to distinguish itself as a newer feminist movement that focused not only on the political inequalities of the first wave but also on social and cultural inequalities. Second-Wave Feminism

Second-wave feminism is associated with activities starting in the early 1960s and curtailing toward

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the end of the 1980s and the beginning of the 1990s. In the context of the civil rights movements and the anti–Vietnam War protests, this wave was highly concerned with and focused on equality, sexuality, and reproductive rights, and the voice of this wave became more radical. The s­econd wave was also more theoretical and was associated with the subjugation of women by the oppressive social structures of patriarchy, capitalism, normative ­heterosexuality, and the woman’s role of wife and mother. Simone de Beauvoir wrote her famous book The Second Sex in 1949, which provided a detailed analysis of women’s oppression and a foundation for contemporary feminism. She argued that the social construction of women as other, deviant, and abnormal and of men as ideal is fundamental to the oppression of women. Another seminal book, The Feminine Mystique (1963), by Betty Friedan, was influential in the U.S. women’s movement of the 1960s as it criticized the cultural belief that women find meaning and their identities only through their husbands and children, thus losing their identity to the care of their families. Women’s roles were further devalued by the postwar economic boom and newer technologies that were supposed to make housework less demanding but resulted in making housework less meaningful and valued. “The Personal Is Political,” coined by feminist activist and author Carol Hanisch, became a slogan associated with second-wave feminism. ­ During this wave, women’s social, cultural, and political inequalities were seen as intertwined, and second-wave feminists wanted women to be aware of and understand how their lives were politicized as a result of the sexist power structures of U.S. culture and society. A central activity was the ­passage of the Equal Rights Amendment to the Constitution, which would have guaranteed social equality regardless of sex. However, due to the various social movements during this wave in the United States, the women’s movement was marginalized and devalued. In response, second-wave feminists formed womenonly organizations such as NOW, consciousnessraising groups, and feminist publications such as “The BITCH Manifesto” and “Sisterhood Is Powerful.” Another aspect that emerged out of this was women-only spaces and the belief that women

working solely together creates a different dynamic from a mixed group of women and men. As a result, this would lead to the betterment of the world. A major criticism of the U.S. women’s movement during the second wave was the lack of attention to race and class. One of its best-known critics is bell hooks. In her book Feminist Theory: From Margin to Center (1984), hooks addressed the lack of minority women voices in the women’s movement, and she believed that the movement failed to address “the issues that divide women.” The women’s movement also invigorated researchers and psychologists to study women and gender and improve women’s lives. In 1969, the Association for Women in Psychology was formed, mostly by graduate students and those who were newer to the psychological field. Simultaneously, older and more established psychologists were establishing a Division of the Psychology of Women within the American Psychological Association (APA), which was officially approved in 1973. Canadian psychologists and the British Psychological Society have also incorporated more women into their psychological organizations. These changes acknowledged the presence of women and the diversity within the field of psychology, as well as supporting the professional identity development of women. Third-Wave Feminism

Third-wave feminism began in the 1980s and emphasizes the intersectionality and multiple perspectives of women’s lives and experiences. It seeks the complexity and diverse narratives of multivocality and actions as opposed to synthesis and theoretical justification. It is not so much that the long-standing issues (e.g., reproductive rights and freedoms, violence against women and girls, political representation, equality) or solutions did not continue to be of concern and the focus of activism, but the strategies and approaches used to address the impasses in feminism and feminist theory that were created in the 1980s differentiated third-wave feminism from second-wave feminism. Instead of judgment and critical analysis of what is feminism and feminist thought, third-wave feminism took on a nonjudgmental and inclusive approach wherein there is agreement in a bridging

Feminism: Overview

of dynamics and differences into a political coalition. In addition, third-wave feminist groups also have forged their own agenda, such as the Riot Grrrls, who are reclaiming girl culture, empowering women to enjoy their sexuality, and inserting women’s voices in music. In psychology, feminist theory, practice, and activism continue to develop and become more sophisticated and complex, and younger feminists are making strides in fulfilling the foremothers’ vision. The Association for Women in Psychology remains an independent feminist psychology ­organization and continues to work toward social justice through the integration of professional, ­personal, and political power by promoting and supporting feminist scholarship, teaching, and practice through networking, collaborating, mentoring, and changing public policy. Within the APA, Division 35, formally the Society for the Psychology of Women, is committed to being a base for all feminists who are interested in the teaching, research, and/or practice of the psychology of women. It seeks to be an organizational base and voice for those who are interested in feminist issues within the APA and the larger ­society to promote feminist scholarship and practice as well as activism, advocacy, and service.

Variations of Feminist Ideologies and Theories There are various ideologies and theories related to feminism and the feminist movement. Some of these may overlap with one another, and many feminists may identify with more than one ideology and/or theory. Socialist Feminism

Socialist feminism believes in the Marxist ideas that exploitation, oppression, and labor are interconnected with discrimination and that acts of discrimination are equally wrong and inseparable. However, Karl Marx believed that gender oppression was subsumed under class oppression and that gender oppression would end when class oppression was extinguished, which many socialist feminists thought was naive. As a result, some socialist feminists have criticized placing gender oppression under the umbrella of class oppression

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and attempted to separate the effects of gender oppression from those of class oppression. In particular, socialist feminists work on the differential status and treatment of women in the workplace and home life. It is thought that women are exploited due to the patriarchal system, which devalues and minimizes the work that women do. Because they believe that the oppression of women affects everyone, they work toward broader ­societal and systemic changes as opposed to individual changes. Issues of interest to socialist ­feminists are marriage, child care, domestic work, and prostitution. Liberal Feminism

Traditional liberal feminism developed from liberalism. Works of feminists such as Mary ­Wollstonecraft and John Stuart Mill represent the principles of traditional liberal feminism. However, analysis and goals have further evolved and transformed liberal feminism from its original principles. The overall goal of liberal feminism is to have “a just and compassionate world” so individual rights to exercise autonomy exist for someone to choose for oneself as long as others are not deprived of their rights in doing so. A major focus is on the individual and individuals’ abilities to gain and maintain equality in their lives. It is believed that this can be conducted on the interactional level of individuals, specifically males and females, so systematic and structural changes are not necessarily needed for women to be able to achieve equality. Some more contemporary well-known liberal feminists include Betty Friedan, Elizabeth Holtz­ man, Bella Abzug, Eleanor Smeal, Pat Shroeder, and Patsy Mink. In addition, liberal feminists would also include leaders and members of organizations such as NOW and the Women’s Equity Action League. Among liberal feminists, an important area of work for women’s liberation is gender justice or sexual equality. They believe in freeing women from the oppressive gender roles that relegate women to inferior positions or no position at all in the workplace, academy, marketplace, and other arenas, and in a patriarchal system that conflates sex and gender. This is furthered by laws and legislation that prevent women from doing

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“masculine” jobs. The means through which the equality of men and women is achieved are ­political and legal reform, major economic reorganization, and redistribution of wealth. However, the question of how to handle these issues has led to the emergence of two types of liberal feminists. One is classical liberal feminists, and the other is welfare liberal feminists. Classical liberal feminists believe in limited government, whose primary purpose is to protect civil liberties, such as freedom of speech, freedom of religion, freedom of association, voting rights, and property rights, and to allow a free market in which everyone has equal opportunity to accumulate goods and resources. Conscience, freedom of expression, political and legal rights, and freedom of religion are important values of classical liberal feminists. Welfare liberal feminists, on the other hand, believe that government should focus on civil liberties and economic disparities. Because of the differences in initial standing or advantage, talent, and luck, welfare liberal feminists believe that the system or market is structured so some individuals cannot fairly share in the market due to the initial or inherent differences unless provisions or adjustments are made to reduce these disparities. Due to the systemic inequities, welfare feminists believe that government should provide housing, education, health care, and social security to its citizens, particularly for disadvantaged and underprivileged citizens, and taxes and safeguards on profits should be used to equalize the economic disparities. Furthermore, government interventions in the economy to prevent the perpetuation or entrenchment of these inequities are deemed necessary, including food stamps, low-cost housing, Medicaid, Medicare, school loans, Social Security, and Temporary Assistance for Needy Families. Radical Feminism

Radical feminism consists of a political and social theory about the oppression of women and strategies of action to eradicate all forms of oppression from women’s lives. There are various forms of radical feminism, such as cultural feminism, separatist feminism, and antipornography feminism. However, they have some common general principles. First, it is believed that all women are oppressed by men as a social group, and this is

the primary oppression for women. The oppressive social structure in which male domination and female oppression are entrenched is patriarchy. Patriarchy is seen as a value system that has differed culturally and historically but is commonly a set of structures and institutions developed by men that maintains male power and privilege and female oppression and subordination. These include economic, legal, political, and religious structures and institutions. The goal of radical feminism is to illuminate male control in every aspect of women’s lives, both public and private. Issues such as reproduction, marriage, sexuality, and motherhood are primary areas of concern, as well as to promote and advocate for change. A second key characteristic is that radical feminism is by women for women. “The Personal Is Political” concept is also a central part of the value system of radical f­ eminism. It considers women and women’s experiences as central to its theory, practice, and activism. It believes that the theory and practices cannot be divorced from the women themselves, nor should they be objective or sterile but must be fully embracing of women and women’s experiences through emotions to gain a holistic understanding for activism. There are two material bases of patriarchy. One is the structure of economic systems, where only paid work is valued and money is related to one’s power. Interestingly, women still do not have equal pay outside the home, nor are they given the equated value for their unpaid domestic work in the home. Radical feminism therefore stresses the exploitation of women through the oppression maintained by men, who benefit from it. Women’s bodies are the second material base, according to radical feminism. Patriarchy uses sexuality, reproduction, contraception, and abortion to control women and their bodies. This can be seen in the male-dominated governments, which often determine what happens to women and their bodies through laws, regulations, and access to services. Womanism or Woman-of-Color Feminism

In the 1970s, Black women, including Toni Cade Bambara, Ntozake Shange, Angela Davis, Toni Morrison, June Jordan, Alice Walker, and Audre Lorde, began to give voice to a self-defined,

Feminism: Overview

collective perspective on Black womanhood. It emerged out of the early feminist movements, which were primarily led by White women who advocated for social change such as women’s suffrage but largely ignored issues of race and class. Womanists began to voice how their experiences of oppression were different from and more intense than those of White women and how their experiences were largely omitted from feminism and the feminist movement. Alice Walker, in her volume of essays In Search of Our Mothers’ Gardens (1983), gave meaning to the term womanist. Womanist is a term that describes “a black feminist or feminist of color” (p. xi). The origin of the term came from the Southern expression “you acting womanish,” which meant a girl acting in outrageous, courageous, and willful ways, freeing her from conventions. Womanism seeks the common goals of self-definition and self-determination, with the understanding that sexism, racism, and classism are intricately interrelated with the experiences of Black women and women of color. This voice, according to hooks, is used to raise awareness and confront Black women’s representation, or lack thereof, in dominant discourses. Furthermore, a core womanist belief is that to liberate women of color, all people would need to be liberated, meaning the extinction of all forms of oppression for all people, male and female. Intersections of multiple identities and intersectionality were also outgrowths of womanism. In her book Women, Race, and Class (1983), Angela Davis articulated the intersection of race, gender, and class, while Kimberle Crenshaw extended this with the term intersectionality in discussing identity politics. These theories and ideas gave rise to the articulation and understanding of the complexity and uniqueness of Black women’s lived experiences and the lives of other women of color. Some also include women of color feminism in womanism. The subtypes of women of color feminism would include mixed-race feminism, Latin American/Latina feminism, Asian American feminism, and indigenous feminism. Postcolonial and Third World Feminisms

Postcolonial feminism emerged from the impact of the gendered history of colonization, the

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imposition of Western norms on these colonized cultures, and decolonization. In response to colonization, many traditional practices and roles were embraced by women in colonies as a sign of rebellion. As a result, postcolonial feminists fight gender oppression with their own cultural mores and behaviors. However, these have, at times, been criticized or misunderstood by women in the West as signs of oppression, helplessness, and powerlessness, creating a tension in which the portrayals of non-Western women by women in the West are objected to by postcolonial feminists. Furthermore, Western forms of feminism, particularly liberal and radical feminism, and the universalization of women’s experiences are also highly criticized by postcolonial and Third World feminists. Postcolonial and Third World feminists argue that the historical, social, cultural, economic, and political effects of globalization need to be analyzed and examined within the history and context of Western colonization and imperialism as this continues to shape the world. Postcolonial ­feminists believe that because of the history and context of colonization and imperialism, cultures that have undergone this process are uniquely different from those that have not and the conditions created by colonization, such as economic inequality and exploitation, racism, cultural marginalization, and the domination of the global North over the global South, have been maintained and intensified by neoliberalism. Transnational Feminism

As a result of globalization, injustices against women occur in multiple geographical regions, while technology has connected women globally to create political spaces for feminist resistance. Transnational feminism contends that feminist solidarity across national borders has been created due to the conditions of globalization. It attempts to embrace the theories and ideas of postcolonial, Third World, and ethics of care feminists into its ideology. It also differentiates itself from global and international feminism and from second-wave theories that focused on feminist solidarity primarily through patriarchal oppression. Although transnational feminists believe in feminist solidarity across national boundaries against a global patriarchy that affects all women,

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they are aware of and acknowledge the uniqueness of and differences in women’s experiences and the effects of globalization based on social locations and culture. As such, there is an emphasis on intersectionality, context specificity, and self-reflexivity. Furthermore, there is an understanding that globalization creates benefits for some women and challenges and barriers for other women. Transnational feminism has a political stance for transnational feminist solidarity. It is based on individuals’ political commitments. It does not rely on a group identity or a group’s experiences. This means that challenging injustice and oppression can be done by privileged and advantaged individuals who have not directly experienced the injustice or oppression as well as by those individuals who have experienced the injustice or oppression directly. A major feature of transnational feminism is its specific focus on specific globalizing processes as opposed to a theorized global patriarchy and its use of feminist collectives as models of feminist solidarity. For instance, Ann Ferguson discussed the creation of North-South women’s coalition movements as antiglobalization networks are formed (e.g., worker-owned cooperatives, labor unions, fair trade organizations, and land reform). These are based on the political commitment of individuals to the issue of global gender justice.

Future Directions Although there have been great strides and progress toward women’s equality and equity due to feminism and the feminist movement, there is still more work to be done for a fair and just world to be attained in which women have full equality with men. However, there is a diversity of women in a variety of geographical regions, social locations, and diverse cultures, and their uniqueness and complexity must be acknowledged, validated, and respected. Thus, feminism and feminist movements must embrace all women in their entirety as they continue to evolve and develop, in order to eradicate sexism and sexist oppression as well as other oppressions. Debra M. Kawahara See also First-Wave Feminism; Patriarchy; Second-Wave Feminism; Third-Wave Feminism

Further Readings Crawford, M. (2006). Transformations: Women, gender, and psychology. New York, NY: McGraw-Hill. hooks, b. (2000). Feminism is for everybody: Passionate politics. Cambridge, MA: South End Press. Shaw, S., & Lee, J. (2014). Women’s voices, feminist visions: Classic and contemporary readings (6th ed.). New York, NY: McGraw-Hill. Tong, R. (2014). Feminist thought: A more comprehensive introduction (4th ed.). Philadelphia, PA: Westview Press. Walker, A. (1983). In search of our mothers’ gardens: Womanist prose. New York, NY: Harcourt.

Feminism

and

Men

Although the word feminism implies application only to the feminine, many would argue that feminism has as much to do with men as with women. While the movement of feminism was born out of recognition of a dramatic inequality between the sexes, the movement has changed over time with culture shifts. Recent campaigns in promotion of a revival of feminism have specifically called on the involvement of men, such as the United Nations HeForShe campaign. Still others argue that the role of men in feminism should be limited or even nonexistent. Inequality between the sexes still pervades both the Western world and the globe—as easily seen in the continued wage gap disparity, the limitations on women’s rights inside and outside the home, the staggering incidence of rape and sexual violence against women, and the continued predominance of men in positions of power. As long as such inequality is ubiquitous and global, the argument for feminism will continue, with or without the involvement of men. This entry explores men’s role in the history of the feminist movement, as well as the arguments for and against men’s involvement, and men’s role in feminism on an international level.

Argument for Men to Be Kept Out of Feminism From the beginning of the feminist movement, the idea that men could never be feminists by nature of their being men has existed—this opinion is most

Feminism and Men

commonly associated with what is termed radical feminism. It is thought that by being male and having male experiences, men can never truly ­ understand the plight of women. Without such understanding, men would be unable to represent the movement because they cannot identify with it. Some feel that even if a man himself is not participating in the perpetuation of inequality and patriarchy, the fact that he benefits from it places him on the other side of an invisible fence. To gain entry to the feminist side, he must undergo a twofold process of first recognizing this position of privilege and then rejecting it. This concept was first described by Peggy McIntosh in “White Privilege: Unpacking the Invisible Knapsack,” but it applies broadly to all social justice movements. The idea that one must first reject one’s own privilege to align with the experiences of the oppressed is a key component of being an ally. If a man fails to perform this step, he risks being seen as a participant in the very social constructs feminism is attempting to disassemble. A man cannot simultaneously be both an advocate for feminism and a participant in women’s oppression. Additionally, as is the case for all social movements, monetary support facilitates success. Men’s groups, even when in support of feminism, inevitably limit the funding for female-led and -dominated feminist groups. Although this may seem to be a small element, it is one commonly cited by those who argue against men’s inclusion. In addition to limitations in funding and diversity of experiences, the inclusion of men in feminism further fragments an already divided group. Within women-only feminist groups, there exists division based on race, sexual orientation, and gender identity; tensions have arisen between women of color and White women; between heterosexual women and lesbian, bisexual, and queer women; and between cisgender women and transgender women. The same argument against the inclusion of men is used to justify these ­divisions: Being a Black female feminist is a very different experience from being a White female feminist due to the intersecting experiences of race and gender discrimination of Black women feminists, experiences that cannot be shared by their White female counterparts. As a result, some Black women (and other women of color) have moved to identifying as “womanists,” signifying

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that feminism has traditionally served the needs of White women. As can be imagined from the varied experiences described, the focus of women’s inequality can be lost from feminism when multiple identities are added to its representation. Some feel that involving men in feminism distracts from the focus on women’s inequality. As the focus shifts to research and evidence-based information, a significant limitation of men’s involvement is the lack of evidence that it is to the benefit of the feminist movement.

Argument for Men’s Inclusion in Feminism The idea of men’s involvement in the feminist movement is not new. The National Conference on Men and Masculinities in 1978 touted the statement that the women’s movement was of significant benefit to men. Stereotypes of both sexes abound—the idea of the male as provider, tough, unyielding, and unemotional can be just as harmful as the stereotype of the female as weak, overly emotional, sensitive, and dependent. Ascribing traits that can at times be felt to be requirements to anyone based on their gender assigned at birth can have potentially harmful effects if one does not subscribe to these social norms. The comparison with “corrective therapy” for lesbian, gay, and bisexual individuals is an easy example of how lack of acceptance in favor of forced change of an individual can have potentially life-threatening consequences. From its inception, feminism has promoted breaking down socially constructed norms for women, seen in women’s suffrage (right to vote), women’s inclusion in the workforce, and women’s promotion to positions of leadership. Breaking down socially determined gender norms for women indirectly does the same for men. Arguably, it is necessary for gender norms on each side to be broken for either to live free of such social norms. This concept is easily understood by millennials, those born between the 1980s and early 2000s, who grew up in an era focused on equality and separation from social norms of gender and sex. There is also significant argument for men’s inclusion in feminism in that some of the issues are specific to men. Paternity leave is a growing concern for men who need to provide child care for their families while their partner continues work.

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In addition, as the dynamics of two-parent homes change and more women in male-female partnerships enter breadwinner positions, equal pay for both sexes becomes of particular relevance to men. Women are still paid less than men, approximately 70 cents for each dollar. This creates a challenging position for men desiring to stay home to care for their children. Feminism has seen a rebirth in youth culture with the HeForShe campaign promoted by the United Nations. The principle of the campaign is the recognition of the vital role of men in gender equality, which is also the foundation of the feminist principle. HeForShe is attempting a global campaign to increase the involvement of men in efforts toward gender equality, with almost 500,000 signatures of men on their website pledging their commitment to gender equality. Using well-known young actors across the globe, the HeForShe campaign is specifically targeting young men on college campuses. This is of particular relevance in light of the amount of sexual violence against women occurring on college campuses. Male researchers have studied sexual violence through interviews with male college students; often cited are the stereotypes of maleness and femaleness and the pressures placed on these young men to try to meet such standards.

women’s role as caretakers, lack of access to birth control and safe abortion, as well as religious and cultural views on women’s role in the home and workforce. Femicide, the murder hate crime against women, exists in many parts of the world, including Latin America and the Middle East. Honor killing, a type of femicide in which a woman is murdered following some alleged sexual transgression to preserve the honor of her family or abide by a religious teaching, is still legal in many countries. Honor killings can be performed for a variety of sexual transgressions, including those outside a woman’s control, such as rape. In some countries, women and girls are sold into slavery—with reports indicating that some women are priced lower than cattle. Efforts to preserve the safety of women internationally are in process, but cultural and religious beliefs are commonly the foundation of these acts, making change slow. A strong vision and motivation for equality between the sexes exist internationally, and this calls for the inclusion of men. Specifically in instances of male-perpetrated physical and sexual violence against women, men are being called on to take on the belief systems of feminism to bring an end to violence against women.

Feminism and Men Going Forward International Feminism Feminism is often considered a Western movement, but the principles of feminism can be seen in international women’s rights movements. The Universal Declaration of Human Rights, adopted by the 1948 United Nations General Assembly, provided a global recognition of human rights for both men and women. Since then, multiple milestones have been reached in the inclusion of women in their own promotion by the United Nations during International Women’s Day, International Women’s Year, and United Nations Decade for Women. Women have taken on several leadership positions and adopted positions of power and influence throughout the world as representatives of their countries to the United Nations. But the inequalities of women around the world still abound. Education rates for women globally continue to be significantly less than those for men. This is due to a complex interplay between

Exploring the history of feminism and the current movements, there has been a shift to promote the inclusion of men. While there are strong arguments on both sides, the majority of current theory finds value and even necessity in the inclusion of men. When looking at international efforts toward gender equality, the predominance of men in positions of power necessitates their buy-in. Movements by international organizations such as HeForShe are targeting young men specifically. Although one cannot be sure, it can be predicted that efforts to include men in feminism will continue, both in the Western world and internationally, and arguments against their exclusion may become a part of the history of feminism. Natalie Eileen Hinchcliffe See also Anti-Feminist Backlash; Bullying, Gender-Based; Equal Pay for Equal Work; Equality Feminism; Evolutionary Sex Differences; Feminism: Overview; First-Wave Feminism; Gender Equality; Gender

Feminist Identity Development Model Microinequities; Institutional Sexism; Islam and Gender; Male Privilege; Masculinity Gender Norms; Masculinity Ideology and Norms; Measuring Gender Roles; Misogyny; Patriarchy; Rape; Rape Culture; Second-Wave Feminism; Sexism; Sexual Assault; Third-Wave Feminism

Further Readings Bojin, K. (2013). Feminist solidarity: No boys allowed? Views of pro-feminist men on collaboration and alliance-building with women’s movements. Gender & Development, 21(2), 363–379. doi:10.1080/13552074 .2013.802879 Digby, T. (1998). Men doing feminism. New York, NY: Routledge. Ensler, E. (2015, October 16). Bureau of sex slavery. Retrieved October 10, 2015, from https://www .thenation.com/article/bureau-of-sex-slavery/ Gaag, N. (2014). Feminism and men. London, England: Zed Books. Garcia-Moreno, C., Guedes, A., & Knerr, W. (2012). Understanding and addressing violence against women. Retrieved October 10, 2015, from http://apps .who.int/iris/bitstream/10665/77421/1/WHO_RHR_ 12.38_eng.pdf Stringer, J. (2015, January 23). [Review of the book Feminism and Men, by N. van der Gaag]. Gender & Development. Retrieved October 10, 2015, from http://www.genderanddevelopment.org/page/ feminism-and-men-review UN Women. (2015, September 29). Timeline: The UN at 70: Gender equality milestones and memorable moments. Retrieved October 10, 2015, from http:// www.unwomen.org/en/digital-library/multimedia/​ 2015/9/timeline-un-at-70-gender-equality

Websites HeForShe: http://www.heforshe.org

Feminist Identity Development Model The feminist identity development model is a theoretical model intended to describe the developmental process women go through to take on the social identity of a feminist. Theorists, researchers, and clinicians have used this model, although it has received mixed support. This entry explains the

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model, the various ways in which it has been operationalized in research, and presents critiques of the model and its measurement.

The Model Nancy E. Downing and Kristin L. Roush created the feminist identity development model to describe the stages that women go through as they gain awareness of sexism and gender discrimination and move toward identifying as a feminist. Their stage model was largely based on one by William E. Cross Jr., designed to explain Black identity development, and the specific stages Downing and Roush postulated to be part of women’s feminist identity development were informed by both their personal and their clinical experiences. The model consists of five stages experienced in the following order: (1) passive acceptance, (2) revelation, (3) embeddedness-emanation, (4) synthesis, and (5) active commitment. While these stages are often conceptualized as distinct for the purposes of research, as described in the next section on operationalizations of the model, the transitions between stages were conceptualized to be fluid. In addition, women may revisit any or all of these stages at various points in their lives and may never move through all of the stages. The model was believed to be particularly useful in a therapeutic context as it could provide a developmental framework for use in feminist therapy and could add depth to clinicians’ understanding of the concerns expressed by their clients. Women are believed to start in the stage of passive acceptance. In this stage, they do not notice, or they fail to acknowledge, sexism and discrimination and accept traditional gender stereotypes. As a woman’s awareness of sexism grows, she is believed to be ready to transition into the second stage of revelation. Movement into the revelation stage is typically discussed as being a result of experiences that raise awareness of sexism. These experiences might include the experience of discrimination or participation in consciousness-raising groups or activities. This stage is characterized by anger and feelings of guilt for having been part of a system that oppresses women. Women in this stage may view all men negatively as a result of dualistic thinking.

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The third stage, embeddedness-emanation, consists of two phases. The first, embeddedness, is characterized by women immersing themselves in a female subculture. Women in this stage may seek close relationships with like-minded women and may embrace art and music created by women and focused on women’s experiences. The second phase, emanation, involves a growing openness to other perspectives and interaction with men. It also involves a reduction in the dualistic thinking of “women are good/men are bad,” which characterizes revelation and the embeddedness phase. Synthesis, the fourth stage, involves integrating one’s sense of self as a woman with one’s sense of self as an individual. In this stage, the focus becomes more about personal values and beliefs, and oppression is no longer seen as the sole cause of problems. Internalization of this new aspect of one’s identity is believed to take place in this stage. It has been suggested that this is the stage where women actually begin to label themselves as feminists, although others have suggested that this often happens in the revelation and embeddednessemanation stages as well. The fifth and final stage, active commitment, is related to taking one’s newly internalized identity and participating in activities designed to create social change. It is suggested that few women actually arrive at this final stage and that many who actively work on behalf of women and women’s rights are actually in the stages of revelation or embeddedness-emanation, the stages women are believed to stagnate in most often while developing a feminist identity.

Operationalizations of the Model While the feminist identity development model was initially created as a conceptual tool, researchers adopted the model and developed operationalizations for use in quantitative research. As of 2015, three operationalizations of this model exist: (1) the Feminist Identity Scale (FIS), (2) the Feminist Identity Development Scale (FIDS), and (3) the Feminist Identity Composite (FIC). These operationalizations are attitude measures, with items divided into subscales to represent the different stages of the model based on the attitudes women are believed to hold during that stage.

The FIS assesses the first four stages of the model. Active commitment was not operationalized as it was seen as a behavioral manifestation of the synthesis stage. The scale is used to categorize women into stages. A woman is classified as being in a particular stage if her summary score on the items for that stage is above the median score for the sample while her scores for the other three stages are below those medians. The FIDS assesses all five stages of the model. This measure was not intended to categorize women into a single stage, as was done with the FIS. Rather, women receive scores on the subscales used to assess attitudes associated with all five stages of the model. Given the statistical concerns with both the FIS and the FIDS, a third composite measure, the FIC, consisting of items drawn from the FIS and the FIDS, was developed. This measure assesses all five stages of the model and has been shown to be psychometrically stronger than either of the measures that preceded it.

Critiques of the Model and Its Measurement This model has been frequently critiqued. The bulk of the critiques focus on the developmental nature of the model, the continued relevance of the model, measurement problems associated with operationalizations of the model, and restrictions on the generalizability of the model. As detailed previously, the model was conceptualized as a stage theory, and women were believed to move through these five stages in sequence. The originators of the model, however, specified that the model was not inherently a linear one. Women were likely to revisit stages they had prior experience with and could stagnate in a stage for a period of time or permanently. Few studies have attempted to look at the developmental nature of the model, and those that have report mixed findings. Studies exploring changes in scores associated with each stage during the course of an academic semester have shown decreased passive acceptance and increased revelation and embeddedness-­ emanation among those in women’s studies as compared with non–women’s studies classes. ­Synthesis and active commitment scores, however, showed little or no change. Another study

Feminist Identity Development Model

exploring retrospective reports of prior stage experience found that high scores in a conceptually later stage in the model did not correspond with reports of prior stage experience. More research on the developmental nature of this model is needed. The continued relevance of this model has also been critiqued. The model was developed in the mid-1980s following the peak of second-wave feminism, and Nancy Downing Hansen described the model as reflecting a blending of liberal feminist and radical feminist ideology. While this model may have accurately reflected the experiences of the originators of this model and their contemporaries, it may no longer reflect the path women follow to identifying as feminist. Young women today may be more influenced by thirdwave feminism than the second wave, and ­postfeminist and neoliberal views are also common. A more flexible understanding of gender roles has become prevalent, and sexism is more likely to be experienced in subtle rather than in blatant ways. Given this, fewer women may begin with passive acceptance or experience revelation. In fact, Mindy J. Erchull and Miriam Liss have suggested that synthesis may be a starting point for many young women’s feminist identity development as it reflects a culturally accepted view of empowered femininity. Given this, the five-stage feminist identity development model detailed herein may need to be revised. The stages may be experienced in a different order or not at all, and new stages may need to be added. The way in which the stages of the model are measured has also received significant critique. As noted, a third measure of the model, the FIC, was developed from items drawn from those used in the FIS and the FIDS due to psychometric concerns about each of the original measures. The FIC, however, has also displayed psychometric problems. It has also been critiqued for not capturing the complexity of the perspectives that were conceptualized as part of each stage. Moreover, the scores associated with each stage have not been found to consistently relate to self-identification as a feminist. Theoretically, those in passive acceptance should not identify as feminists, while those in the other four stages should, particularly those in synthesis and active commitment. While research has consistently found that those who score high in passive acceptance do not identify as feminists,

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findings for the other stages are mixed. Synthesis, in particular, has been problematic in this regard. Measurement of the synthesis stage has not just been problematic in terms of the relationship between scores for measures of this stage and feminist identity. It has also been the stage with the most consistent problems in terms of reliability across all three measures. The items used to assess this stage in the FIC have been critiqued as capturing only one aspect of the conceptual underpinnings of this stage. In addition, synthesis scores have been found to be associated with some conservative constructs in addition to feminist-related constructs, creating a paradox that is not consistent with the conceptualization of this stage as the one where feminist identity is internalized. The measurement of the model has also been critiqued because it is unclear how to interpret the scores for each stage. First, the extent to which different scores do or do not reflect actual presence within a given theoretical stage is not clear. In fact, much research has shown that individuals often score high on measures of multiple stages. Second, the operationalizations of the model are all measures of attitudes believed to be representative of views associated with each conceptual stage. There are, however, no clear boundaries between the stages, and attitudes associated with one stage could well be endorsed while in another stage. Given these concerns as well as those detailed earlier, new operationalizations may need to be ­ developed, and caution should be used in drawing conclusions about the model based on data using the current operationalizations. Finally, it is important to note that this model was developed to reflect a specific set of experiences at a specific point in time, and people should be cautious about assuming universality across time, place, or populations. As noted, the model may no longer reflect the developmental path of young women. Moreover, the model was developed in the United States, as were all operationalizations of the model, so the model and the ­operationalizations may not be useful for understanding feminist identity development elsewhere. Even within the United States, the model has been largely studied among young, college-educated, White women. Given this, related but distinct models reflecting different cultural values and the experience of multiple oppressions have been

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proposed for women from different racial and ethnic groups. Most notably, Janet E. Helms proposed a model of womanist identity development. It should also be noted that the feminist identity model has been explored only among women. While this is appropriate given that the model was conceptualized to capture the experience of women, men can and do also identify as feminists. Given this, attention should also be paid to the developmental process men experience as they take on this identity—one that is often even more stigmatized for men than it is for women. Mindy J. Erchull See also Feminism: Overview; Feminist Therapy; Gender Roles: Overview; Second-Wave Feminism; Sexism; Third-Wave Feminism; Womanism

Further Readings Bargad, A., & Hyde, J. S. (1991). Women’s studies: A study of feminist identity development in women. Psychology of Women Quarterly, 15, 181–201. doi:10.1111/j.1471-6402.1991.tb00791.x Downing, N. E., & Roush, K. L. (1985). From passive acceptance to active commitment: A model of feminist identity development for women. The Counseling Psychologist, 13, 695–709. doi:10.1177/00110000 85134013 Erchull, M. J., Liss, M., Wilson, K. A., Bateman, L., Peterson, A., & Sanchez, C. E. (2009). The feminist identity development model: Relevant for young women today? Sex Roles, 60, 832–842. doi:10.1007/ s11199-009-9588-6 Feminist identity development [Seven articles]. (2002). The Counseling Psychologist, 30(1), 6–117. Fischer, A. R., Tokar, D. M., Mergl, M. M., Good, G. E., Hill, M. S., & Blum, S. A. (2000). Assessing women’s feminist identity development: Studies of convergent, discriminant, and structural validity. Psychology of Women Quarterly, 24, 15–29. doi:10.1111/ j.1471-6402.2000.tb01018.x Liss, M., & Erchull, M. J. (2010). Everyone feels empowered: Understanding feminist self-labeling. Psychology of Women Quarterly, 34, 85–96. doi:10.1111/j.1471-6402.2009.01544.x Ossana, S. M., Helms, J. E., & Leonard, M. M. (1992). Do “womanist” identity attitudes influence college women’s self-esteem and perceptions of environmental bias? Journal of Counseling & Development, 70, 402–408. doi:10.1002/j.1556-6676.1992.tb01624.x

Rickard, K. M. (1989). The relationship of self-monitored dating behaviors to level of feminist identity on the Feminist Identity Scale. Sex Roles, 20, 213–226. doi:10.1007/BF00287993

Feminist Psychology This entry is about feminist psychology globally, with a focus on the United States. Feminist psychology has been a key force in the establishment of a psychology of gender. Feminist psychology has many definitions. Therefore, definitions of feminism, psychology, and feminist psychology are discussed first. Next, common and unique themes in the history and status of feminist psychology, across countries, are examined. The entry concludes with a description of the evolution, ­ status, contributions, and impact of U.S. feminist psychology.

What Is Feminist Psychology? Definitions of feminist psychology vary within and across cultures and countries, and over time, depending on the positions and concerns of those who generate the definitions. British writer Rebecca West (1892–1983) was quoted as saying about feminism, “I myself have never been able to find out precisely what feminism is: I only know that people call me a feminist whenever I express sentiments that differentiate me from a doormat.” More recently, U.S. author bell hooks (1952– ), in her 2000 book Feminism Is for Everybody, stated that feminism is the “movement to end sexism, sexist exploitation, and oppression” (p. viii). Feminism has also been associated with different terms in different communities. For example, womanism is a term coined by U.S. writer Alice Walker (1944– ) to articulate a vision of feminism that puts at the center of the discourse the concerns of women of color, for example, racism, poverty, and the right to have children (not only the right to choose not to have children, which in the United States has been viewed as primarily a concern of European-descent women). Womanism has also been defined as an alliance, rather than an opposition, between women and men of color—because of shared

Feminist Psychology

experiences of racism. Another example of the diversity of feminisms is represented by transnational feminism. Transnational feminism was born out of the recognition that country and culture are not isomorphic and that feminism needs to work across various types of borders and boundaries. Transnational feminism is unique in its concern for transnational systems of oppression, including capitalism, imperialism, colonialism, and fundamentalism, as well as in its emphasis on the diversity of issues women face in different societies. The position of psychology as a scientific and academic discipline also varies across country and over time. In many countries (e.g., the United States, Canada, Australia), psychology is well established and thriving. In other countries (e.g., China, India), psychology has a tenuous position among the sciences and in academia. In yet other countries (e.g., Sri Lanka), psychology is not institutionalized. As an example of the variable relation between psychology and feminism, psychology in India has engaged with issues of caste discrimination but not as much with issues of gender discrimination. Common denominators across definitions of feminist psychology transnationally generally include (a) a psychology based on an analysis of systems of oppression; (b) attention to the diversity of people’s locations in societies, depending on dimensions of social classification such as sex, ­gender, age, sexual orientation, social class, caste, ethnicity, religion, national origin, and nationality (and with implications for the specific forms of oppression and privilege individuals experience); and (c) a commitment to equality in individual rights and responsibilities.

Common and Unique Themes Across Countries A common theme in feminist psychology across countries is that much of its theory and research originated in independent feminist scholarship or in disciplines other than psychology (e.g., sociology). Another theme is that institutional psychology has historically been resistant to feminist ideas and practices. A major reason for institutional psychology’s historical resistance to feminist ideas and practices may be psychology’s identity and traditions as the science of the individual. Another

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reason is psychology’s historical tendency to overlook the impact of contextual and structural f­ actors (e.g., poverty and cultural ideologies of gender) on people’s lives and, ultimately, their ­ psychology. Yet another reason is psychology’s dominant methodology tradition, specifically its predilection for laboratory settings, convenience samples (e.g., undergraduate students), and structured, quantitative methods, which is inconsistent with the ­methodological-diversity values of much of feminist psychology. In some countries, feminist psychology has become relatively institutionalized. For example, the Society for the Psychology of Women of the American Psychological Association (APA) has a Feminist Psychology Institute. There are several English language, international (e.g., Feminism and Psychology), and U.S.-based (e.g., Psychology of Women Quarterly, Women and Therapy) feminist psychology journals. Courses in the psychology of women, men, and/or gender are offered in universities around the United States and Canada, with most of the texts used in these classes including, if not informed by, a feminist perspective. By contrast, in other countries (e.g., China, Turkey), there are few or no institutionalized relationships between psychology and feminism. In yet other countries (e.g., Italy), feminist psychology is mostly housed in, and advanced by, social psychology, building on the insights of feminist activists. For example, in Italy, feminist psychology built on the work of journalist Oriana Fallaci (1929–2006), who, in 1975, published Letter to a Child Never Born, a book about an unplanned pregnancy; pedagogy scholar Elena Gianini Belotti (1929– ), author of the 1973 book On the Side of Girls; and Trento University’s Broken Circle’s collective authors of the 1975 book The Conscience of Being Exploited.

The Evolution, Status, Contributions, and Impact of Feminist Psychology in the United States Defining a starting point to a set of ideas and a political movement such as U.S. feminist psychology is difficult. Many factors, close and far, visibly and invisibly, contributed to the establishment of U.S. feminist psychology. Also, what is considered critical to an intellectual and political movement

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ultimately reflects the standpoint, values, and sources of the definer. Many U.S. psychologists advanced feminist psychology frameworks and values prior to U.S. feminist psychology becoming a movement and an institution. For example, Leta Stetter Hollingworth (1886–1939), who completed a doctorate at Columbia University, dedicated her dissertation to challenging the assumption that women are ­psychologically impaired during menstruation. She later contributed empirical evidence disproving pervasive stereotypes about women’s inferior intellectual abilities and founded the Feminist ­ ­Alliance, an organization that fought sex discrimination. Alice Bryan (née Beaver; 1902–1992), another Columbia University doctorate holder, collaborated with Edwin Boring (1886–1968) in a series of articles (published in the 1940s) about the underrepresentation of women in APA leadership. Mary Whiton Calkins (1863–1930), the first female APA president, in 1905, wrote extensively about women’s inequality and spoke at women’s suffrage conventions in support of women’s right to vote. According to some sources, milestones in the past century’s U.S. feminist movement, and U.S. feminist psychology, were the publication of Simone de Beauvoir’s (1908–1986) The Second ­ Sex in English in 1952 and Betty Friedan’s (1921– 2006) The Feminine Mystique in 1963, the founding of the National Organization of Women in 1966, and the establishment by Mexican ­Americans in 1970 of La Raza Unida, one of the first political parties with a feminist agenda. Antisexist and antiracist work by African American women’s groups was critical to the evolution of U.S. feminism and ­feminist psychology, particularly with regard to the development of intersectional perspectives. An influential book was Shulamith F ­ irestone’s (1945– 2012) The Dialectic of Sex: The Case for Feminist Revolution, published in 1970. Firestone, a Canadian, examined men’s oppression of women from the perspective of class oppression theories and argued against using the categories of female and male for allocating rights and responsibilities. Other 1970s publications important to the establishment of U.S. feminist psychology were Kate Millet’s (1934– ) Sexual Politics (1970), Toni Cade’s (1939–1995) The Black Woman: An Anthology (1970), Naomi Weisstein’s (1939–2015)

1971 article “Psychology Constructs the Female” or “The Fantasy Life of the Male Psychologist (with some attention to the fantasies of his friends, the male biologist and the male anthropologist),” Phyllis Chesler’s (1940– ) Women and Madness (1972), Jean Baker Miller’s (1927–2006) Toward a New Psychology of Women (1976), The Counseling Psychologist’s 1973 issue on gender bias in counseling psychology and its 1976 issue on counseling women, and Nancy Chodorow’s (1944– ) The Reproduction of Mothering: Psychoanalysis and the Sociology of Gender (1978). The 1970s’ activist stream of feminist psychology got its start in the consciousness-raising groups that feminist psychologists led to identify and refute sexist practices within psychology and society. These groups became the foundation of feminist therapy. U.S.-organized feminist psychology began during the 1969 APA convention. The conference program featured few female speakers. None of them presented work on women. Therefore, a group of feminists organized sessions on sexist practices in psychology and founded the Association of Women Psychologists (now called the Association for Women in Psychology). The ­ ­following year, the members of the Association for Women in Psychology presented the APA Council of Representatives a series of demands, including the establishment of a standing committee to address ­sexism in the APA. Since its start, the APA Task Force on the Status of Women in Psychology (which became the Committee on Women in ­Psychology) has contributed to significant institutional transformations, including the establishment, in 1973, of APA Division 35, the feminist Society for the Psychology of Women, and, in 1977, of the APA Women’s Program Office.

The Contributions and Impact of Feminist Psychology in Mainstream Psychology “Mainstream” psychology has historically been resistant to feminist ideas, methods, evidence, and practices, with feminist psychologists often working from the margins of the discipline. However, as it matured, mainstream psychology incorporated many of the insights, frameworks, and practices developed by feminist psychologists, though often without recognition of their sources and, therefore,

Feminist Psychology

without credit given to the feminist psychologists who generated them. The contributions of feminist psychology to mainstream psychology span a wide range of fields. An area of much work by early feminist psychologists was the issue of sex stereotypes and attitudes. Early studies exposed explicit negative biases about, and discriminatory attitudes against, women. The findings of these studies led to institutional changes to reduce the biases and discrimination. A negative consequence of these findings was that biases and discrimination against women became more covert and, therefore, more difficult to detect but no less pernicious, leading to the development of implicit measures. Work-family issues have also been an important domain of feminist psychology discourse and research, with feminist psychology’s theory and findings challenging the assumption that stay-­ at-home parenting is easy while being employed is stressful, as well as the assumption that children do best when they are raised in a family with a stay-at-home, unemployed mother, and a fully employed father who spends little time with his children. Other major areas of U.S. feminist psychology scholarly work and activism have been men’s violence against women, sexual harassment, women and relationships, women’s reproductive choices, body image and eating disorders, the sexualization of girls and women, women and depression, sexuality and sexual orientations, and men and masculinities. Given the extent and diversity of feminist psychology scholarship, the rest of this section focuses on the contributions of feminist psychology to questions of sex similarities and differences across psychological domains. This section also briefly touches on the contributions of feminist clinicians to psychotherapy theory, practice, and ethics. Finally, there is mention of the contribution of feminist psychology to the discourse on research methods. Since its inception, feminist psychology has contended with the ubiquitous assumption that women and men are naturally and fundamentally different from each other. A popular version of this theory is that women are from Venus and men from Mars—that is, they are opposite kinds of human beings. In the scientific literature, women have been assumed to be intrinsically different from, and inferior to, men in their cognitive abilities and

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their moral development. Women and men have also been presumed to be naturally and fundamentally different from each other with regard to their emotional and interpersonal needs, as well as their motivations and behavior in the domains of achievement, work, and play, as well as in the domains of sexuality and parenting. Whatever traits or behaviors were assumed or appeared to be more common in men were treated as normal as well as desirable for human beings. By contrast, traits or behaviors assumed or appearing to be unique to women were considered at best “special” and often inferior or faulty. Over the decades, feminist psychologists have contributed theory and evidence to the debate on women’s and men’s psychologies, their similarities and differences, as well as the sources of the differences and similarities. For example, in her 1982 book In a Different Voice, Carol Gilligan (1936– ) challenged dominant views of the natural inferiority of women in moral development. According to dominant theory, women’s having a vagina, and not a penis, made them immune to the threat of castration, which was believed necessary to spur the highest level of moral development, defined as firm adherence to abstract principles of justice. In opposition to Lawrence Kohlberg (1927–1987), her professor at Harvard University, Gilligan argued that ambivalence in moral judgment indicates the highest moral development, as it signals awareness of nuances, perspective taking, empathy, and attention to relationships. More recently, meta-analyses have been used to evaluate similarities and differences in women’s and men’s psychology across domains (including cognition, emotion, attitudes, beliefs, and behavior). These meta-analyses have revealed few and small sex differences and great overlap in women’s and men’s psychologies, including in areas assumed to show stable and large differences, such as in the domains of verbal and math abilities. These metaanalyses also showed that the presence and size of sex differences vary depending on the developmental stage as well as context. For example, sex differences in aggressive or altruistic behaviors ­ were found to be more likely in public than in private contexts. Also, women’s preference for good financial prospects in male partners and men’s preference for good looks in female partners were revealed to

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be more common in societies where women’s status is low and women’s access to education, employment, and capital is restricted. In other words, women seek men as providers when they cannot be providers themselves—not because of an innate biological drive and physical design, as some evolutionary psychologists postulated. The contribution of theories and empirical ­evidence by feminist psychologists on questions of sex differences and similarities has produced a paradigm shift in mainstream psychology. Not only have the research questions of mainstream psychology changed, but the methods considered scientifically appropriate to test these questions also evolved and now include, for example, national gender equity indices, not just self-report measures of mate preferences. In the clinical psychology domain, feminist psychologists have been leaders in pointing to the problems created by the large power differences between clinicians and their so-called patients. Feminist psychologists’ insights about the dangers of the unchecked authority of clinicians, and about the inadequacy of medical models of psychological suffering and intervention, contributed to the development of the theories and practice of feminist psychotherapy. Although feminist psychotherapy never became dominant as a separate school of psychotherapy, it triggered a revolution in the language, practice, and ethics of clinical work across psychotherapy schools. For example, it led to a change in the language used to denote the users of psychological services, from patients to clients. It also contributed to a general expectation of collaborative relationships between persons in psychological distress and their professional providers. Feminist psychologists have also been leaders in articulating the role of sociocultural and economic adversities in poor health and dysfunctional coping, often in contraposition to clinical peers and supervisors who emphasized individual, biological, or intrapsychic etiologies. Feminist psychotherapists’ insistence on attending to context led to expanding the frameworks of clinicians across psychotherapy orientations, with greater emphasis now given to interpreting psychological symptoms as cultural idioms of distress rather than as individual deficits. Finally, feminist psychologists are generally recognized for advancing the discourse on the value

of methodology eclecticism. Specifically, feminist psychologists were pioneers in challenging psychology’s reliance on laboratory experimentation and quantitative methods and in arguing for qualitative methodologies as an adjunct to or in lieu of quantitative methods, depending on the research questions. Feminist psychologists also contributed to articulating the importance of research participants having, via unstructured qualitative methods, opportunities to not only respond to but also challenge and expand psychology’s research questions. With regard to future directions, there has been a call to broaden the domains of U.S. feminist psychology scholarship, practice, and activism to include issues that are relevant, transnationally, to vulnerable girls and women, including older, lowincome, immigrant, ethnic, and sexual minority women, as well as women with disabilities. These domains include, for example, the effects of world trade agreements on women and women’s exploitation in underpaid positions and unsafe working environments. A focus on the violation of girls’ and women’s human rights in their families (via practices such as genital cutting, child marriage, or the barring of girls and women from education and employment), transnationally, is also viewed as demanding the attention and commitment of feminist psychology researchers, practitioners, and activists.

Current and Future Directions With regard to current and future directions, there is a growing recognition that the feminist psychology voices that are dominant in academia, in influential media, and in political activism are ­ those of privileged individuals (e.g., native English speakers of northern European descent living in high-income countries), the perspective of most other feminist psychologists (e.g., individuals from low-income countries, persons whose first language is not English, or ethnic minorities from high-income countries) being underrepresented. There is also growing impatience transnationally with the U.S. dominance of psychology in general, and U.S. feminist psychology specifically. While it is recognized that the perspectives and evidence generated by U.S. feminist psychology have been and are immensely valuable to the

Feminist Therapy

advancement of feminist psychology and gender equity globally, there is also awareness that U.S. perspectives and experiences are culture specific and they should be treated as such. A positive ­outcome of this discontent is an increasing commitment on the part of feminist psychologists transnationally to diversify the leadership of feminist psychology organizations and to include the diversity of experiences in feminist psychology theories and practices so that feminist psychology can truly speak about and address the global female experience. Silvia Sara Canetto See also Anti-Feminist Backlash; Critical Race Feminism; Equality Feminism; Feminism: Overview; Feminism and Men; Feminist Therapy; Neofeminism; Neurofeminism; Psychoanalytic Feminism; SecondWave Feminism; Third-Wave Feminism; Womanism

Further Readings Chrisler, J. C., de las Fuentes, C., Durvasula, R. S., Esnil, E., McHugh, M., Miles-Cohen, S. E., . . . Wisdom, J. P. (2013). The American Psychological Association’s Committee on Women in Psychology: 40 Years of contributions to the transformation of psychology. Psychology of Women Quarterly, 37, 444–454. Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64, 170–180. Eagly, A. H., Eaton, A., Rose, S. M., Riger, S., & McHugh, M. C. (2012). Feminism and psychology: Analysis of a half-century of research on women and gender. American Psychologist, 67, 211–230. Eagly, A. H., & Wood, W. (2013). The nature-nurture debates: 25 years of challenges in understanding the psychology of gender. Perspectives on Psychological Science, 8(3), 340–357. Else-Quest, N. M. (2012). The political is personal: Measurement and application of nation-level indicators of gender equity in psychological research. Psychology of Women Quarterly, 36, 131–144. Hare-Mustin, R. T., & Marecek, J. (1988). The meaning of difference: Gender theory, postmodernism, and psychology. American Psychologist, 43, 455–464. hooks, b. (2000). Feminism is for everybody. Cambridge, MA: South End Press. Hyde, J. S. (2005). Gender similarities hypothesis. American Psychologist, 60, 581–592. McHugh, M. C., Koeske, R. D., & Frieze, I. H. (1986). Issues to consider in conducting nonsexist

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psychological research. American Psychologist, 41, 879–890. Rutherford, A., Capdevila, R., Undurti, V., & Palmary, I. (Eds.). (2011). Handbook of international feminisms: Perspectives on psychology, women, culture, and rights. New York, NY: Springer. Rutherford, A., & Pettit, M. (2015). Feminism and/in/as psychology: The public sciences of sex and gender. History of Psychology, 18, 223–237. Stewart, A. J., & Dottolo, A. L. (2006). Feminist psychology. Signs: Journal of Women in Culture and Society, 31(2), 493–509. Tavris, C. (1991). The mismeasure of woman: Paradoxes and perspectives in the study of gender. In J. D. Goodchilds (Ed.), Psychological perspectives on human diversity in America (pp. 91–136). Washington, DC: American Psychological Association.

Feminist Therapy Feminist therapy is defined as the practice of therapy informed by feminist political philosophies and analysis rather than by theories of psychopathology. It is informed by multicultural feminist scholarship on the psychology of gendered experiences. Its aim is the transformation not only of the clients seeking therapy but also of the therapists, the therapy process, and, ultimately, the larger culture; this goal is accomplished through the use of therapy as a means of raising awareness about problematic narratives of gender and by identifying ways in which those narratives, not psychopathology, are the sources of the problems people bring to treatment. While feminist therapy began in the late 1960s with a focus on the lives of women as psychotherapy clients and psychotherapists, it has grown in the intervening decades. Feminist therapy is now a model that makes gender, all genders, and the experiences of power and powerlessness that inhere in gendered experiences central to its understanding of the emotional difficulties that humans experience. A feminist therapist can be a person of any gender who uses this conceptual framework and who adheres to feminist therapy’s model for how the therapy relationship is structured and how change occurs. Because feminist therapy is the first and still one of the few approaches to therapy

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that make gender a core construct, an understanding of its concepts can enhance the knowledge base for students of the general topic of gender. Feminist therapy inquires into the ways in which social constructions of gender create experiences of disempowerment and distress for people of all ­ ­genders and sexes.

History of Feminist Therapy Feminist therapy began developing in the late 1960s and early 1970s. This was the period during which the second-wave women’s movement came into being in the context of other social movements calling for greater justice in society. Women’s liberation, or feminism, turned its attention to the everyday lives of women and girls and began to uncover the numerous ways in which discrimination based on sex and gender was systemic in all institutions of society. Feminism as a political movement also focused sharply on women’s personal experiences. In consciousness-raising ­ (CR) groups, women met together to explore their shared experiences of living in a sexist society. The phrase “The Personal Is Political” arose in the women’s movement as a means of expressing that the minute details of women’s personal lives were not trivial but were rather evidence of the ways in which sexism and women’s oppression were pervasive. One of the many personal experiences coming under the CR spotlight was psychotherapy. During the time in which feminism was experiencing its reemergence, almost all psychotherapists were classically psychoanalytic; a few followed the lead of humanistic psychologies. All psychology to that point included little to no scientific information about women’s lives and experiences. Research studies usually excluded women from the participant pool, as women’s responses were often not in line with the researcher’s paradigms. Instead, extrapolations were made about women from the behavior of female rats and nonhuman primates in animal labs, and assumptions based on those extrapolations were treated as the truth about women. Psychoanalytic theory about women’s ­psychology painted women as a lesser sex, unable to be rational or logical because they had never e­xperienced the fear of losing a penis.

Psychoanalytic models defined women’s role as passive and receptive and argued that women were inherently masochistic because they endured the pain of childbirth. Humanistic psychologies were not any less sexist, although they did encourage women to develop self-actualization. However, most humanistic theorists, who had originally been psychoanalytically trained and who were almost entirely men, saw that such actualization would come for women from marriage and motherhood. The therapists who were participating in CR and the women’s liberation movement had been in therapies in which their career goals and strivings had been defined as neurotic and pathological; they had attended graduate programs in which they were denigrated for being women and were often the targets of sexual harassment by professors. In CR groups, they came to the realization that these experiences, and psychology’s view of women, were simply additional elements of sexist oppression hiding under the cloak of science and professional knowledge. Some of the psychologists and other mental health professionals participating in these CR groups wrote articles and books about the relationship between sexism and ­psychotherapy, which served as an inspiration and impetus for other therapists to begin to define themselves as feminist therapists. These therapists began holding impromptu meetings during larger conventions of psychological and psychiatric associations. In 1969, a group of feminists in psychology formed the Association for Women in Psychology and held feminist protests during the annual American Psychological Association Convention. Some of the same psychologists also founded what is now known as the Society for the Psychology of Women, Division 35 of the American Psychological Association. Within the American Orthopsychiatric Association, feminist members founded a Women’s Institute. These organizations began to sponsor conferences and workshops at which feminist therapists presented their work and began to train and mentor one another; feminist therapy developed in this manner during most of the 1970s. In 1982, senior feminist therapists involved in these groups founded the Feminist Therapy Institute, which became the leading source of scholarship in the field until it was dissolved in the early part of the 21st century.

Feminist Therapy

Feminist therapy has developed into an integrative, theory-driven approach to treatment that works well with all human beings; it has long ago ceased to be only about women as clients and therapists. There are few specific techniques in feminist therapy—feminist therapists integrate methodologies from almost every other approach to therapy. What differentiates feminist therapy is that in all feminist practice the core constructs of feminist therapy inform how the therapist proceeds in working with clients.

Core Constructs of Feminist Therapy Analysis of Power and Gender

Feminist therapists looked at therapy as it was being done and saw two central obstacles to that treatment being helpful to women. First, there was no attention to the systemic power dynamics present in the therapeutic relationship. The power of the therapist over the client was taken for granted and not questioned. Second, stereotypes and biases about gender, particularly about how women were supposed to think, feel, and behave, were also unquestioned in therapy as usual. Consequently, analysis of the power dynamics and gender issues in therapy, and in the lives of therapists and clients themselves, became central to theory in feminist therapy. Feminist therapy theory defines power and powerlessness as the central sources from which resilience and distress emerge. Power is defined in a broad manner to include the capacity to have an effective impact on oneself, others, and the social and emotional environments in which one lives. Power is not equated with control, although that is one form of power, but with the capacity to know one’s own thoughts and feelings, to be in touch with and value one’s body, and to be adequately skillful in dealing with others. In addition, powerful people are seen as having a meaningmaking system that informs their lives and choices. Powerlessness is, conversely, construed as the absence of some or all of these capacities. Feminist therapy theory posits that experiences of discrimination based on gender and other aspects of identity engender powerlessness, which then leads to difficulties in relationship to oneself and the world.

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Feminist therapists thus invite clients to explore their experiences of being disempowered. They attend to the ways in which people have been silenced, betrayed, or oppressed. They also look at the ways in which clients have attempted to be powerful and to resist, even when those attempts have led to people being labeled crazy or bad. Gender role analysis is a second core feminist therapy methodology. To feminist therapists, gender is a social construct, a way of performing a role that is socially defined. Sex is not seen as equivalent to gender, and gender nonconformity is seen as one way to perform gender rather than evidence of pathology. Feminist therapists invite their clients to consider how they learned to live gendered lives and how gendered experiences have been sources of power and powerlessness. Freeing oneself from rigid, socially prescribed narratives of femininity and masculinity is a goal for feminist therapy. Feminist therapists will support clients in exploring the ways in which they learned how to enact the gendered and other roles in their lives. As part of feminist therapy’s multicultural emphasis, feminist therapists will also invite clients to consider how their other identities, including but not limited to race, ethnicity, culture, social class, and sexual orientation, helped shape their own narratives of gender. Finally, feminist therapists will explore how those gendered rules and roles have been empowering or disempowering for clients. Egalitarian Relationship

A structural methodology for addressing power imbalances in feminist therapy has been the concept of the egalitarian relationship. Psychotherapy is not a relationship of equals. Therapists always have power inherent in their role. The client defines themselves as the person who is suffering and struggling, and the therapist is defined as the expert who will assist the client in meeting goals. Feminist therapists do not deny that there is a power imbalance. However, they conceptualize the relationship in a somewhat different manner. Feminist therapy is seen as a collaborative relationship between two experts. The therapist is the expert in creating the conditions in which change can occur and in devising strategies that are likely to facilitate the desired changes for people. Clients are also experts; they are the experts in what they think,

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feel, and know and experts in their values and goals. It is frequently the case that people start therapy completely out of touch with these forms of personal expertise. In an egalitarian framework, feminist therapists do not substitute their own judgment for that of their clients. Instead, they utilize their expertise to awaken and activate the dormant expertise of their clients. Therapy goals are set collaboratively, and feminist therapists educate clients about the techniques they are using so that clients can make choices. Empowerment of Clients

Both the structure of the egalitarian relationship and the analyses of power and gender are the foundations for the central task of feminist therapy, which is to empower the client. Empowerment can and does take many forms; the goal is that clients become able to know and act from their own beliefs, feelings, and values and develop skills for navigating the world in the most effective fashion possible. A first step for feminist therapists to empower their clients is thinking about people’s emotional distress and behavior problems not as evidence of psychopathology but as evidence of attempts to resist being silenced and to solve the problems and difficulties of life. So, for example, a person who presents to therapy with the problem of cutting on themselves when they are overwhelmed with emotions is met with questions about what the ­ function of the self-inflicted violence might be. The client gets the message that the therapist sees this behavior as an attempt to solve some kind of life problem rather than as a symptom of severe psychopathology. This framework empowers clients to understand themselves as people with competence and capacities whose problem-solving ­strategies need editing and revision, rather than as people with symptoms of psychopathology. ­Feminist therapy sees the oppressive hierarchies in society as the actual location of pathology. Another empowerment strategy in feminist therapy is the use of the question “What is the one small thing you, the client, can do that will change your life, no matter how slightly?” This question is the quintessence of feminist empowerment strategies. The therapist conveys to the client that there is power available to the client and that the client

can become aware of being an actor in their own life rather than only the target of other people’s actions. Feminist therapists continuously explore with their clients ways in which clients might become more powerful. In addition, feminist therapists empower clients in the session. They actively solicit feedback and collaboration from their clients and support and encourage clients’ setting therapy goals and choosing the treatment strategies. A feminist therapist will not say, “Here’s how we’re going to treat your problem.” Rather, feminist therapists will offer the choices to clients and, whenever possible, honor clients’ decisions about what directions to take.

What Feminist Therapy Practice Looks Like Feminist therapy always begins with a thorough process of informed consent. The process of empowering clients begins at the consent form, where clients are educated as to their rights in therapy, including their rights to see and correct notes, challenge the therapist, end therapy when they want to, and make a complaint against the therapist to the licensing authorities if desired. The feminist therapy consent form also outlines the corresponding responsibilities and rights of the therapist. The feminist therapist educates the client in the consent form about what feminist therapy is and about what other methods of treatment are likely to be integrated into the feminist framework. Empowerment begins by stripping away the mystery and demonstrating what the rules and framework of therapy are from the outset. The actual work of a feminist therapy session will vary greatly from client to client, however. This is because feminist therapy practice is informed by research on common factors in psychotherapy, which says that people are at different stages in the change process. Thus, feminist therapists will tailor the treatment to client’s stage of change and offer empowerment strategies that are congruent with the client’s stage. This norm communicates respect for the client, as well as removing the notion that the client is being “resistant” when the change interventions that a therapist offers are not a good fit for the client. Feminist therapy believes that people are best empowered by being met where they are in their change process.

Femme

What will also differ from client to client, and session to session, in feminist therapy is the degree to which there is an overt discussion of gender and power dynamics. Most feminist therapists will attempt to integrate these into their explorations with clients of the dynamics in the clients’ own lives. So, for example, a male client who is struggling with feeling shame when he is transparently vulnerable with people will be invited to develop mindful compassion strategies for addressing his shame; he will also be invited to consider how narratives of masculinity in his cultures of origin might have been the source of that shame and to explore how to change his relationship to those narratives. Or a feminist therapist might respond to a client’s description of the client’s experiences by noting how the client was disempowered by what happened. Analysis of gender and power are integrated into the fabric of what happens in each session. What is also likely to occur in a feminist therapy session is some use of therapist self-disclosure. The Ethics Code of the Feminist Therapy Institute, which codified feminist ethical norms, empowers feminist therapists to do this in the service of the client and the therapy. The concept of a ­“consciousness-raising group of two,” which was developed early in the history of feminist therapy, means that therapists can serve the function of normalizing people’s experiences by making informed choices to share their own, as appropriate, with their clients. Otherwise, each session of feminist therapy will be unique and specific to the client in the room and the problems that are in the foreground. Feminist therapists, consequently, are often familiar with many different treatment interventions so as to meet clients where they are in terms of stage of change and specific needs.

Feminist Therapy Clients and Settings Although it began as a therapy by and for women, feminist therapy is now utilized with people of all genders, ages, and situations. Feminist psychological science has expanded the purview of what feminist therapists address; thus, there is no longer a “women’s issues in psychotherapy” framework but rather one of looking more broadly at gender, power, and other aspects of people’s multiple and intersecting identities.

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Feminist therapists work in the range of settings where psychotherapists can be found: prisons, hospitals, the military, schools, university counseling centers, and independent practice. Feminist therapy is practiced with children and families, with couples of all gender configurations, and with groups. Feminist therapists who are trained in psychological assessment also apply these principles to their work in the interpretation of test findings. Laura S. Brown See also Feminism: Overview; Feminist Psychology; Gender Dynamics in Psychotherapy; Mental Health and Gender: Overview; Psychological Measurements, Gender Bias in; Women’s Health

Further Readings Ballou, M., & Brown, L. S. (Eds.). (2002). Rethinking mental health and disorder: Feminist perspectives. New York, NY: Guilford Press. Ballou, M., Hill, M., & West, C. (Eds.). (2008). Feminist therapy theory and practice. New York, NY: Springer. Brown, L. S. (1994). Subversive dialogues: Theory in feminist therapy. New York, NY: Basic Books. Brown, L. S. (2009). Feminist therapy. Washington, DC: American Psychological Association. Enns, C. Z. (2004). Feminist theories and feminist psychotherapies: Origins, themes and variations. Binghamton, NY: Haworth Press. Kaschak, E. (1992). Engendered lives. New York, NY: Basic Books. Worell, J., & Remer, P. (2003). Feminist perspectives in therapy: Empowering diverse women. New York, NY: Wiley.

Femme Femme refers to a sexual and gender identity typically associated with gender expression and ­ presentation congruent with culturally defined feminine norms. A femme is typically one who identifies with or is presenting oneself in a feminine manner through dress, makeup, and mannerisms and generally taking on all or some aspects of culturally defined expressions of femininity. “Femme” can be used across gender identities, including cisgender and transgender men and

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women. Femme came into usage in Western countries around the 1940s, as a part of butch-femme culture in lesbian communities. The term has expanded in its current usage to encompass any feminine identified person within queer communities. “Femme” in lesbian contexts is associated with an identity, such as “I am a femme lesbian,” whereas in other contexts it may be used in a more descriptive manner, such as “He is very femme.” In transfeminine communities, femme (sometimes spelled fem) has meant “to be present in the female role,” or to refer to one’s feminine or female self. Gay men also use the term femme, increasingly as an identity term, but historically, this has been less common parlance than in the lesbian community. Historically, the term femme has been more often used within gay male communities as a description of a person’s gender expression as feminine.

Butch-Femme Historical Context Historically, femme was a term associated with lesbian working-class communities from the 1940s until the mid-1960s. There was a strong butchfemme culture in lesbian communities, with ­subculturally communicated modes of dress and presentation, gendered relationship styles, and expectations around sexuality and gender presentation. Femmes were seen as the more feminine counterpart within a butch-femme couple and could be identified by their more feminine presentation and style. Butch-femme identities became problematized with the rise of the feminist movement, as the butch-femme dynamic was seen as re-creating patriarchal heteronormative malefemale roles. Subsequently, femme identities became stigmatized, and lesbian women who expressed feminine gender identities were seen as complying with patriarchal norms, and androgynous gender expressions became more valued within lesbian subcultures. The critique within lesbian communities of butch-femme roles mimicking heterosexual relationships did not acknowledge the fact that given the context of homophobia and the pressure on women to conform to heteronormative gender norms, many butch (masculine presenting) women could not find employment and experienced harassment for their gender expression. Thus, many femmes would be the breadwinners in the

relationship and would navigate social situations for butches. Femmes often experienced a different type of stigma for their seemingly feminine normative presentation, experiencing invisibility within lesbian spaces and then also being seen as “perverts” for their “deviant” sexual attraction to masculine women. Femmes of the time described dual points of discrimination in that they were being seen negatively within the lesbian community as re-creating normative heterosexual femininity while also experiencing stigma and rejection from heterosexual peers and family. Beginning in the 1990s, feminine lesbian presentations became more visible in popular culture with the propagation of the idea of “lipstick lesbians.” This term was unknown outside lesbian cultural definitions of femme presentations but made legible the idea of feminine lesbian sexuality. Femme as an identity term experienced a rebirth in the late 1990s to early 2000s as many lesbian women reclaimed the term and worked to expand the visibility of femmes across gender identities, raising awareness of gay men and transfeminine people who identify as femme and expanding the term outside lesbian communities. Current femme dialogue has pushed to raise the critique that stigmatization of femme identities within queer spaces often mirrors the larger sexism and misogyny in the dominant culture, pathologizing femininity and placing limiting stereotypes on femme-presenting people.

Femme Identity Outside the Lesbian Community Femme has long been a term used within transfeminine and gay men of color communities. Within the drag ball scene, where gay men and transfeminine people of color would perform different gender presentations, femme genders were represented, with the femme queen being among them. To perform a femme presentation in this context included presenting an exaggerated stereotypical high femininity, associated with high-­ fashion models or celebrities, although this was not the only type of femme presentation represented. Femme gay men and transfeminine people who were assigned male at birth are often targeted for stigma and discrimination because of their presentation of femininity. This can be evidenced within

Fetal Programming of Gender

transfeminine and gay male communities through an overemphasis on masculine ideals, insults aimed at feminine presenting or femme identified gay men, and the emphasis within transfeminine communities on presenting as female to “pass” being seen as birth-assigned women. Male-assigned-atbirth ­people who are perceived as male and exhibiting feminine traits, who may identify as femme, can be targets of violence through expressions of femininity in a patriarchal culture that devalues femininity and places a high value on masculinity.

Current Definitions and Context Femme carries different meanings within different queer communities and is shaped by race, class, and location. A commonality within identifications of femmeness is a resistance and critique of heteronormative stereotypes of femininity of the dominant Western culture. Femme identity within a queer context is not a simple re-creation of normative femininity. Queer sexualities subvert the normative expectations of femininity through the desire, practice, and political critique of placements of femininity as passive or in relationship to maleness or masculinity. Femme identity is a sexual and gender identity that stands on its own as a conscious claim on feminine presentation and experience. Many femme writers have described a process of “reclaiming” femininity for themselves and defining it as internally separate from stereotypes of what it means to be feminine in the dominant Western culture. Katherine G. Spencer See also Doing Gender; Femininity; Gender Identity; Gender Socialization in Women; Gender Stereotypes; Homosexuality; Lesbians; Lesbians and Gender Roles; LGBTQ Community, Gender Dynamics in; Queer; Sexual Identity; Sexual Orientation Identity; Transmisogyny

Further Readings Hollibaugh, A. L. (2000). My dangerous desires: A queer girl dreaming her way home. Durham, NC: Duke University Press. Levitt, H. M., Gerrish, E. A., & Hiestand, K. R. (2003). The misunderstood gender: A model of modern femme identity. Sex Roles, 48(3–4), 99–113.

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Livingston, J. (Producer/Director). (1990). Paris is burning [Motion picture]. United States: Insight Media. Rose, C. T. B., & Camilleri, A. (Eds.). (2002). Brazen femme: Queering femininity. Vancouver, British Columbia, Canada: Arsenal Pulp Press. Rothblum, E. D. (2010). The complexity of butch and femme among sexual minority women in the 21st century. Psychology of Sexualities Review, 1(1), 29–42. Serano, J. (2007). Whipping girl: A transsexual woman on sexism and the scapegoating of femininity. Berkeley, CA: Seal Press.

Fetal Programming

of

Gender

Human gender development begins before birth. Sex chromosomes and sex hormones are the two major sources of prenatal influence on lifelong neurobehavioral gender phenotypes. Differential expression of genes during the embryonic stage of life begins the processes by which sex differences develop. Variation in exposure to prenatal hormones, particularly testosterone, is an important contributor to behavioral and cognitive differences between the sexes, as well as an important explanatory factor for why certain individuals are more sex typical than others. In addition, males and females adjust their neurobehavioral developmental trajectories differentially in response to the same signals.

Biology of Sex In all mammals, including humans, the first stage of gender development is conception, which in nonpathological conditions results in a genome that includes two X chromosomes (genetic female) or one X and one Y chromosome (genetic male). During the early embryonic phase of life, the genital ridges have the potential to develop into either ovaries or testes depending on certain genes that are differentially expressed in XX and XY embryos. Testes development is initiated by expression of the sex-determining region Y (SRY) gene. Subsequently, many other genes and their transcription factors, as well as hormones and their receptors, are involved in the complex developmental process of sex differentiation. Across the life course, males and females differ in physiological (the concept of

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Fetal Programming of Gender

sexual dimorphism) and neurobehavioral phenotypes. These range from conspicuous differences such as gonadal organs to subtle differences such as the likelihood of preferring certain activities. The placenta, the organ at the interface between the mother and the fetus, plays a central role in synthesizing hormones and regulating developmental processes. It is therefore worth noting that not only are fetuses sexually dimorphic but the placenta itself contains primarily fetal (XX or XY) tissue and functions differently based on the sex of the fetus.

Fetal Programming While some of our traits are determined directly by DNA sequence, many of our traits, especially those involved in cognition and behavior, exhibit a wide degree of flexibility (the concept of phenotypic plasticity). Evidence suggests that the genes related to neurobehavioral traits often allow for a wide range of possible outcomes (the concept of reaction norms). Environmental conditions determine which particular phenotype will be expressed among the wide array of potential phenotypes (the concept of developmental programming). In this context, the intrauterine phase of life represents a particularly important period because during this time, phenotypic plasticity is the greatest in the life span and critical developmental p ­ rocesses occur with lifelong, often irreversible consequences (e.g., cellular proliferation, tissue differentiation, and organ development). In the process of prenatal development, an embryo or fetus detects and responds to biochemical cues in the intrauterine environment, altering developmental trajectories that shape the phenotype. Many traits involved in neurobehavioral sex differences and sex-typical cognition and behavior exhibit high degrees of phenotypic plasticity, with hormonal cues exerting programming effects during prenatal development.

Programming of Sex Differences In 1959, in a landmark study of guinea pigs, it was recognized that prenatal androgen exposure can produce masculinized behavior in females. Charles Phoenix’s prescient prediction that prenatal testosterone (the primary androgenic hormone) exerts

organizational effects on the neural systems involved in sex-typical behavior has been supported by thousands of subsequent studies in a variety of mammalian species. Female fetuses are only exposed to extremely low levels of testosterone that derive from the fetal and maternal adrenal glands and the maternal ovaries and fat tissue, whereas male fetuses are additionally exposed to much higher levels of testosterone that derive from the fetal testes. Animal models involving the manipulation of prenatal hormones confirm that exposing female fetuses to exogenous testosterone causes masculinization of behavior, and in the absence of exogenous testosterone, female-typical behavior develops. This observation of behavioral phenotype is consistent with the endocrinology of gonadal phenotypic determination: Female phenotype can be regarded as a “default” developmental pathway that ensues unless there is significant androgenic exposure. An important body of research has investigated whether humans exhibit androgenic prenatal programming of neurobehavioral sex differences, as observed in other mammals. Measuring the effects of prenatal testosterone is a difficult challenge in human studies, as the experimental manipulations typical of animal research are obviously unethical for human research. In this entry, reference is made to research involving direct measures of amniotic testosterone levels, prenatal exposure to therapeutic exogenous hormones, and studies of individuals with endocrine disorders. Behavior and Cognition

An important category of sex differences concerns behavior and activity interests and preferences across the life span, such as children’s toy preferences and adults’ career preferences, which generally exhibit strong associations with measures of prenatal testosterone. This field of inquiry is led by research performed by Simon BaronCohen and Melissa Hines, who have demonstrated that amniotic testosterone is negatively correlated with empathy and positively correlated with restricted interests (one or more overriding specific interests) in boys during childhood, but no effects were found in age-matched girls in these studies. Some studies demonstrate a positive association between amniotic testosterone and male-typical

Fetal Programming of Gender

play for children of both sexes, although others have found no such effect. Females exposed to unusually high concentrations of prenatal testosterone due to the genetic disorder classic ­ ­congenital adrenal hyperplasia (CAH) exhibit masculinization of behavior even in light of the observation that parents encourage sex-typical play more for their CAH daughters than their unaffected daughters. During childhood, compared with unaffected girls, CAH girls more often choose male-typical play styles and male playmates and play more with male-typical toys and less with female-typical toys, with the degree of masculine preferences corresponding to the degree of prenatal androgen exposure. CAH girls report greater preference for male-typical and less preference for female-typical activities during adolescence compared with unaffected peers, and CAH adult women exhibit greater preference and prevalence in male-typical careers than unaffected women. Sex differences are apparent in various cognitive traits and abilities, such as male advantages in mathematics and spatial ability (e.g., mental rotation, navigation) and female advantages in spatial location and verbal skills (e.g., verbal learning, memory, fluency, perceptual speed, vocabulary, reading, writing, speech). Work led by Jo-Anne Finegan and Sheri Berenbaum has been particularly influential in demonstrating that these differences appear to be in part attributable to prenatal testosterone exposure. One study of 7-year-old girls performing mental rotation found that those who had higher (compared with lower) amniotic testosterone performed better, but this pattern was not consistent across other measures of spatial ability. Across the life span, females with CAH appear to have superior spatial ability compared with unaffected peers, with enhanced spatial ability corresponding to the degree of prenatal androgen exposure. Evidence has been inconsistent in demonstrating associations with prenatal testosterone for mathematical ability, and evidence is weak or unsupportive for other cognitive sex differences. Females with CAH exhibit less empathy and more physical aggression than unaffected peers, but no differences in dominance have been detected. A now unfavored therapy for miscarriage prevention involves administration of progestins during pregnancy, which are in some cases androgenic. Children exposed prenatally to androgenic progestins

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exhibit greater physical aggression than untreated peers. Sexual Orientation and Gender Identity

The categories of greatest neurobehavioral sex differences are sexual orientation and gender identity, with the overwhelming majority of female sex individuals exhibiting female gender identity and sexual attraction to males, and vice versa. Evidence generally supports a negligible contribution of prenatal hormone exposures to sexual orientation and gender identity, with the caveat that scientific inquiry into these topics is severely limited because cultural stigmas are a barrier to scientific interest, funding, and self-report. Another barrier to investigating this topic is that CAH studies are of only limited use because the sexual behaviors of women with CAH may be affected by genital abnormality, potentially masking the effects of prenatal endocrine programming. Nonetheless, work by Hines as well as Heino Meyer-Bahlburg demonstrates that compared with unaffected peers, women with CAH appear to be less sexually attracted to men, with the degree of sexual attraction to men ­negatively correlated with the degree of prenatal androgen exposure. There is less evidence for a positive association of prenatal androgen with sexual attraction to women, partly explained by the association of CAH with generally reduced sexual interest. Another source of information is studies of XY individuals with complete androgen insensitivity syndrome. These individuals lack any (including prenatal) responsiveness to androgens, have male internal and female external reproductive structures, and typically identify as female. Females with complete androgen insensitivity syndrome exhibit sexual orientation that is no ­ ­different from the general female population, suggesting that androgen exposure (rather than the Y chromosome) is necessary to promote maletypical sexual orientation; but it remains unclear whether prenatal or postnatal exposure is responsible for this effect. Because psychosocial stress affects adrenal hormone production (including that of testosterone), the effect of maternal stress during pregnancy on the offspring’s sexual orientation has been investigated. Results have been inconclusive, with some suggesting that maternal stress during pregnancy is

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Fetal Programming of Gender

associated with increased rates of homosexuality in male and female offspring and others finding no such effects. A small number of studies have investigated prenatal estrogen exposure and sexual ­orientation in populations who were exposed during fetal development to another, now discredited therapy for miscarriage prevention, the synthetic estrogen diethylstilbestrol. Most studies converge to suggest that individuals exposed to diethylstilbestrol do not exhibit different sexual orientation from unexposed peers. As for gender identity, evidence has been inconsistent on the programming effects of prenatal hormones. Approximately 3% of women with CAH prefer a male identity instead of female, a rate far greater than that of the general female population. However, women with CAH are no more likely to exhibit gender dysphoria based on the degree of exposure to prenatal androgens, suggesting that perhaps the enhanced rate of gender dysphoria among women with CAH is due to an aspect of CAH other than prenatal hormone exposure. Psychopathology

Many psychiatric conditions are more prevalent in one sex than in the other. For example, autism spectrum disorders (ASD), obsessive-compulsive disorder, and Tourette syndrome are more common in males than in females, whereas eating disorders, schizophrenia, and most affective disorders are more common in females than in males. There is a vigorous debate among researchers on whether prenatal testosterone exposure could contribute to risk for ASD, obsessive-compulsive disorder, and Tourette syndrome, based on evidence that ­individuals who go on to develop these conditions often exhibit more male-typical behaviors as children (a trait positively associated with prenatal testosterone). Although prenatal testosterone exposure is associated with the normal range of variability for certain traits associated with these disorders, no direct evidence has linked these exposures with the disorders themselves. For example, prenatal testosterone has been associated with attention to detail and inversely associated with social skills, extreme deficits of which are symptoms of ASD, but the association of prenatal

t­ estosterone with ASD has been inconsistent (as of 2016, a Baron-Cohen 2015 study provides the only evidence in support of this possibility). Despite sex differences in prevalence, empirical studies have not supported evidence of prenatal sex hormone programming effects for eating disorder, schizophrenia, or bipolar disorder, and evidence has been inconsistent for depression and attentiondeficit/hyperactivity disorder.

Sex Differences in Programming Effects Male and female fetuses differ in the ways in which they respond to intrauterine conditions, with implications for gender development. Research led by Curt Sandman, Laura Glynn, and Elysia Davis demonstrates sex-based differences in both developmental responsiveness and developmental responses to maternal stress physiology. Their prospective, longitudinal studies of mother-child pairs followed beginning in early pregnancy lend insight into how the intrauterine endocrine environment over the course of gestation affects neurobehavioral development ­ across the first decade of life. Sandman, Glynn, and Davis have observed sex differences in how fetal exposure to stress hormones affects neurobehavioral development. During gestation, concentrations of the stress hormone cortisol in maternal circulation are significantly correlated with fetal cortisol exposure because the placenta has only a limited ability to regulate how much cortisol passes into the fetal compartment. Cortisol plays a critical role in normal fetal development, and variations in cortisol exposure represent an important mechanism of fetal programming. Male Fetuses Respond to Prenatal Stress With Developmental Delay

Exposure to high levels of cortisol during early fetal development appears to affect males by ­altering developmental trajectories in ways that result in delayed maturation compared with females. Elevated maternal cortisol during early gestation was associated with delayed physical and neuromuscular development in male newborns and with impaired mental development in

Fetal Programming of Gender

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male 12-month-old infants; no such effects were found for females.

the corpus callosum. No equivalent effects have been found in female children.

Female Fetuses Respond to Prenatal Stress With Development of Anxiety- and Fear-Prone Behavioral Phenotypes

Conclusion

While females appear to be more robust in avoiding male-typical developmental delays in response to prenatal stress, females exhibit higher rates of anxiety-related neurobehavioral phenotypes in response to prenatal stress. These differences can be detected as early as the fetal period, during which higher cortisol concentrations during late gestation are associated with greater responsiveness to challenge among female compared with male fetuses at 31 weeks’ gestation. Elevated gestational concentrations of cortisol and the placental stress hormone corticotropin-­ releasing hormone were associated with a more fearful temperament and distress behavior in female, but not male, infants. Among 6- to 9-yearold girls, but not boys, those who had been exposed to maternal pregnancy-specific anxiety during gestation exhibited poorer executive function and reduced gray matter volume in the brain regions associated with executive function, behavioral/emotional regulation, and inhibition (precursors of affective disorders). Elevated maternal cortisol in early gestation was associated with enlargement of the right amygdala and affective problems in preadolescent girls but not boys. These studies converge to ­ suggest that females respond to signals of stress during the intrauterine phase of life by promoting neurobehavioral development of anxiety- and fear-related behaviors that are evident across infancy and childhood, with implications for psychopathology in adults. Sex-Dependent Responses to Prenatal Testosterone Exposure

Male and female fetuses differ in neurobehavioral developmental responses to prenatal testosterone exposure. Among male children, amniotic testosterone has been positively associated with fear reactivity and brain lateralization for language function and negatively associated with empathy, variation of interests, and brain connectivity via

Many of the neurobehavioral differences that characterize gender norms in adulthood appear to have their roots in the prenatal phase of life. Also, male and female fetuses differ in their sensitivity and responses to specific intrauterine signals. It is important to note that in addition to prenatal influences, gender development is also influenced by hormone exposures and gene expression during other sensitive periods of development, particularly the neonatal and pubertal phases. Furthermore, prenatal influences on gender development interact with postnatal factors, including postnatal development, socialization, learning, and culture, to determine neurobehavioral gender phenotypes. Molly Fox and Laura M. Glynn See also Biological Sex and Cognitive Development; Biological Sex and Mental Health Outcomes; Biological Sex and the Brain; Developmental and Biological Processes: Overview; Pregnancy; Testosterone

Further Readings Bale, T. L., Baram, T. Z., Brown, A. S., Goldstein, J. M., Insel, T. R., McCarthy, M. M., . . . Nestler, E. J. (2010). Early life programming and neurodevelopmental disorders. Biological Psychiatry, 68(4), 314–319. doi:10.1016/j.biopsych.2010.05.028 Berenbaum, S. A., & Beltz, A. M. (2011). Sexual differentiation of human behavior: Effects of prenatal and pubertal organizational hormones. Frontiers in Neuroendocrinology, 32(2), 183–200. doi:10.1016/ j.yfrne.2011.03.001 Hines, M. (2011). Gender development and the human brain. Annual Review of Neuroscience, 34, 69–88. Mathews, G. A., Fane, B. A., Conway, G. S., Brook, C. G., & Hines, M. (2009). Personality and congenital adrenal hyperplasia: Possible effects of prenatal androgen exposure. Hormones and Behavior, 55(2), 285–291. doi:10.1016/j.yhbeh.2008.11.007 Sandman, C. A., Glynn, L. M., & Davis, E. P. (2013). Is there a viability-vulnerability tradeoff? Sex differences in fetal programming. Journal of Psychosomatic Research, 75(4), 327–335. doi:10.1016/j.jpsychores .2013.07.009

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Fetal Sex Selection

Fetal Sex Selection Sex selection occurs throughout history and takes many forms, and is most often rooted in cultural traditions that favor sons over daughters. Parental motivations for wanting to control the biological sex of their future child are complex and include patriarchal cultural systems that devalue girls, inheritance traditions that enable sons to keep property in the family but deny inheritance to daughters, the economic cost of daughters in cultures where dowry is paid on marriage, and other cultural and religious traditions. The most drastic form of sex selection is female infanticide, which can be either direct killing or abandoning of female infants or indirect killing through neglect, such as withholding of food when resources are scarce. There are numerous nontechnological methods used to increase the chances to conceive either a female or a male child. These include timing intercourse at a particular point in a woman’s cycle and dietary changes; however, such approaches are not necessarily effective. Advances in technologies enable a new form of parental control over the biological sex of their future child. However, cross-cultural tendencies toward son preference, combined with sex selection technologies, raise both ethical and social challenges and can have unforeseen consequences when sex ratios become unbalanced. In some cases, sex selection technologies are used for medical reasons—to reduce the possibility of passing down X- or Y-linked genetic diseases to one’s offspring. In other cases, such technologies are utilized to ensure the birth of a child of the desired sex due to social reasons.

Sex Selection Technologies There are different types of sex selection technologies, including both preimplantation and postimplantation methods. Postimplantation methods to determine fetal sex and sex selection include the following: (a) maternal blood tests, (b) amniocentesis or chorionic villus sampling followed by sexselective abortion, and (c) ultrasound followed by sex-selective abortion. There are also a variety of preimplantation methods for sex selection. Sperm sorting to

produce higher concentrations of X or Y sperm is only about 78% effective. Prenatal genetic testing or diagnosis (also known as PGT or PGD, respectively) and implantation of only embryos of the desired sex through in vitro fertilization is 99% effective. PGD is also quite expensive. In the United States, PGD costs approximately $20,000 per in vitro fertilization cycle. In the United States, PGD for sex selection is a booming business and is commonly referred to as family balancing. While this may be a more neutral and culturally acceptable term than gender ­selection, the practice is still not without ethical dilemmas. In the United States, especially among White Western women, sex selection technologies are most commonly used to ensure a daughter rather than a son. Many immigrant communities in the United States, particularly those from Asian and South Asian communities, utilize PGD to ensure boys.

Sex Selection in the Global Context Sex-selective abortions are either prohibited outright or banned for nonmedical reasons in 36 countries, 25 of which are in Europe. Although the practice is legal in the United States, in some other parts of the Western world, such as Canada, the United Kingdom, and Australia, it is not. In China, sex selection practices are prohibited. However, it still occurs widely and varies by region, leading to an imbalance in male-to-female ratios, in favor of male children. In India, the 1994 Pre-Conception and Prenatal Diagnosis Act, which banned sex selection, was passed in Parliament. However, the ban is not widely enforced. A 2011 census in India indicated that some states, such as Kashmir, have an extremely skewed male-to-female sex ratio of 125 boys to 100 girls. The southern state of Kerala, however, has a relatively balanced ratio of 103:100. These data indicate that there are higher rates of sex selection in some states than in others, whether by infanticide, by sex-selective abortion, or through prenatal diagnostic techniques. This has led some investigators to address the rising problem of “millions of missing girls” as “genocidal in nature.” Some investigators have attributed the rise of this problem not only to patriarchal systems but also to the overzealous Western family planning

Fetishism and Gender

programs instituted by UN population planners. Gender imbalance in many Asian countries reduces the number of women available for marriage. The long-term consequences are not yet known, but these may lead to possible changes in cultural ­practices such as shifts from dowry to bride price marriages or cause men to seek out women from distant locations, further separating women from their natal families.

Sex Selection and Ethical Concerns There are no universal ethical standards among countries surrounding the use of fetal sex selection through available technologies. Even when used for medical reasons, such as to reduce risk for X- or Y-linked genetic diseases or disabilities, disability rights activists have raised concerns about the implications of this practice for people with disabilities. Non-medical use of sex-selective technologies to meet parents’ procreative desires not only reflects the cross-cultural devaluation of females in various patriarchal cultural systems but can also further lead to broader challenges associated with gender imbalance. Simultaneously, some providers of sex selection services argue that these technologies correspond to women’s reproductive autonomy and rights, despite the fact that some women’s choices may be constrained by family and community pressure. Diane Tober See also Biological Sex and Cognitive Development; Biological Sex and the Brain; Evolutionary Sex Differences; Misogyny; Neurosexism; Sexism

Further Readings George, S. M. (2006). Millions of missing girls: From fetal sexing to high technology sex selection in India. Prenatal Diagnosis, 26(7), 604–609. Hvistendahl, M. (2011). Unnatural selection: Choosing boys over girls, and the consequences of a world full of men. New York, NY: PublicAffairs. Parens, E., & Asch, A. (2003). Disability rights critique of prenatal genetic testing: Reflections and recommen­ dations. Mental Retardation and Developmental Disabilities Research Reviews, 9(1), 40–47. Puri, S., Adams, V., Ivey, S., & Nachtigall, R. (2011). “There is such a thing as too many daughters, but not

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too many sons”: A qualitative study of son preference and fetal sex selection among Indian immigrants in the United States. Social Science and Medicine, 72(7), 1169–1176.

Fetishism

and

Gender

Fetishism is the psychological tendency to attribute inordinate significance to a target. The target, also called the fetish, can be an idea, an event, or an object, among other things. Characteristically, the fetish is not only highly valued but also perceived in especially simple and concrete terms. Consequently, complex or nuanced aspects of the fetish are downplayed in the person’s awareness, as are those features that are abstract and difficult or impossible to grasp with the senses, such as the target’s history or inner workings. In short, fetishism involves separating a target from its context and injecting it with undue significance, such that the target becomes a focal point of attention and desire. Social scientists have noted the importance of fetishism for a range of behaviors and cultural practices. For example, anthropologists note that many religious adherents lend ordinary objects divine status; similarly, economists note consumers’ obsessional desire for particular luxury goods. In the context of gender relations, fetishism predominantly takes the form of bodily objectification, that is, valuing features of (typically) women’s bodies at the cost of downplaying their psychological attributes. This is expressed in several behaviors, with most scholarly attention focused on men’s objectification of women by reducing them to sexualized body parts and, more recently, women’s objectification of themselves by basing their self-esteem narrowly on their physical appearance. Objectification in gender relations can go beyond the body, as when men and women are valued in  terms of attributes that contribute to gender-­ specific roles and identities. As with other forms of fetishism, objectification characteristically involves downplaying the significance of complex or abstract qualities—in this case, the unique qualities that make up the target individual’s personality. This entry considers research-based insights into

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the causes and consequences of fetishism in the realm of gender relations.

Causes of Gender-Relevant Fetishism Gender-relevant fetishism has been traced to several distinct sources, which are summarized below. Culture

One long-standing position traces this tendency to cultural norms and the institutions that promote it. Several theoretical perspectives converge on the claim that men and women are often socialized in a cultural setting that trains both groups to value women’s appearance above their psychological attributes. For example, the media often present women as sexual objects (e.g., in pornography, advertising) or downplay women’s psychological attributes, as with one-dimensional female characters. These cultural representations, combined with widespread ideologies restricting women’s social roles, encourage fetishistic perceptions of women as bodies. Indeed, research shows that the more men are exposed to popular media, the more they objectify women, viewing them as instrumental in pursuing their (men’s) goals to attain sexual pleasure or status. According to objectification theory, socialization into an objectifying culture also leads women to value themselves primarily as bodies. Supporting research shows that women are more likely to self-objectify in response to cultural messages and experiences that heighten awareness of their ­bodies, such as overheard comments about their physical appearance, being in the presence of ­full-length mirrors, mere exposure to appearancerelated words (e.g., figure), or anticipating a future interaction with a male peer. Concerns About Mortality

Another perspective holds that gender fetishizing others, particularly women, satisfies the psychological need to cope with threatening thoughts about one’s own mortality. Specifically, it is claimed that the idealization of women’s bodies as sexual objects averts the distressing realization that the human body is a biological entity that will inevitably die. For example, thinking of breasts as primarily instruments of sexual pleasure suppresses their

evolved purpose for lactation, a reminder of humankind’s animal, and thus mortal, nature. On this account, although men’s objectification of women is, on the surface, a change in the way women’s bodies are represented, it serves the unconscious goal of denying that they (men) are themselves destined to die. Studies testing this account reliably show that men and women respond to reminders of personal mortality with negative attitudes toward aspects of women’s bodies that closely resemble those of other species. For example, mortality reminders increase disgust toward breastfeeding, presumably because this shatters the fetishistic illusion that breasts exist solely for sexual pleasure. Also, mortality reminders prompt people to think about sex narrowly in terms of its uniquely human or “spiritual” meanings (e.g., a sacred union) and, correspondingly, to suppress awareness of sex’s carnal aspects (e.g., ejaculation). This reflects the narrowing of attention characteristic of fetishism, and it is driven by the urge to assuage mortality concerns. Concerns About Personal Efficacy

A third explanation traces fetishism to feelings of uncertainty, particularly about one’s ability to effectively relate to others. According to this perspective, successful social interaction is a central element in maintaining a positive view of the self. When people perceive that they lack the interpersonal skills necessary to carry out successful interactions, their self-worth is called into question. They compensate by fetishizing—reducing others to simpler terms, such as their bodies. Put differently, narrowing attention to others’ bodies, and correspondingly suppressing awareness of their inner qualities, minimizes uncertainty about one’s own interpersonal efficacy. Studies show that when people are led to feel uncertain about their ability to effectively relate to others, they respond by thinking about others in terms of simple, concrete characteristics as opposed to more abstract or elusive qualities. In one study, a group of men were asked to reflect on their difficulties relating to women. Compared with men in a control group, these uncertain men were more likely to think about women in terms of their body parts rather than their personality characteristics. In short, objectification can serve as a means to fetishize, or focalize, on aspects of other people

Fetishism and Gender

that seem easier to understand and relate to, and to focus attention away from others’ subjective ­qualities, which are more difficult to control.

Consequences of Gender-Relevant Fetishism The following subsections outline several consequences of fetishism in gender relations, distinguishing between the consequences of fetishizing others and the self. Fetishizing Others

The act of seeing others in more simplified, fetishistic terms can strip those individuals of moral consideration and protections. As noted earlier, ­ fetishizing characteristically involves suppressing awareness of the target’s inner states. Many of these states—such as agency, freedom of choice, and a capacity for suffering—are the basis of people’s ordinary ethical treatment of others. Hence, the person fetishizing might feel less inhibited about exploiting or harming the target. Supporting research shows that individuals attributed fewer mental states to and were more willing to harm a target who was pictured in sexually revealing clothing. Fetishized targets are also perceived and treated more negatively. For example, women who report being more interpersonally objectified feel more ashamed about their bodies and experience more frequent negative social interactions. Furthermore, objectified targets are typically seen as less intelligent and less competent by others. In the context of close relationships, the tendency to see one’s partner in fetishized terms predicts decreased relationship satisfaction and ­ intimacy. Objectification also reduces commitment to one’s partner, shifting the nature of the relationship to be more superficial and temporary. In short, fetishizing others can harm not only the target individuals (e.g., by exempting them from ethical treatment or undermining their selfesteem) but also the perceivers, because it keeps them from contributing to, and benefitting from, deeper social connections. Fetishizing Self

As noted, women often adopt an objectified perspective of their bodies, such that they come to

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view and treat themselves as objects to be looked at and evaluated based on external standards. Hinging self-worth narrowly on one’s appearance creates apprehension about others’ ­evaluation of the self, which in turn impairs performance. Studies show that situations designed to shift focus to one’s bodily appearance impair intellectual performance, including mathematical ability and memory. In addition, women prone to selfobjectification underperform on physical tasks like throwing a softball. Over time, chronic anxiety about the presentation of oneself as a body takes a toll on physical and mental health. One well-documented consequence is that women who tend to self-objectify are more likely to show patterns of disordered eating, including anorexia and bulimia. Numerous studies have shown that self-objectification increases symptoms associated with these disorders, including skipping meals and binge eating, primarily through an increase in shame about one’s body. Because self-objectification reduces personal worth to physical appearance, women are encouraged to sacrifice physical health for the ability to meet cultural standards of beauty. Self-objectification is also a risk factor for depression. Early research found that depressive symptoms correlate with self-objectification and that this correlation was due in part to feeling ashamed about one’s body. More recent research finds that exposure to objectifying media itself predicts depressive symptoms as a function of selfobjectification. In addition, self-objectification is associated with greater fear and perceived risk of being raped, greater hostility toward other women, greater likelihood of self-harm, and stronger support of cosmetic surgery. Self-objectification has social costs as well. One line of recent research explored the possibility that self-objectification would undermine political activity. Findings showed, in fact, that women who based their value primarily on their appearance, or those led to temporarily focus on their appearance, expressed less motivation to effect political change.

Research Directions Whereas past research on fetishism and gender has focused primarily on the objectification of women, recent research has extended this focus to perceptions of men. The results of this work largely

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First-Wave Feminism

parallel research on the objectification of women. For example, men who were placed in a situation in which their physical appearance was emphasized showed the same cognitive performance deficits observed with women in the same scenario. However, other research suggests some noteworthy discrepancies between men and women. One study found that the experience of being objectified increased heart rate in both men and women but the increase was higher for women. In addition, objectified women had more negative experiences of objectification than similarly objectified men. Future research is needed to uncover the ways in which the experience of being fetishized differs between men and women. Another important area of research is understanding how to reduce the negative consequences of fetishism. In the context of self-objectification, practitioners have developed and tested several methods. For example, some programs draw attention to objectifying media to increase awareness of their psychological effects. Initial evidence shows that such programs can substantially increase awareness of the prevalence of objectification and its detrimental impact on the target’s well-being. Further developing and implementing these programs are important goals for future research. Also, more work is needed in developing a nuanced picture of the various forms of genderrelevant fetishism. As mentioned, most research focuses on objectification, but fetishism is an inclusive term that encompasses several other important phenomena. A person fetishizes not only by treating others narrowly in terms of their bodies but also by treating others with undue focus on their gender-specific roles, belongings, lifestyles, or identities. Developing a richer scientific understanding of the causes, consequences, and expressions of ­gender-relevant fetishism will advance theory on social thought and behavior. At a practical level, it will inform interventions for encouraging people to think about and regard others as complete persons. Lucas A. Keefer, Ariel J. Mosley, and Mark J. Landau See also Body Objectification; Cultural Gender Role Norms; Feminism: Overview; Media and Gender

Further Readings Fredrickson, B. L., & Roberts, T. (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173–206. Goldenberg, J. L., & Robert, T. (2011). The birthmark: An existential account for the objectification of women. In R. M. Calogero, S. Tantleff-Dunn, & J. K. Thompson (Eds.), Self-objectification in women: Causes, consequences, and counteraction (pp. 77–100). Washington, DC: American Psychological Association. Landau, M. J., Sullivan, D., Keefer, L. A., Rothschild, Z. K., & Osman, M. R. (2012). Subjectivity uncertainty theory of objectification: Compensating for uncertainty about how to positively relate to others by downplaying their subjective attributes. Journal of Experimental Social Psychology, 48, 1234–1246. Tiggemann, M., & Williams, E. (2012). The role of self-objectification in disordered eating, depressed mood, and sexual functioning among women: A comprehensive test of objectification theory. Psychology of Women Quarterly, 36, 66–75.

First-Wave Feminism Historians have sometimes metaphorically described movements for social justice or change, such as feminist movements, as a series of waves or cycles with distinct beginnings and ends. In reality, these waves of feminism are not circumscribed as there is much continuity and overlap among the issues, approaches, and even some activists from wave to wave. Furthermore, there has never been just one type of feminism, but there are many feminist perspectives that have informed and continue to inform advocates of gender equality. This entry focuses on first-wave feminists, who were active primarily during the 19th century up through World War II, and provides an overview of the issues with which they were concerned, including social, political, educational, economic, and legal rights.

Historical Background The Seneca Falls Convention, which took place in Seneca Falls, New York, in July 1848, is often identified as the event that defined the beginning of

First-Wave Feminism

first-wave feminisms. Not only does this assumption ignore the fact that feminists and woman’s rights activists were engaged in advocacy long before 1848, but it also ignores the fact that many feminists were advocating for gender equality around the world, not just in the United States. A primary concern of early feminists was to demonstrate that women were human and moral persons and should, therefore, be afforded the rights and privileges that men had. There is a long history of many philosophers and writers opining that women were not fully human and that they were inferior to men. For example, Aristotle (384–322 BCE) described females as deformed ­ males, French philosopher Jean-Jacques Rousseau (1712–1778) wrote that women should be submissive to their husbands, and German philosopher Arthur Schopenhauer (1788–1860) compared women with childish beings. Countering these beliefs were Theodora (ca. 500–548), Empress of Byzantium from 527 to 548, who advocated for women’s property and marriage rights. Christine de Pizan (1364 to ca. 1430) was an Italian French writer who included many feminist ideas in her writings, such as property rights for women. Her allegory The Book of the City of Ladies (1405) described a city where women were respected and contributed meaningfully to society. The Revolutionary War in the United States and the French Revolution increased interest in the struggle for human rights, including women’s rights. In addition, many feminists were abolitionists and were very active in the antislavery movements, especially in Europe and the United States For example, British writer Mary Wollstonecraft (1759–1797) wrote the influential A Vindication of the Rights of Woman (1792), which is credited with being one of the earliest feminist writings. In this work, Wollstonecraft drew analogies between the status of slaves and the status of women and argued that women were viewed as inferior to men because they did not have the same opportunities that men had to develop their intellects and enhance their knowledge. This, in turn, prevented women from participating in society as full citizens. In the United States, feminists and woman’s rights activists of different classes and races were also advocating for societal change before the Seneca Falls Convention. For example, in the 1820s,

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Scottish émigré Fanny Wright (1795–1852) spoke out in favor of working women’s rights, and the reform of divorce laws, among other issues. Angelina (1805–1879) and Sarah Grimké (1792–1873) were especially active during the 1830s and emphasized the parallels between the status of slaves and the status of women in their speeches. Black women such as Margaretta Forten (1806–1875) and Sojourner Truth (ca. 1797–1883) advocated for women’s rights as well as the end to slavery. Mexican and Seneca women battled to maintain property and marriage rights after they lost their homelands to the U.S. government.

Suffrage Suffrage for women, or women’s right to vote and participate as candidates in political elections, is often seen as a primary issue concerning first-wave feminists. For example, British philosopher John Stuart Mill (1806–1873), who echoed some of Wollstonecraft’s concerns about the status of women in his famous piece On the Subjection of Women (1869), was also a strong proponent of women’s right to vote. The World Women’s Christian Temperance Union, founded in the United States in 1873, was one of the first organizations to address suffrage, and it provided inspiration to other suffrage organizations nationally and internationally. New Zealand is often touted as the first country, in 1893, to grant women the right to vote, although women were not allowed to run for political office until 1919. However, other countries granted women the right to vote before New Zealand but often with restrictions. For example, only women who paid taxes could vote in Finland (1863 and 1872), women in South Australia who owned property could vote only in local elections (1861), and voting rights in some countries were later rescinded (e.g., women’s right to vote in Corsica was rescinded in 1769, after that country was annexed by France). Also, although Maori women were allowed to vote in New Zealand, they were allowed to vote only for Maori candidates. The Nineteenth Amendment to the U.S. Constitution, which granted suffrage to women, was passed in 1920; however, even before 1920, women in several states or territories had the right to vote, including the Wyoming Territory (1869), the Utah

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Territory (1870), Colorado (1893), and Idaho (1896), among others. As with the Maori in New Zealand, there was racial discrimination regarding who could or could not vote. For example, although women in Arizona won the right to vote in 1912, neither women nor men of Mexican descent in that state could vote. Also, many Black women exercised their right to vote in 1920, but obstacles were placed in their way, such as literacy tests and poll taxes. Some historians argue that Black women in the South did not fully gain the right to vote until the Voting Rights Act of 1965. The movements for women’s suffrage did not end in the early 20th century, and they have continued worldwide through the early 21st century. In 1948, the United Nations declared that the right to vote was a human right. Nevertheless, women in Saudi Arabia were granted the right to vote by King Abdullah only as recently as 2011, and they voted for the first time in the 2015 municipal elections.

Citizenship Rights In addition to the right to vote, citizens enjoy other rights as members of a community, including, but not limited to, property rights, free speech, and rights within marriage. Education was viewed by many feminists as a necessary component to becoming a full citizen. In A Room of One’s Own (1929), British feminist and writer Virginia Woolf (1882–1941) addressed women’s lack of educational opportunities and the opinions of primarily male authors who characterized women as inferior beings lacking virtue. Woolf predicted that ­sometime in the future women would be full and autonomous participants in society but only after systemic discrimination against women was dismantled. In the United States, some girls benefited from a formal education in the 1700s, especially if they were from White wealthy families, although this education was not always academic. Women’s colleges started in the 1800s, but it was not until the late 1800s through the early 1900s that colleges allowed women and men to be educated together. Still, some universities and colleges were slow to admit women; Harvard, the oldest university in the United States, was founded in 1636 but did not allow women to earn degrees until 1963. Racism

was also prevalent regarding rights to education. For example, it was illegal for Black women (and men) to be formally educated, especially before the end of the Civil War. Teachers who provided these services were often harassed and arrested, and their schools were sometimes burned down. Also, Native American girls and boys were separated from their families and sent to boarding schools, where they were not allowed to learn about their own cultures and languages. In addition to education, feminists fought for rights in other areas such as freedom of movement and rights within marriage. For example, 5,000 women signed a petition to repeal a law passed in 1893 in the Orange Free State in the Union of South Africa that required Black women to work as domestic servants if they moved to urban areas. In the United States, feminists lobbied against laws regarding married women’s citizenship; for example, as a result of the Expatriation Act passed by the U.S. Congress in 1907, American women lost their rights as citizens if they married someone who was not a U.S. citizen. The law making a woman’s citizenship dependent on that of her husband remained in effect until 1940. In Britain, the feminist Six Point Group, founded by Lady Rhondda (1883–1958), advocated for equal rights of guardianship for married women and for the rights of widowed and unmarried women.

Sexuality and Reproductive Rights International feminist and women’s rights organizations, such as the Women’s Christian Temperance Union, and many individual feminists were also concerned with sexual double standards (e.g., men were allowed to be promiscuous before marriage, whereas women were expected to be ­ virgins) and women’s reproductive rights. For example, in her book L’émancipation sexuelle de la femme (1911), French writer Madeleine Pelletier (1874–1939) argued in support of birth control and abortion and against the restrictions placed on women’s sexuality. The Contagious Diseases Acts, passed by the British Parliament in 1864, were developed to control venereal disease by regulating prostitution. Under these acts, women could be arrested, forced to undergo medical examinations, and held for months in hospitals if they were found to be infected. Feminists such as Josephine

Fraternities

Butler (1828–1906) lobbied for the dismantling of these acts because they supported the oppressive sexual double standard against women; she reportedly referred to the forced examinations as “surgical rape.” Birth control and abortion were also prominent issues for first-wave feminists, who saw them as critical to women’s sexual and reproductive health. Perhaps the most well-known proponent of birth control was Margaret Sanger (1879–1966). She traveled internationally and spoke openly about the need to legalize birth control, and in 1916, she opened the first birth control clinic in Brooklyn, New York. Her American Birth Control League, founded in 1921, was the forerunner of the Planned Parenthood Federation of America. Sanger has been criticized for her support of eugenics, specifically the control of reproduction in those deemed to be unfit, such as poor, uneducated women. Stella Browne (1880–1955) from England was another advocate of women’s reproductive rights, including abortion. Furthermore, Browne supported the rights of transgender and lesbian women and did not view homosexuality as an illness.

Economic Rights The struggle for women’s economic rights focused on several issues, including access to employment, labor laws, equal pay for equal work, and maternity leave benefits. Class concerns were prominent in many women’s labor reform movements. For example, because working-class women were ­protected by labor laws in some but not all occupations, the extension of work protections was critical. Middle- and upper-class women were concerned about improving access to professions that had been traditionally dominated by men. Maternity leave benefits and the repeal of restrictions on married women’s employment were important regardless of class status. In some occupations, women were forced to work long hours in unsafe conditions. One example of the consequences of these conditions is the Triangle Shirtwaist Factory fire on March 25, 1911, in New York City. The doors to the stairs and exits had been locked by employers to prevent theft and unauthorized rest breaks. Of the 146 people who died, 123 were women, primarily

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Jewish and Italian immigrants. This event led to reforms such as better facilities for workers, reduced working hours, and fire inspections. Also, this tragedy occurred soon after the first International Women’s Day was celebrated on March 19 in Austria, Denmark, Germany, and Switzerland, a day that is still observed around the world. Many of the early feminists spoke of a global sisterhood but were frequently blind to their class and racial biases when advocating for women’s rights. Nevertheless, they provided important and needed catalysts for changes and improvements in women’s lives that are still relevant today. Veanne N. Anderson See also Equality Feminism; Feminism: Overview; Gender Equality; Human Rights; Labor Movement and Women; Reproductive Rights Movement; Workplace and Gender: Overview

Further Readings Hewitt, N. A. (Ed.). (2010). No permanent waves: Recasting histories of U.S. feminism. New Brunswick, NJ: Rutgers University Press. Moynagh, M., & Forestell, N. (2012). Documenting first wave feminisms: Vol. 1. Transnational collaborations and crosscurrents. Toronto, Ontario, Canada: University of Toronto Press. National Women’s History Museum. (n.d.). The history of women and education. Retrieved from https://www .nwhm.org/online-exhibits/education/introduction.html Scholz, S. (2012). Feminism: A beginner’s guide. Oxford, England: Oneworld.

Fraternities Fraternities are collectives of male college or university students. They have long had an air of secrecy and exclusivity due to how they select and initiate new members. Although fraternities, or analogous social clubs, exist in other countries, the present entry covers only U.S. fraternities. Many of the oldest fraternities were founded in the early to mid-19th century. The fraternity s­ ystem has consisted predominantly of White members, stemming in part from some fraternity charters (and some entire universities) having official

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Fraternities

Whites-only policies prior to the civil rights movement of the 1960s. African American fraternities, which remain a part of contemporary college life, formed at the beginning of the 20th century, some at historically Black colleges and universities. Latino and Asian American fraternities emerged later in the century. Each fraternity has its own house (which hosts social functions and, in some cases, contains living quarters for members) and name consisting of Greek letter initials. An estimated half a million young men participate in fraternities annually. ­Fraternities appear to be most common at state universities and larger private institutions. Fraternities can make both positive and negative contributions to society and their members’ development. On the positive side, fraternities promote leadership, volunteerism, and community activity. Networking opportunities with fraternity alumni also can aid students’ occupational careers. On the negative side, fraternity members appear more likely than other male college students to exhibit degrading attitudes and sexually aggressive behavior toward women. Attitudes and behaviors linked to risk taking and self-perceived invincibility seem to be relatively common among fraternity members. Several aspects of fraternity life, possibly stemming from the group dynamics of all-male organizations, thus raise questions of genderrelated attitudes and behavior.

Leadership Many studies show fraternity participation to be linked to enhanced leadership skills. In some studies, however, fraternity members’ enhanced leadership had been detected early in their college careers and had dissipated by the senior year. As student development scholars Michael Hevel and Daniel Bureau have noted, expert conceptions of l­ eadership shifted during the 1990s, away from leadership styles based on power and control (traditionally considered stereotypically masculine by some leadership researchers) to those placing greater ­ emphasis on interpersonal relationships and collaboration (seen as more stereotypically feminine). Because fraternities (and sororities) are often run via hierarchical organization (i.e., led by officers and committees, with senior members playing a large role in selecting and initiating the newest

members), some question whether Greek letter organizations provide the full breadth of leadership skills.

Unsupportive Attitudes and Aggressive Behaviors Toward Women Fraternities have made headlines in recent years for allegations of sexual assault in their houses and insensitive displays regarding sexual assault (e.g., signs saying “No Means Yes”). Many universities have formed task forces to address sexual assault prevention and fraternity culture. Such occurrences have raised the issue of gender-related ­attitudes among fraternities, both at the institutional level and among individual members. According to some observers, fraternities can create extreme attitudes of masculinity in their members (or accentuate such attitudes in those who already hold them) and promote degrading attitudes toward women (e.g., “Bro’s before ho’s”). Sociologist Michael Kimmel wrote of a “Guy Code” that exists for many males between the ages of 16 and 26 years throughout society but with particular intensity within fraternities. The Guy Code is a belief system that boys and young men enforce among themselves, in which toughness is expected and any sign of emotional vulnerability is punished. Research reviewed by Kimmel suggests that attitudes conducive to sexual aggression toward women—and actual sexual aggression— are likely to be most prevalent in all-male organizations (including, but not limited to, fraternities), whose members feel a sense of “sexual entitlement” deriving from self-perceptions of one’s group as having high prestige. Recent studies have compared the genderrelated attitudes of fraternity men and nonaffiliated male college students (sometimes also ­including comparisons with sorority women and nonaffiliated female students). Sarah Murnen and Marla Kohlman’s 2007 meta-analysis (statistical aggregation) of multiple studies found statistically significant tendencies for fraternity men to score higher on rape myth acceptance and self-reported sexual aggression than nonaffiliated men. A separate study published by Dianne Robinson and ­colleagues in 2004 assessed participants’ responses to the Gender Attitude Inventory. Fraternity men exceeded the three other groups studied (sorority

Fraternities

women and unaffiliated men and women) on 6 out of 14 subscales believed to measure gender stereotypicality: (1) acceptance of traditional stereotypes, (2) acceptance of male heterosexual violence, (3) endorsement of traditional family roles, (4) rejection of female political leadership, (5) opposition to women’s rights, and (6) belief in differential work roles. A statistical association between fraternity membership and unsupportive (or even hostile) attitudes toward women appears fairly clear. What is not clear, however, is whether fraternity participation may have caused these attitudes, whether men already holding these attitudes may have been attracted to fraternity life, or whether other factors could have led some men both to join fraternities and to hold attitudes unsupportive of women. Hostile and unsupportive fraternity attitudes and behaviors toward LGBT and racial minority students have also been observed. The experiences of LGBT students within fraternities (whose members appear to be heavily heterosexual) have received increased attention in recent decades. The Lambda 10 Project: National Clearinghouse for Gay, Lesbian, Bisexual, Transgender Fraternity & Sorority Issues was started in 1995. Allegations continue to surface of openly gay men being rejected for membership in fraternities and closeted members being dismissed from fraternities after their sexual orientation was discovered. Some openly gay members, however, report positive experiences in fraternity life. A 2015 incident in which members of a University of Oklahoma fraternity were seen on video engaging in racist chants during a group bus trip brought the racial attitudes of some fraternities back into the national spotlight. A Washington Post article on this incident noted that even long after federal and university nondiscrimination policies were put in place, some fraternities have been slow to allow minority members and incidents such as parties with racially stereotypical themes have continued.

Risk Taking and Self-Perceived Invincibility A 2014 Atlantic Monthly article probed the different areas in which fraternities have faced lawsuits and how they have attempted to defend against them. Although allegations of sexual assault and hazing-related injuries are perhaps the sources of

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potential liability that receive the greatest public attention, fraternities also spend heavily on liability insurance related to falls from upper floors of fraternity houses, assault and battery, and car accidents (frequently the result of or aided by alcohol consumption). Such occurrences, along with other types of reported mayhem, appear to map onto common youth development concepts owing to David Elkind and others, such as the perception of oneself as invulnerable (i.e., “young invincibles”) and risk-taking behaviors. In a 2014 study, Charles Corprew and Avery Mitchell found that fraternity members averaged significantly higher on measures of disinhibition (i.e., sensation/thrill seeking), hypermasculinity, and sexually aggressive attitudes than their unaffiliated counterparts. The authors suggest that these behaviors and attitudes may stem partly from the self-­ perceived pressure in college men, enhanced in fraternities, to live up to traditional standards of manhood.

Conclusions and Policy Implications Many aspects of fraternity life appear linked to gender-related attitudes, including ones unsupportive of women. A number of universities have formed task forces to prevent sexual assault and other antisocial behavior, their scope varying from a focus on Greek letter organizations to treating them as one of many units on campus. Reports from these task forces have included recommendations to address fraternity culture and social norms pertaining to manhood, masculinity, and rapesupportive attitudes. Alan Reifman See also Gender Role Behavior; Sexual Assault; Sororities

Further Readings Hevel, M. S., & Bureau, D. A. (2014). Research-driven practice in fraternity and sorority life. New Directions for Student Services, 2014, 23–36. Kimmel, M. (2008). Guyland: The perilous world where boys become men: Understanding the critical years between 16 and 26. New York, NY: Harper. Windmeyer, S. L., & Freeman, P. W. (Eds.). (1998). Out on fraternity row: Personal accounts of being gay in a college fraternity. Los Angeles, CA: Alyson.

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Friendships in Adolescence

Friendships

in

Adolescence

This entry considers girls’ and boys’ friendships during adolescence. Specifically, the entry considers adolescents’ tendency to have same-sex friends, the number and quality of girls’ and boys’ friendships, a focused discussion of girls’ and boys’ disclosure to friends, and other-sex friendships. Friendships are considered because they are central relationships in the lives of both girls and boys. In fact, during adolescence, friendships become particularly salient. Developing autonomy from parents is a key task of adolescence. As such, in adolescence, youth spend more time with their peers and rely more on peers for support. Moreover, the majority of early and middle adolescents do not have serious romantic partners yet, which also contributes to the significance of adolescents’ friendships. Nonetheless, despite the importance of friendships for both boys and girls, there are also significant gender differences in these relationships. One of the most robust findings in the literature on gender and peer relationships involves sex segregation, or youths’ tendency to interact with same-sex peers. Sex segregation is present even during early childhood in that children tend to play in groups of same-sex peers. In middle childhood and adolescence, most friendships are with same-sex peers. Therefore, many studies of adolescents’ friendships have focused on the same-sex friendships of boys and girls. When studying the friendships of boys and girls, researchers often focus on the number of friends youth have as well as the quality of the friendships. In terms of number of friends, some studies suggest that boys have larger, more interconnected friend groups than girls and that girls spend more time than boys in dyadic interaction with a single friend. High-quality friendships are typically thought to be characterized by features such as disclosure, warmth, affection, affiliation, and support. Girls tend to report higher levels of these features than boys. Nonetheless, boys typically report as much overall satisfaction with their friendships as girls. In terms of behavior in friendships, one of the most consistent gender differences involves disclosure of personal information. Disclosure in friendships can include sharing secrets, talking about thoughts or feelings, and discussing problems.

Overall, girls report greater disclosure in their friendships than boys. With regard to talking about problems, girls and boys differ in the content of problems they discuss and how they talk about these problems. For example, girls are more likely than boys to discuss interpersonal problems, such as problems in romantic relationships. In terms of how friends talk about problems, girls are more likely than boys to respond to friends’ disclosure of problems in supportive ways, such as by agreeing with them or encouraging them. Although girls produce more supportive responses than boys, these supportive responses are related to feelings of closeness between friends for both genders. Interestingly, boys are more likely than girls to respond to friends’ discussion of their problems with humor, which is related to friendship closeness only for boys. There are also gender differences in the degree to which adolescent friends engage in a specific type of disclosure referred to as corumination. Corumination involves frequent and repetitive problem discussions characterized by speculating about problems, dwelling on the negative emotions associated with the problems, and mutual encouragement of problem talk. Girls coruminate with friends more than boys. Importantly, corumination has adjustment trade-offs. Similar to other types of disclosure, corumination is related to positive friendship quality. However, corumination is also related to internalizing issues, such as depression, probably due to its negative focus. Importantly, girls may be especially susceptible to the negative adjustment outcomes of corumination. For example, one study found that corumination was related to emotional problems 6 months later more strongly for girls than for boys. Adolescent girls and boys also think and reason differently about disclosure in friendships. Compared with boys, girls have more positive expectations regarding how talking about problems will make them feel. For example, girls expect that talking to friends about problems will make them feel better and cared for and understood. Other research indicates that boys report avoiding talking about problems because they are worried that they would not know what to say and because they prefer other activities. Differences in how girls and boys think about problems help explain why girls talk about problems with friends more than boys.

Frotteurism and Gender

Although most adolescent friendships are samesex friendships, other-sex friendships do become more frequent in adolescence. As discussed in terms of disclosure, girls and boys develop different communication styles through their experiences with same-sex friends, which can create challenges for cross-sex communication. Adolescents’ ability and willingness to adjust their ­interaction style may be especially important for other-sex friendships. Girls report that their othersex friendships involve characteristics that may be especially valued by boys (i.e., shared activities), suggesting that they do alter their relationship style. In contrast, boys do not report increased emphasis on characteristics that may be especially valued by girls (i.e., intimate disclosure) in othersex friendships. Moreover, boys are more likely than girls to report that they receive help from other-sex friends. These findings suggest that boys may benefit more than girls from other-sex friendships. Furthermore, girls’ having other-sex friendships, especially with older boys, is associated with risks such as alcohol use, drug use, and antisocial behaviors. Nonetheless, for many adolescents, learning to navigate friendships with other-sex peers is important for creating a foundation for other-sex relationships later in development, including romantic relationships. Amanda J. Rose and Sarah K. Borowski See also Adolescence and Gender: Overview; Gender Segregation; Gender Socialization in Adolescence; Men’s Friendships; Romantic Relationships in Adolescence; Women’s Friendships

Further Readings Mehta, C. M., & Strough, J. (2009). Sex segregation in friendships and normative contexts across the life span. Developmental Review, 29, 201–220. doi:10.1016/j.dr.2009.06.001 Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: Potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132, 98–131. doi:10.1037/0033–2909.132.1.98 Rose, A. J., & Smith, R. L. (2009). Sex differences in peer relations. In K. H. Rubin, W. M. Bukowski, & B. Laursen (Eds.), Handbook of peer interactions, relationships, and groups (pp. 379–393). New York, NY: Guilford Press.

Frotteurism

and

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Gender

Frotteurism is a disorder characterized by fantasies, sexual behaviors, or urges involving rubbing or touching, especially the genitals, against the body or clothing of a nonconsenting person, usually in crowded public places. The term frotteurism is derived from the word frotteur, which comes from the French verb frotter, meaning “to rub.” Frotteurism is relevant to gender issues for various reasons, including the finding that most of the perpetrators are male and most of the victims are female. In this entry, the diagnosis, demographics, and prevalence of frotteurism are described, and legal and cultural issues related to this condition are identified. The entry concludes with a discussion of theories and treatments related to frotteurism.

Diagnosis, Demographics, and Prevalence Frotteurism is classified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) as a paraphilia, a disorder characterized by recurrent sexual fantasies and urges involving objects, the suffering or humiliation of oneself or one’s partner, or children or other nonconsenting persons. Frotteurism was renamed frotteuristic disorder in the fifth edition of the DSM (DSM-5), which was published in 2013. According to the DSM-5, the criteria for frotteuristic disorder are met if for a 6-month period an individual has experienced recurrent and intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person; they have acted on these sexual urges; or the sexual urges or fantasies have caused them marked distress or interpersonal ­difficulty. In some cases, people with frotteuristic disorder achieve orgasm during the act. Frotteuristic disorder sometimes co-occurs with other ­mental health disorders and clinical problems, especially other paraphilic disorders such as exhibitionism and combinations of paraphilic disorders. Individuals with frotteuristic disorder may also experience anxiety, shame, self-image, and other emotional problems that relate to and exacerbate their conditions and complicate treatment. The prevalence rate of frotteurism has not been firmly established because it is presumed that most people with this condition do not voluntarily seek

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professional help. It is difficult to assess the prevalence of frotteurism because studies often lack methodological quality, include small sample sizes, use local rather than national or international samples, and do not consistently apply the DSM criteria. The prevalence rate of frotteurism may also be unreliable because victims are frequently unaware that they have been touched or rarely report ­incidents to the authorities. Frotteurism is a predominantly male disorder and usually first appears during late adolescence and declines by age 25 years. It has been estimated that 30% of adult males have engaged in frotteuristic acts, and 10% to 14% of males diagnosed with paraphilic disorders also meet the diagnostic criteria for frotteuristic disorder. Data regarding the prevalence of female diagnoses of frotteuristic disorder are unavailable.

Legal and Cultural Issues In most countries, unwelcome touching of another person’s body is illegal. In many jurisdictions, ­frotteurism is considered a sexual assault and constitutes a misdemeanor or a felony criminal offense. Conviction may result in prison, mandatory mental health treatment, and registration as a sexual offender. Victims may file private civil lawsuits to seek monetary damages from the perpetrator. It is difficult to prosecute perpetrators as intent to touch is difficult to prove. If an alleged victim accuses an individual, the alleged perpetrator often denies the act. As a result, perpetrators are rarely prosecuted. In some cultures, it is common for a woman’s buttocks to be pinched or slapped in crowded areas. In Japan, the perpetrator of an act of frotteurism is often referred to as a chikan, or ­ “groper.” In India, frotteurism is referred to as “Eve teasing” and is also considered “a little rape.” Frotteurism is widespread on public transportation in large cities. It has been estimated that 66% of female passengers in their 20s and 30s reported that they had been groped on trains in Tokyo. Due to widespread frotteurism in Tokyo, Mexico City, and Rio de Janeiro, women-only buses and trains have been introduced.

Theory and Treatment Frotteurism is not well understood because few people with the condition present in clinical

settings. Frotteurism has been conceptualized as ineffectual sexual assault and the perpetrators as less aggressive or timid rapists. A theory of courtship disorder views frotteurism as a deviation of the normal phase of tactile interaction that occurs during human sexual interaction. Cognitive behavioral theory presumes that thoughts play a mediating role in the development of ­frotteuristic behavior and associated feelings. Psychoanalytic theory holds that frotteurism is the result of repressed traumas and unconscious conflicts. Treatment approaches for frotteurism include cognitive behavioral therapy, psychodynamic therapy, twelve-step programs, and medication. Cognitive behavioral therapy focuses on identifying and replacing the thoughts presumed to maintain frotteurism. Psychodynamic approaches aim to help people recall how their early-­childhood experiences and past traumas unconsciously affect their adult sexual behaviors. Some i­ndividuals with frotteurism have experienced effective treatment outcomes in response to psychopharmacology, especially when used in combination with therapy. Research has found that it is critical for individuals to develop some degree of motivation to modify this behavioral pattern. Jeffrey T. Guterman See also Sexual Assault; Sexual Disorders and Gender; Sexual Offenders; Sexuality and Adolescence

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. First, M. B. (2014). DSM-5 and paraphilic disorders. Journal of the American Academy of Psychiatry and the Law, 42, 191–201. Johnson, R. S., Ostermeyer, B., Sikes, K. A., Nelsen, A. J., & Coverdale, J. H. (2014). Prevalence and treatment of frotteurism in the community: A systematic review. Journal of the American Academy of Psychiatry and the Law, 42, 478–483. Laws, D. R., & O’Donohue, W. T. (Eds.). (2008). Sexual deviance: Theory, assessment, and treatment (2nd ed.). New York, NY: Guilford Press.

G Gambling

and

For both men and women, the DSM recognizes gambling disorder as a critical problem similar to drug and alcohol addictions, with comparable effects on an individual. According to the DSM criteria, disordered gambling is diagnosed when an individual demonstrates problematic gambling behavior that results in clinically significant impairment or distress as indicated by an individual displaying four (or more) of the following in a 12-month period: The person (1) depends on the finances of others to solve desperate monetary situations generated by gambling; (2) has lost or endangered a valued relationship, employment position, or career or educational prospect through gambling; (3) attempts to hide the magnitude of their gambling; (4) has failed repeatedly in attempts to stop, reduce, or control their gambling; (5) gambles in response to feelings of depression, anxiety, disempowerment, or guilt; (6) has to gamble bigger quantities of money to gain the required excitement; (7) regularly gambles in attempts to recoup previous losses; (8) becomes irritable or restless when trying to control or quit gambling; and (9) is frequently preoccupied reliving previous gambling exploits or planning their next gambling venture or how to finance it. The DSM disqualifies from this definition such gambling behavior as can better be explained as a manic episode.

Gender

Historically across the world, gambling has been held to be a predominantly male activity; nowadays, in many countries, it is increasingly being acknowledged as a mainstream pastime for women too. Although only minimal gendered gambling research has been conducted, gender differences seem likely not only in relation to gambling motivations and preferences but also in progressions to problem gambling and with help-seeking behaviors. Limited reasons for these gendered differences have been proposed. While this entry reviews gambling generally, it more specifically examines gambling and problematic gambling as they relate to gender.

Diagnoses of Disordered Gambling Toward the end of the 20th century, definitions of what constituted a problem with gambling were widely discussed, debated, and amended. Diagnostic terms varied and were adjusted, and included pathological gambling, compulsive gambling, and gambling addiction. The contemporary diagnostic term used in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is disordered gambling. Where previously the condition was categorized as an impulse control disorder, it is now classified under “Substance-Related and Addictive Disorders.” However, the term problem gambling is commonly used among researchers and clinicians.

Gender Differences in Gambling Some research indicates gendered differences including gambling preferences and motivations, as well as progressions to problem gambling. 589

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For  instance, a number of researchers have suggested that women tend to prefer recognizably noncompetitive luck-based games such as video poker games and gaming and slot machines (sometimes referred to as electronic gaming machines or “pokies”), while they see men as preferring more competitive and strategic options, such as sports betting and blackjack. ­Furthermore, gambling preferences often appear to be culturally based and influenced by the availability and social acceptance of different types of gambling, and therefore frequently determined according to gender. In women, motivations for gambling include a need to escape from everyday stress and psychological comorbidity; but social isolation seems to be key, both to initiating gambling and in triggering its progression to problematic levels. Although these motivations can apply to men also, studies suggest that there may be factors compounding their impact on women. The findings imply, moreover, that women are liable to progress to problematic levels of gambling more quickly than men. Pressures, including stigma, shame, and guilt from failure to meet traditional social roles such as caring responsibilities, appear to be heightened in women. Particularly, under traumatic circumstances, these additional concerns are thought to bring women’s gambling-related problems to the forefront, prompting them to seek help earlier than men. The dearth of gendered gambling research has, however, limited understanding of differences in coping styles and help seeking between men and women faced with stressful events.

Investigations have also intimated gender specific barriers to seeking help. An example would be a preference by women to access female counselors; men commonly seem not to have a gendered preference. Neither do women necessarily feel comfortable in mixed-gender self-help groups, perhaps perceiving them to be male dominated and as generating safety concerns seldom identified by men. Those experiencing gambling problems exhibit generally low rates of help seeking, and better understanding of gender-based preferences and barriers restricting these levels would inform and assist facilitators. This topic clearly merits further attention, particularly in recognizing the most gender ap­­propriate and culturally effective treatment options. Better knowledge of the cultural and gendered perspectives of gambling would clarify motivations and behavior accompanying gambling and, therefore, be useful in informing prevention, harm minimization, and treatment strategies for all who gamble problematically. An imperative for improving treatment rates of those with gambling problems is gaining understanding of the barriers different cultural groups (e.g., people of color, LGBTQ people) discern as preventing their seeking help. Louise Holdsworth See also Help-Seeking Behaviors and Women; Mental Health and Gender: Overview; Mental Health Stigma and Gender; Social Anxiety Disorder and Gender; Social Role Theory; Substance Use and Gender

Further Readings

Gendered Approaches to Help Seeking The vulnerability of those gambling at problematic levels can have many contributing factors. Irrespective of gender, these individuals often have complex issues and needs relating to or existing alongside their problem gambling. They may include financial worries, employment concerns, relationship breakdown, drug and alcohol problems, physical and or mental health difficulties, housing-related stress or homelessness, and legal troubles; but gender too can influence the ways in which individuals negotiate these issues and helpseeking preferences.

Boughton, R., & Falenchuk, O. (2007). Vulnerability and comorbidity factors of female problem gambling. Journal of Gambling Studies, 23, 323–334. Holdsworth, L., Breen, H., & Nuske, E. (2011). Only the lonely: An analysis of women’s experiences of pokermachine gambling. Gambling Studies, 23(2), 17–38. Toneatto, T., Boughton, R., & Borsi, D. (2002). A comparison of male and female pathological gamblers. Toronto, Ontario, Canada: Ministry of Health and Long Term Care. Westphal, J. R., & Johnson, L. J. (2003). Gender differences in psychiatric comorbidity and treatmentseeking among gamblers in treatment. Journal of Gambling Issues, 8, 79–90. doi:10.4309/jgi.2003.8.17

Gay Male Identity Development

Gay Male Identity Development This entry provides a summary of theory and research that have been occurring since the 1970s focused on sexual identity development in nonheterosexual populations. This theory and research have sought to explain and generalize how nonheterosexual populations develop their sexual identities. This entry particularly focuses on how gay men develop their sexual identities and describes methods for exploring gay male identity development. A discussion on the importance of language and categories when developing theories and models that are meant to generalize sexual identity development for gay men is provided. Furthermore, the entry discusses the usefulness of intersectional frameworks, which consider race, gender, class, culture, ability, and nationality, among others, to explore heterogeneity or differences within gay male populations. Finally, future directions in studying gay male identity development and the stakes of doing this work are considered.

Sexual Identity Development Theories and Models In the United States, beginning in the 1970s, theoretical stage models were introduced describing homosexual identity development. Vivienne Cass,  in 1979, introduced her six-stage model—­ homosexual identity model—in the Journal of Homosexuality. The six stages are the following: 1. Identity awareness (i.e., becoming aware that one’s sexual identity is different from that of others) 2. Identity comparison (i.e., comparing one’s feelings and emotions with those of heterosexual individuals) 3. Identity tolerance (i.e., tolerating one’s nonheterosexual identity) 4. Identity acceptance (i.e., accepting one’s nonheterosexual identity and becoming active in the gay community) 5. Identity pride (i.e., becoming proud of one’s nonheterosexual identity and engaging in gay culture)

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6. Identity synthesis (i.e., fully accepting one’s nonheterosexual identity and synthesizing one’s former heterosexual life with one’s new identity)

Cass’s stage model is one of the most prominent homosexual identity development models used. Other stage models introduced by Ruth E. Fassinger, Ritch C. Savin-Williams, and Richard R. Troiden incorporate similar ideas, particularly about the coming out process. The coming out process is when an LGB (lesbian, gay, or bisexual) person accepts their nonheterosexual identity, identifies as LGB individually or publicly, and develops an LGB social identity. These models generally begin with a stage where an individual rejects acknowledgment of their nonheterosexual feelings. This phase of rejection lasts for an indefinite period of time, and the individual hopes that this will minimize their nonheterosexual feelings. Trying to minimize their nonheterosexual feelings may negatively affect their emotional and mental health. However, individuals will begin to increasingly accept their nonheterosexual feelings, and that is followed by emotional and behavioral experimentation with people of the same gender. As the individual continues to accept their nonheterosexual feelings, they develop a sense of identity as a lesbian or gay, and that becomes integral to their self and is seen as positive. There can be starting, reversing, and stopping across the developmental periods described in these models. Nonetheless, the stage models were based on research with small, White adult samples. The adults in these studies were reflecting on their experiences, which may not be indicative of how adolescents are experiencing and understanding their sexual identity. These stage models also assume a linear progression from lack of awareness to acceptance, to integrating one’s nonheterosexual feelings into one’s identity, which may not be true for adolescents and can vary across racial, ethnic, cultural, and socioeconomic identities. The stage models also assume that there is an end point in sexual identity development, where an individual has achieved the highest and healthiest level of identity formation. Other early theories developed by Anthony D’Augelli, Ronald C. Fox, Fritz Klein, and Robert A. Rhoads take into account sociocultural and life

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span contexts, which the earlier stage models did not. Few models address developmental characteristics of gay male adolescents, such as sexual experimentation, confusion about and changes in markers of identity, or earlier sexual debut. Moreover, the differences across the stage models indicate that using only one model to illustrate the development of sexual identity, a complex psychosocial process, is challenging.

Research Methods to Study Gay Male Identity Development Research examining gay male identity development may benefit from using different methods to overcome the challenges of earlier models and elicit more information on how gay men develop throughout adolescence and within various political and social contexts. Researchers have used the life history calendar method, which is a visual, calendar-based assessment of life events and behaviors attached to contextual cues. The life history calendar method can provide a framework to explore the complexities of gay male adolescents’ developmental, sexual, and gendered experiences. Furthermore, the early stage, life span, and nonlinear models highlighted engagement with gay culture. Given that there are neighborhoods and centralized spaces that support and embody gay culture, more attention should be given to how these spaces affect the development of gay men. There may be differences in gay male identity development for individuals who live in or near spatial settings that support and embody gay culture compared with those who do not live in those areas. Research has indicated that there are differences in substance use and sexual behavior for those who frequent these settings. However, with the use of social media and networking applications, this may be less critical. Studies have shown that social media and networking applications may facilitate the sexual identity development for gay and bisexual male adolescents by allowing them to communicate with, learn from, and find acceptance from other gay and bisexual men. Therefore, exploring spatial settings and social media and networking applications for gay men may provide more insight into understanding ­sexual identity development for this population.

Moreover, there is a growing body of research that studies gay men’s sexual desire, intimacy, and development through sexually explicit media (SEM). Studies that have examined the use of SEM on sexual development have shown that SEM may aid learning about sexual organs and functions, the mechanics of same-gender sex, and sexual identity negotiation. Also, SEM may help gay men develop sexual scripts and learn about sexual performance, sexual behaviors, (gendered) sexual roles and responsibilities, and affective models in sex. Considering the high use of SEM, researchers might enhance models and theories for gay male identity development by examining how these representations of gay men’s sexuality affect sexual experimentation, gendered preconceptions of sex, desires and motivations, attitudes, and risk behaviors. These and other methods may reveal to be useful for advancing knowledge on gay male identity development.

Language in Gay Male Identity Development Theory The term homosexual was used in the 1800s to categorize those who engaged in same-gender sexual behavior as sick or deviant. Over the years, the term homosexuality has been associated with sin, criminal behavior, uncleanliness, and mental i­ llness. One example of the negative use of this term by larger societal institutions is the inclusion of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Although homosexuality was removed from the DSM in 1973 as a specific mental illness, it was not until 1987 that all references to LGB sexual orientation were removed. During the 12th century, the word gay meant joyful, carefree, or bright and showy. However, during the early 17th century, the word started to become sexualized—associated with immorality or, according to the Oxford English Dictionary, being addicted to pleasures. In the 19th century, gay was used to refer to a woman who was a sex worker. A gay man was a man who slept with a lot of female sex workers. By the mid- and late 20th century, gay had shifted to mean a man who has sex with other men or a homosexual man.

Gay Male Identity Development

In the 21st century, gay typically means a homosexual man or a man who has sex with or is sexually intimate with other men; however, it has also come to signify culture and politics. An example of this is the House and Ball Community (HBC), which primarily consists of Black LGB, transgender, and queer people. The HBC began in Harlem, New York City, in the early 1900s, flourished during the 1960s, and has spread across the United States. The HBC consists of two primary features: (1) family-like structures called “houses” and (2)  competitive, performance-based “balls.” The houses adopt a family structure in which a House Father and House Mother mentor the remaining members (“children”) as they compete against other houses at balls. Members progress in status within the larger HBC (i.e., Stars, Legends, Icons) as they win category-based competitions that challenge or complicate U.S. sexual and gender norms. Another example is the 1969 Stonewall Riots. The Stonewall Riots were a series of political demonstrations that addressed homophobic, transphobic, and discriminatory policing practices. The demonstrations were led by LGBT community members in Greenwich Village, New York City, a predominately LGBT-friendly neighborhood. Also, the early HIV/AIDS activism in the 1980s and 1990s led by gay men is similarly emblematic of how gay men have culture and politics that inform their lived experiences. Therefore, the decision to use words such as gay and homosexual is important because they convey a sociopolitical and cultural history that informs how individuals understand themselves. Consequently, researchers may need to use new language to describe gay male identity development and even question if using words such as gay or male is referring to the developmental issues and behaviors they are examining or describing. Similar arguments have been discussed for the term men who have sex with men, or MSM. This term, which originated in the 1990s from epidemiologists who wanted to study the spread of disease among men who have sex with men regardless of sexual identity, emphasizes sexual and behavioral practices between men. However, it does not emphasize the political, historical, or cultural contexts or intimacies and pleasures that gay and bisexual men experience and navigate,

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which is important to their developmental and health outcomes. Language is cultural and political and is a part of the contexts, processes, and outcomes of gay men’s sexual identity development and the models and theories that are used to frame this development. When researchers are developing theories and models for gay men’s sexual identity development, it will be meaningful to ask if those theories and models are capturing what it means to be gay in specific contexts. To help avoid depoliticizing language in sexual identity theories and models, researchers should specify the goals and generalizability of their proposed theory or model. Research and theories have to account for the context and variability of language, particularly when they are generalizing sexual identity development theories across whole populations.

Intersectional Framework in Gay Male Identity Development Despite the practicality of stage models to describe sexual identity development, these models overlook differences within LGB groups that may influence or interact with sexual identity. Nonetheless, more research is being dedicated to understanding how LGB identity development occurs in relationship with and to other forms of identity. Gay men are not a monolithic group and differences across race, gender, class, culture, ability, and nationality may influence how gay men develop their sexual identities across their life span. Life span and other nonlinear models take into account how identity development occurs within sociocultural and life span contexts. However, these ­models may be challenging to apply if gay men are unable to find or become integrated into an LGB community that embraces the full scope of their identities. Moreover, the research that has developed the stage and life span models have mostly used White and male samples. Therefore, it is difficult and problematic to generalize these models to nonWhite or nonmale populations. Gay men of color may distance themselves from or not identity with mainstream White gay culture. Gay men of color may do this by choosing to identify using other terms, such as same-gender ­ loving, same-gender practicing, or two spirited, or

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by consciously or unconsciously placing their racial or ethnic identity in front of their sexual and gender identity (e.g., Black gay man compared with gay Black man; Filipino gay man compared with gay Filipino man). In addition, gay men of color may go through an active negotiation of blending or heightening their sexual, gender, racial, ethnic, or class identities in various spaces and contexts to avoid having their racial and ethnic identities lost within dominant White gay culture. Furthermore, stage, life span, and nonlinear models have assumed that an individual’s gender will remain consistent across their life span. However, researchers have demonstrated that people across all sexual identities, including gay men, may come to disidentify with the sex and gender they were assigned at birth and identify as transgender, gender nonconforming, genderqueer, or with other nonbinary genders later on in life. In addition, gay men’s sexual and gender identities are fashioned within a larger context of patriarchy, which privileges and gives power to binary conceptions of gender and the lives of men and masculinity. Gay men can perpetuate oppressions and hold positions of privilege, access, and power. Clearly, then, heterogeneity in identities, power, and privilege within gay male populations have the potential to affect sexual identity development. Intersectionality can be useful for understanding and exploring the multiplicity and complexity of gay men’s identities. Intersectionality is, in part, rooted in the writings of Black and Chicana feminist activists, many of them lesbian identified. Intersectionality, as an academic term, was initially coined by Kimberlé Crenshaw to refer to the sociopolitical position of Black women within U.S. ­culture within the context of critical race studies. This framework can help advance understanding of the range of human experiences for gay men by considering the various political and social categories that embody multiple identities. Utilizing an intersectional framework can be beneficial to ­ ­understanding how gay men develop their sexual identities across differences in identities, power, and privilege. Scholars such as Keith Boykin, Eli Clare, Rafael M. Díaz, Susan Raffo, Bianca D. M. Wilson, and Alex Wilson have discussed or investigated sexual identity development in gay men with this approach.

Directions and Stakes in Gay Male Identity Development The theories and models developed to describe sexual identity development in nonheterosexual populations have been used across different settings by researchers and practitioners to target gay male populations. Given this use, the stakes for researching and constructing theories and models that generalize developmental milestones and achievements are high. If a gay man does not meet or navigate their sexuality according to a sexual identity development model, should they be classified as dysfunctional or underachieved? If therapists, educators, policymakers, administrators, or anyone has the power to make that classification, what can psychologists do to ensure that gay men’s voices are being actively heard when these theories and models are developed? Will that theory or model be sufficient enough to account for the complexity of gay male identity development? Is that necessary when psychologists develop theories or models? These and other questions demonstrate the limitations in studying and explaining gay male identity development. It is not simple. Clarifying how a sexual identity development theory or model should be used is necessary to avoid misclassifying someone’s lived experience as dysfunctional. ­Furthermore, as this entry has demonstrated, there are various methods, considerations, and frameworks that can be utilized to improve how social scientists, including psychologists, study gay men’s sexual identities and their development across the life span. Kenneth M. Pass and Gary W. Harper See also Behavioral Theories of Gender Development; Gay Men; Gay Men and Gender Roles; Gender Development, Theories of; Homosexuality; Psychosexual Development

Further Readings Arrington-Sanders, R., Harper, G. W., Morgan, A., Ogunbajo, A., Trent, M., & Fortenberry, J. D. (2015). The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males. Archives of Sexual Behavior, 44(3), 597–608.

Gay Men Bailey, M. M. (2013). Butch queens up in pumps: Gender, performance, and ballroom culture in Detroit. Ann Arbor: University of Michigan Press. Bilodeau, B. L., & Renn, K. A. (2005). Analysis of LGBT identity development models and implications for practice. New Directions for Student Services, 2005(111), 25–39. Brown, J. D. (2002). Mass media influences on sexuality. Journal of Sex Research, 39(1), 42–45. Cass, V. C. (1979). Homosexuality identity formation: A theoretical model. Journal of Homosexuality, 4(3), 219–235. Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs, 38(4), 785–810. Collins, P. H. (2004). Black sexual politics: African Americans, gender, and the new racism. New York, NY: Routledge. Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989(1), 139–167. Fassinger, R. E. (1991). The hidden minority: Issues and challenges in working with lesbian women and gay men. The Counseling Psychologist, 19(2), 157–176. Fisher, C. M. (2013). Queering data collection: Using the life history calendar method with sexual-minority youth. Journal of Social Service Research, 39(3), 306–321. Frye, V., Egan, J. E., Van Tieu, H., Cerdá, M., Ompad, D., & Koblin, B. A. (2014). “I didn’t think I could get out of the fucking park”: Gay men’s retrospective accounts of neighborhood space, emerging sexuality and migrations. Social Science & Medicine, 104, 6–14. Harper, G. W., Serrano, P. A., Bruce, D., & Bauermeister, J. A. (2015). The Internet’s multiple roles in facilitating the sexual orientation identity development of gay and bisexual male adolescents. American Journal of Men’s Health, 10(5), 359–376. doi:10.1177/ 1557988314566227 Pingel, E. S., Bauermeister, J. A., Johns, M. M., Eisenberg, A., & Leslie-Santana, M. (2013). “A safe way to explore” reframing risk on the Internet amidst young gay men’s search for identity. Journal of Adolescent Research, 28(4), 453–478. Savin-Williams, R. C. (1988). Theoretical perspectives accounting for adolescent homosexuality. Journal of Adolescent Health, 9(6), 95–104. Ten Brink, C. J. (2012). Gayborhoods: Intersections of land use regulation, sexual minorities, and the creative class. Georgia State University Law Review, 28(3), 789.

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Tremble, B., Schneider, M., & Appathurai, C. (1989). Growing up gay or lesbian in a multiculutral context. Journal of Homosexuality, 17(3–4), 253–267. Troiden, R. R. (1979). Becoming homosexual: A model of gay identity acquisition. Psychiatry, 42(4), 362–373. Wilson, B. D. M., & Harper, G. (2013). Race and ethnicity in lesbian, gay and bisexual communities. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 281–296). New York, NY: Oxford University Press. Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95(7), 1144–1149.

Gay Men Same-sex relationships have occurred throughout history and across cultures. This entry presents scientific knowledge of gay men in contemporary society. Although the ways in which gay men are defined has varied over the 20th century, both by researchers and within gay communities, key commonalities and controversies are highlighted and described. Current knowledge is limited by the extent to which research has centered on the experience of gay men in North America, Europe, and Australia among primarily White, middle-class people. An accurate estimate of the number of gay men in society is difficult to ascertain, as the number can vary depending on how the question is asked, the degree to which the labeling is based on selfidentification versus sexual behavior, and the ­anonymity of the response. Furthermore, the percentage increases when the questioning is completely anonymous, such as with web-based data collection, and there is a strong generational effect, with larger percentages of younger individuals identifying as sexual minorities in recent national samples.

History of a Category Naming conventions for gay men have varied considerably over the past century, particularly as referred to by Western researchers. As the field of sexuality studies and psychiatry arose in the late

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19th century, a number of labels were promoted. Initially, researchers within the English-speaking world preferred the label “invert” or “sexual inversion,” as it captured the popular thinking that sexuality was a reflection of binary gender, and therefore, gay men were psychologically inverted— female minds within male bodies. Pioneering advocates within the gay community, such as Karl Heinrich Ulrichs, promoted their own, less pathologized terms, such as urnings. It was the work of Magnus Hirschfeld, an early sexologist as well as a gender and sexual minority rights activist, that promoted the use and eventual adoption of the term homosexual. The use of the word gay has a history separate from those debates among researchers and activists, however, and became commonly used within the community itself. As early as the 14th century, gay had acquired the connotation of moral licentiousness, which was sometimes applied to men we would now consider as gay; it has likely been used within the gay community for much longer than the past century. By the mid-20th century, this use of the word gay had crossed into popular speech, and by the 1970s, it was more commonly used to refer to an individual’s sexual orientation than to its prior uses referring to either a joyful state or gaudy and bright colors. Within the scientific literature, reference began to shift from “homosexual” to “gay men” in the 1990s and has been promoted by publishing ­standards within the American Psychological Association that encourage the use of community selfidentification. Since the 1990s, it has become increasingly preferred over previously common labels, such as homosexual, which has been deemed too pathologizing.

Pathology and Psychotherapy The belief that gay men reflected a psychological or biological feminization was the basis for institutionalization, experimentation, and psychotherapy over most of the 20th century. There were limited exceptions, such as Hirschfeld’s Institute for S­ exual Science in Berlin, which posited that being gay was an innate, natural expression of human sexuality. The political arm of Hirschfeld’s organization, the Scientific-Humanitarian Committee, inspired Henry Gerber to create the Society for Human

Rights, the first gay rights organization in the United States. These groups represented minority views, however, and by the 1930s, the Institute had been shuttered and much of its works destroyed by the National Socialists, and the Chicago Society for Human Rights was shuttered by the police department due to complaints by a founding member’s wife that it promoted deviant sexual practices. Attitudes elsewhere in Europe and North America tended toward disease models that required intervention for gay men. Early treatments ranged from psychoanalysis, which posited a desire for masculine men and identification with one’s mother as indicative of an inability to outgrow developmental fears of one’s father in early childhood, to suggestions that one practice or rehearse masculine behaviors such as hunting or sport. As the century progressed, these treatments became increasingly harmful to the gay men subjected to them. Numerous cases of lobotomy have been documented, as well as electroconvulsive therapy, both often in the context of involuntary hospitalization. Nazi doctors experimented with hormone injections under an assumption that gay men must lack the testosterone of their heterosexual peers. Faith-based programs have been documented into the 2000s in the United States that rely on the belief that gay men or boys are experiencing a failure of masculinity, often requiring extensive exercise and manual labor. Change began, in part, through the increasing visibility and activism of gay men. Until the 1950s, being publicly identified as a gay man could jeopardize one’s job, social standing, and familial relationships, and in many states, it could lead to arrest or harassment by the police or a violent public. Military bans on same-sex sexual encounters were strictly enforced. Bar raids were frequent in most major cities, and it was not uncommon for some gay men to be married to women and have children. “Homophile” organizations, such as the Mattachine Society, began to appear, though less for the purpose of fostering political change and more as secret societies that created space for safe and anonymous gatherings, free from the threat of arrest. Many global movements trace their beginning to the Stonewall Riots, which began on June 28, 1969, which shifted the dormant gay rights movement from one focused on seeking safety to

Gay Men

one oriented toward social change. The Stonewall Inn was raided, as many gay bars routinely were, and the patrons, including gay men, drag queens, transgender individuals, and gender nonconforming patrons, fought back against the police. In 1973, the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), in part inspired by Evelyn Hooker’s groundbreaking work with noninstitutionalized gay men. However, this did not immediately reduce the desire of psychotherapists to treat gay men. A study on gender nonconforming boys by Kenneth J. Zucker was used to suggest that enforcing gender conformity in play might reduce the likelihood of identifying as a gay male in  adulthood, though this study likely underestimated or neglected the long-term impact of parental correction of gender nonconforming behavior on subsequent coming out. Egodystonic homosexuality was also retained as a diagnosis in the DSM-III, and concepts such as “pseudohomosexuality” were introduced to attempt to account for increasingly visible gay men whose gender presentation was masculine, defying the stereotypic assumptions of many psychiatrists. Other mental health professionals were not accepting of this diagnostic change, or felt it premature, and the National Association for the Research and ­Therapy of Homosexuality (rebranded in 2015 as an institute with the Alliance for Therapeutic Choice and Scientific Integrity) was formed to promote the continued advocacy for the use of therapy for those distressed or dissatisfied with living as gay men. By the 1980s, however, mainstream psychiatric and psychological practice had largely given way to affirmative psychotherapy models that stressed the importance of an accepting and nonjudgmental stance toward the sexuality of gay men. Beginning in 2014, a number of states within the United States and some countries in Europe have banned or debated legislation to ban sexual orientation change efforts, and in 2015, one prominent faith-based group that offered support in sexual ­ orientation change efforts, Jews Offering New Alternatives for Healing, was found guilty of consumer fraud in New Jersey. Since 2000, U.S.-based organizations that continue to promote psychopathology models of

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homosexuality have shifted their focus abroad, as the changing climate within the United States has reduced the likelihood of a return to criminalization or active persecution. These primarily evangelical religious organizations have promoted pathology models of gay men primarily in Africa and eastern Europe. These activities have specifically been linked to the Ugandan “Kill Gays” bill, which has been resubmitted or proposed repeatedly in the 2010s, and copycat bills that have arisen in Nigeria, Kenya, and Zimbabwe. U.S. spokespersons for antigay faith-based groups, such as Brian Brown and Scott Lively, have also testified before the Duma in support of the increasingly oppressive antigay Russian laws. As a result, a historic ruling allowed for the case Sexual Minorities Uganda v. Scott Lively to move through the U.S. federal court system, where he has been charged with crimes against humanity under the Alien Tort Statute.

HIV/AIDS No account of gay men is complete without an exploration of the impact of HIV/AIDS. HIV, initially dubbed “gay cancer” or gay-related ­ immune disorder, rapidly spread through urban gay male communities in the early 1980s. After the development of an HIV test in 1982, it was estimated that most of the affected persons died within 2 years of diagnosis. Fledgling gay rights groups born in the 1970s either disappeared or the leadership became less dominated by gay men as lesbian community leaders fought to maintain their political gains while supporting gay men in this time of crisis and loss. Research into HIV/AIDS expanded the science of psychology both generally and specifically to gay men. Steve W. Cole’s landmark study linking more rapid disease transmission to not being out to one’s family helped establish the deep psychophysiological toll that concealment takes on gay men. The necessity of understanding how stigma affected sexual health, well-being, and disease risk built the architecture of contemporary research into minority stress and microaggressions. Furthermore, as HIV shifted its impact to increasingly affect gay and bisexual men of color, important research was funded to explore how cultural ­contexts intersected with the gay experience.

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HIV Among Gay Men of Color

There were challenges to the process of expanding research beyond urban, White gay men. ­Outside coastal urban enclaves and among some communities of color, public identification as a gay man was a prohibitive barrier for participation in research. In addition, a climate of bias and concern over research funds being spent on gay men led to the creation of the MSM or “men who have sex with men” label, placing the focus back on sexual behavior and erasing the cultural context of gay men. For a time, particularly in the late 1990s and early 2000s, there was a great emphasis on the idea of the “down low”—men of color, particularly Black men, having sex with men outside a primary relationship with women. While this fit some popular stereotypes of gay men of color, Black and White gay men appear equally likely to adopt, or in rare cases not adopt, the label “gay.” This misconception served to diminish the important presence of Black gay men in U.S. gay history, at a time when Black gay men are one of the fastest-growing groups of new HIV infections. New attention has been paid to the role of sexual racism in the gay community—attitudes ­ and stereotypes held by primarily White gay men that influence partner selection as well as social and sexual expectations. For instance, gay men of Asian descent are frequently stereotyped as being more effeminate, passive partners and may be more expected to be the “bottom,” or receptive partner, in anal sex. Black gay men are often stereotyped as hypermasculine ideals, expected to be the “top,” or insertive partner, and may be perceived as more promiscuous or sexually active. These stereotypes can also serve as drivers of the HIV epidemic. Black gay men, for example, engage in safer sexual practices at a higher rate than other ethnic groups, yet are at a higher risk of exposure to HIV due to the smaller pool of available sexual partners; sexual racism segregates Black gay men from the larger local community of gay men. Future Directions for Gay Men and HIV

HIV had a marked effect on how gay men thought of themselves and their lives. Long-term survivors and those whose experiences as gay men were largely shaped by the HIV crisis and their experience living with HIV formed tight bonds

and distinct social groups, both for support and as a buffer against HIV-related stigma among the broader community of gay men living without HIV. A number of major changes have occurred in the early 21st century that have shifted the ways in which gay men discuss and consider HIV. First, it has been more clearly established that sex with a gay man living with HIV whose viral load is stable and undetectable poses a negligible or no risk of transmission of the virus. Second, postexposure prophylaxis is a highly effective treatment to reduce the likelihood of seroconversion if begun within 72 hours of exposure to the HIV, expanding options beyond waiting and retesting after a feared exposure. Finally, and most dramatically, preexposure prophylaxis (PrEP) became widely available in North America in the 2010s, as well as in some parts of Europe. PrEP is a once-aday antiretroviral that when taken daily markedly decreases the likelihood of seroconversion when exposed to HIV. Early studies have suggested that PrEP does not affect current sexual behaviors. Some social commentators have noted that among gay men the availability of PrEP has reduced the segregation between communities of gay men that are HIV negative and those that are HIV positive.

From Criminal to Celebrated Relationships Sodomy laws have been common in Europe since the 11th century. When European colonies spread across the globe in the 14th century, legal codes were exported that criminalized homosexual contact. Gay sex was decriminalized slowly and piecemeal across Europe and North America. France became the first nation to do so in 1791, followed by England and Wales in 1861. In many nations, however, death penalties were replaced with hard labor or imprisonment, and only more gradually to no penalty and complete legalization. In the United States, sodomy laws were not overturned nationwide until a U.S. Supreme Court decision in 2003, when four states still specifically criminalized same-sex sexual encounters. Differences also exist in the application of the law toward gay men. For example, in Limon v. Kansas, a teenager was penalized for sex with a younger teenage boy because gay men are excluded from Kansas’s

Gay Men

“Romeo & Juliette” clause; despite a difference in age that would not have been legally punishable if they were a heterosexual couple, Matthew Limon spent more than 15 years in prison. An unknown number of men have been similarly penalized, entrapped, or in other ways prosecuted for crimes that exist only for gay men. Publicity around the life of British mathematician Alan Turing led to the posthumous pardon of his 1952 conviction for homosexuality in 2013. This created heightened publicity around the thousands of gay men still living in the United Kingdom whose convictions have never been pardoned. The legal status of gay men has changed significantly in other ways. In 2000, Vermont created the new legal structure of civil unions. In part, civil unions were a compromise; state courts had ordered the recognition of same-sex unions, though legal Vermont marriage licenses might compel other states to recognize those unions. In 2001, the Netherlands became the first nation to legalize same-sex weddings. Same-sex marriage was first legalized in the United States in Massachusetts in 2004 and then extended nationwide by a U.S. Supreme Court ruling in 2015. It is not yet clear what impact marriage will have on gay men. M. V. Lee Badgett’s research on marriage equality has suggested that the greatest impact is on the heterosexual majority, as the association of relationships between gay men or between lesbians with the word marriage appears to normalize these relationships, largely reducing levels of societal stigma. Within gay men’s marriages, differences appear to have been maintained that are distinct from the relationships of heterosexuals or lesbians. For instance, gay men are more likely to report sexual or romantic contact with partners outside their primary relationship, with only 36% responding that monogamy is an important aspect of a relationship. More studies are needed to see if this changes in the future or as a result of higher rates of gay parenting.

Resilience Among Gay Men As challenges have mounted or been overcome by gay male communities, some researchers have shifted their attention toward resilience. There are two lenses by which one can consider gay male resilience. One is through the lens of clinical

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intervention research, which has highlighted the importance of cultivating self-compassion and emotion regulation skills. Glenda M. Russell and Jeffrey A. Richards’s work has highlighted the broader social and communal factors that influence resilience within a homophobic society, which has yielded a helpful list of factors consistent with the clinical research. Resilience through a communal lens includes a sense of historical perspective of a collective movement toward seeking equal treatment; a willingness to confront one’s own shame and internalized homophobia; the expression of affect, particularly anger toward persecutory groups and sadness over community losses; successful witnessing, or the experience of hearing valued heterosexual family and friends offer support or act on behalf of sexual minority causes; and the opportunity for contact and connection within the community.

Conclusions Scientific research on gay men is growing, though as this review illustrates, the research that has been completed always occurs within a changing social context. Discrimination against gay men has lessened in some parts of the world, though significant challenges remain, and wealthy U.S. individuals with antigay bias have shifted their resources to the promotion of bias in Africa and Eastern Europe. The culture of gay men has been shaped by assumptions and stereotypes that conflate sexuality with gender nonconformity, or as a pathological process that represents a pathological deviation from normative heterosexuality. Societal changes in the late 20th and early 21st centuries have had a rapid impact on the lifestyles of gay men, as well as on the global discussion of how sexuality and gender relate. Marriage is also changing both the individual and the social experience of gay men in ways that have not yet been fully researched. Most research on gay men has been conducted in Europe and North America, which is an important limitation on the generalization of these findings. Much less is known about the experience of individuals from other cultures, as the gay men within many major global cultures have not yet formed a visible community or articulated those identities. Matthew D. Skinta

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See also Gay Male Identity Development; Gay Men and Dating; Gay Men and Gender Roles; Gay Men and Romantic Relationships; Sexual Orientation: Overview; Sexual Orientation Identity Development

Further Readings Drescher, J., Shidlo, A., & Schroeder, M. (2002). Sexual conversion therapy: Ethical, clinical and research perspectives. Boca Raton, FL: CRC Press. Faderman, L. (2015). The gay revolution: The story of the struggle. New York, NY: Simon & Schuster. Halkitis, P. N. (2013). The AIDS generation: Stories of survival and resilience. New York, NY: Oxford University Press. Katz, J. (1992). Gay American history: Lesbians and gay men in the U.S.A: A documentary history. New York, NY: Plume. Patterson, C. J., & D’Augelli, A. R. (2012). Handbook of psychology and sexual orientation. New York, NY: Oxford University Press. Richards, C., & Barker, M. J. (2015). The Palgrave handbook of the psychology of sexuality and gender. Basingstoke, England: Palgrave Macmillan.

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Dating

As lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities have become more visible and less stigmatized in society, there has been an  increase in scholarship involving gay men’s behavior—including gay men’s relationship, dating, and sexual practices. While gay men’s dating relationships have many of the same qualities as heterosexual pairings, there are many unique challenges that gay men may experience in dating.

Dating Landscape The normalization and acceptance of gay male dating patterns are still relatively new, as it was not until recent years that gay men (and other LGBTQ people) were even allowed to proclaim their sexual orientation identities. Prior to the Stonewall Uprising in 1969, most gay men convened in secret places (e.g., bars, basements) that were often raided by police officers. Even after Stonewall, clubs and bars that were deemed gay bars were stigmatized and vandalized. Although gay dance

clubs and bars began to emerge in every metropolitan city and many smaller towns in the 1990s, there were many gay men who did not feel comfortable in seeking these spaces. With the emergence of HIV/AIDS in the 1980s and 1990s, there was also an increase of research on men who had sex with men (MSM). Today, MSM refers to men who identify as gay, bisexual, or heterosexual and engage in male-to-male sexual behavior. MSM includes men who are “out” with their sexual orientation identities in all aspects of their lives as well as those who are discreet and engage in same-sex sexual behavior while living seemingly heterosexual lives. In present times, a multitude of gay men use social media on the Internet and mobile dating applications (apps) such as Grindr and Scruff to interface with potential partners for dating, relationships, and sex. These technological advances are building communities that facilitate connections that have superseded traditional cultural landscapes within gay men’s communities. Research has indicated that online use among MSM has been associated with HIV risk behaviors such as greater number of multiple/anonymous sexual partners, higher rates of condomless anal sex, higher diagnoses of sexually transmitted infections (STIs), and increased rates of substance use in connection with sex.

Sexual Health Decisions Regarding HIV and other STIs, dating poses complex sexual health decisions for MSM. There are three types of couples or dating relationships based on HIV status: (1) HIV-concordant negative couple/ dating relationship (i.e., partners in a relationship are HIV negative), (2) HIV-concordant positive couple/dating relationship (i.e., partners in a relationship are HIV positive), and (3) HIV-discordant couple/dating relationship (i.e., one partner is HIV negative, while another is HIV positive). P ­ revention efforts have indicated that mutual monogamy with an HIV/STI-uninfected partner in a longer-term relationship reduces HIV/STI transmission risk. Mutual monogamy refers to the agreement between sexual partners that they both will be sexually active only within the relationship. Mutual monogamy is contingent on requisite accurate knowledge and communication (e.g., HIV/STI

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disclosure) about the HIV/STI status (i.e., HIV/STI infected or HIV/STI uninfected) of sexual partners and informed by HIV/STI testing. Prevention efforts have also focused on the development and utilization of sexual agreements within relationships among MSM. For example, while sexual agreements vary across relationships, one common threshold involves how sex will be negotiated within and outside of one’s relationship. For example, some couples or partners in a dating relationship may decide to have condom-less anal sex only within the relationship, which forms the basis of the sexual agreement. Others may decide to have condom-less anal sex within the relationship, but if a partner decides to have sex with a sexual partner outside of the relationship, then condoms will be used during sex.

(i.e., receiving a penis in the anus by a sexual partner) during anal sex without a condom with an HIV-uninfected male partner. Withdrawal before ejaculation during anal sex without a condom with sexual partners is another form of HIV risk reduction that has been used among MSM. To be effective, these partner selection strategies must be based on accurate knowledge of the HIV status of oneself and one’s sexual partners. In addition, communicating with a sexual partner about one’s HIV status (i.e., HIV disclosure) is germane to making decisions about the types of sexual practices that one will engage in with a sexual partner. With increasing rates of HIV and other STIs among MSM, these sexual partner selection strategies must also be based on frequent HIV and STI testing.

Sexual Partner Selection Strategies

Couples Testing and Counseling

Within dating relationships, sex is one core ­element that MSM have to consider as a component of sexual health. In this regard, MSM have utilized sexual partner selection strategies as a form of HIV risk reduction. These sexual practices have emerged organically within gay men’s communities in response to the AIDS epidemic. Serosorting and strategic positioning are two widely used sexual partner selection strategies used by MSM. Serosorting involves the selection of a sexual partner to engage in anal sex without a condom based on the perceived or actual HIV status of a sexual partner or information about HIV transmission risk. Based on this logic, HIV-infected men may have anal sex without a condom with other HIV-infected men and use condoms with HIVuninfected men as a form of HIV risk reduction. HIV-uninfected men may have anal sex without a condom with other HIV-uninfected men and use condoms with HIV-infected men as a form of HIV risk reduction. Strategic positioning refers to when a man engages in a sexual position during anal sex with a man without a condom based on a sexual partner’s perceived or actual HIV status. For example, an HIV-uninfected man may assume a top or insertive role (i.e., placing his penis in the anus of a sexual partner) during anal sex without a condom with an HIV-infected male partner, or an HIV-infected man may assume a bottom or receptive role

Based on the aforementioned considerations, couples HIV testing and counseling (CHTC) is available for couples or people in dating relationships who are interested in testing for HIV together. CHTC is a process by which two or more partners who intend to or who are currently in a sexual relationship have HIV testing and counseling together. For example, sexual partners receive HIV prevention counseling, delivery of HIV test results, and linkage to follow-up care and services together. Some of the benefits of CHTC include the building of social support within the context of the relationship related to HIV testing, HIV disclosure, and the development of relationship sexual agreements as well as risk reduction plans.

Additional Considerations Finally, there have been increasing studies examining how race, size, age, and other identities influence dating processes for gay men. In using the Internet and the mobile dating applications, many men of color (e.g., Asian Americans, African ­Americans) report being discriminated by White men who do claim that they have a “preference” to only date other White men. Men of color also report that other men of color (often of their same racial group) also interact in similar ways—­ demonstrating their desires to only date or engage in sexual activities with White men. Men of size

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report ­similar sentiments, in that they are often rejected because of their weight or body type. Feminine men also report similar instances, particularly by gay men who are interested in dating only “real men.” A popular phrase that has been used to capture these biased trends in gay male communities is “No Fats, No Femmes, No Asians, No Blacks.” People who identify with these groups (or the intersection of two or more of these) may feel undesirable or unwanted, which may have an effect on their self-esteem or internalized oppression. Leo Wilton See also Gay Men; Gay Men and Health; Gay Men and Romantic Relationships; HIV/AIDS

Further Readings Han, C. S., Ayala, G., Paul, J. P., Boylan, R., Gregorich, S. E., & Choi, K. H. (2015). Stress and coping with racism and their role in sexual risk for HIV among African American, Asian/Pacific Islander, and Latino men who have sex with men. Archives of Sexual Behavior, 44, 411–420. doi:10.1007/s10508-0140331-1 Hirshfield, S., Grov, C., Parsons, J. T., Anderson, I., & Chiasson, M. A. (2015). Social media use and HIV transmission risk behavior among ethnically diverse HIV-positive gay men: Results of an online study of three U.S. states. Archives of Sexual Behavior, 44, 1969–1978. doi:10.1007/s10508-015-0513-5 Wilton, L., Koblin, B., Nandi, V., Xu, G., Latkin, C., Seal, D., . . . Spikes, P. (2015). Correlates of seroadaptation strategies among Black men who have sex with men (MSM) in 4 US cities. AIDS & Behavior, 19, 2333–2346. doi:10.1007/s10461-015-1190-z

Gay Men

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Feminism

Feminism is a social movement that advocates for equality and equity within the context of political, social, and economic areas—foremost for women but inclusive of everyone. Early feminists questioned the role of men in feminism, expressing concern that men, with their privileged gender identities within a patriarchal society, would usurp power from the feminist movement. Yet more

liberal feminists have argued that not all men have equal access to male privilege and may benefit from feminism. The topic of gay men and feminism relates to psychology and gender in that it explores the sociopolitical feminist movement as well as the ways in which it has influenced gay men across different contexts to deconstruct their perceptions of masculinity and advocate for equality. To date, the discourse of gay men and feminism has been limited to the gay rights movement, gay men in academia, and gay men in feminist psychotherapy, which are discussed below.

Male Privilege and Feminism Before delving into the feminist contexts in which gay men operate, it is important to consider the construct of male privilege for gay men. Access to male privilege can vary depending on factors such as race, class, disability status, sexual orientation, and gender identity and expression. Gay men are male bodied and may have masculine traits, yet their preference for same-sex partners renders them unqualified for full male status under a maledominated gender binary. For many sexual minority men, supporting the feminist movement allows them to transcend dominant masculine ideals and redefine manhood. A consistent theme for gay men who align with feminist ideals is that it creates a sense of empowerment to challenge oppressive power structures of heterosexism. The experience of being a gay male feminist is a unique intersection of feminism and men’s issues that is explored in this entry.

Gay Rights Movement First, the history of the gay rights movement has roots in feminism, specifically with the Stonewall Riots and the Gay Liberation Front in the 1960s and 1970s. During the early gay rights movement, there was an emphasis on examining the systemic oppression of gays and lesbians, a critical analysis of gay oppression and sexism, and a commitment to sociopolitical change through activism (a core tenet of feminism). The central principles of the gay rights movement during this time period reflect a strong feminist doctrine. The feminist and gay rights movements share a common oppressive force—the patriarchal system

Gay Men and Feminism

that imposes a power structure where men are privileged compared with women and heterosexual men are privileged compared with gay men. In addition, the power structure supports a narrow conceptualization of masculinity and gender that is usually not inclusive of the experiences of gay men. This power structure creates similar, though not identical, forms of oppression—­ sexism, for women, and heterosexism, for sexual minority individuals. The feminist and gay rights movements are ultimately working toward a similar goal—gaining equity and equality for their marginalized identities.

Gay Men in Academia Furthermore, gay men have found a space in feminist and women’s studies departments mainly because they are able to deconstruct the sex-gender binary in a safe space free of phallocentric privilege. Women’s studies and feminist courses encourage the creation of spaces to explore the experience and understanding of marginalized identities (i.e., gender and sexual orientation). Feminism provides a theoretical lens to dismantle the dominant power structures that serve to subordinate and marginalize women and other stigmatized groups, as well as develop strategies to create power equity. Yet ­others have argued that gay men will never truly be accepted in feminist and women’s studies departments given the inherent gender difference and the associated gender privilege of being a man. Theorists describe a fine line between working with women to transform the patriarchy and decentralizing women from the focal point of feminist and women’s studies.

Gay Men and Feminist Psychotherapy Similarly, within the context of psychotherapy, gay men have served as therapists who operate from a feminist theoretical orientation and as clients seeking feminist psychotherapy. A feminist psychotherapist can be described as an individual who aligns their therapy approach with a feminist value system—viewing the personal as political, promoting an egalitarian relationship, working toward social change, and acknowledging and analyzing sociocultural-political forms of oppression. In one qualitative study, by Kathleen Baird, Dawn

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Szymanski, and Sara Ruebelt, examining feminist identity development among 12 feminist male therapists, three noted that their feminist identity was strongly tied to their sexual minority identity (i.e., being gay). The gay male therapists reported a fit between their perceived marginalized identity within the context of a heterosexist society and the ideals of feminism. In particular, they shared that feminist therapy values empowered them to challenge the power structures of oppression in their own lives and in therapy with their clients. Moreover, gay male clients have reported benefiting from feminist psychotherapy in that this approach allows them to further explore the social construct of gender in their lives. Some authors have argued that heterosexism is a form of sexism that further enforces the gender binary and has detrimental effects on mental health. In addition, traditional diagnostic criteria that have perpetuated the marginalization of women’s experiences are also thought to negatively affect diverse men. Therefore, using a nonpathologizing approach can further develop feelings of empowerment. Finally, the scarcity of literature regarding gay men and feminism suggests a lack of understanding, as well as potential mixed feelings, regarding the role of gay men in feminism given their inherent gender privilege. Yet feminism can help gay men reevaluate traditional forms of dominant masculinity, serve as allies for gender sex rights, and fight societal patriarchy. Feminism seeks to assist all men, including gay men, to construct new ways of understanding their masculinity while developing an increased awareness of their unearned privilege as men in a patriarchal society. Clearly, additional exploration of the intersection of being a gay man within a feminist context is warranted. David G. Zelaya and Cirleen DeBlaere See also Feminism: Overview; Feminist Psychology; Feminist Therapy; Gay Men and Feminism; Gay Men and Gender Roles

Further Readings Alilunas, P. (2011). The (in)visible people in the room: Men in women’s studies. Men and Masculinities, 14, 210–229. doi:10.1177/1097184X11407047 Baird, M. K., Szymanski, D. M., & Ruebelt, S. G. (2007). Feminist identity development and practice among

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male therapists. Psychology of Men & Masculinity, 8, 67–78. doi:10.1037/1524-9220.8.2.67 Kahn, J. S. (2011). Feminist therapy for men: Challenging assumptions and moving forward. Women & Therapy, 34, 59–76. doi:10.1080/02703149.2011.532458 Murphy, M. J. (2011). You’ll never be more of a man: Gay male masculinities in academic women’s studies. Men and Masculinities, 14, 173–189. doi:10.1177/ 1097184X11407045

Gay Men

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Gender Roles

Social, cognitive, feminist, and queer theoretical frameworks all account for various aspects of gay men’s gender roles. Although these different theoretical perspectives are beyond the scope of this entry, their implications are synthesized in this discussion to account for gay men’s gender roles. This entry briefly defines gender roles and describes the influence of gender role orientation on r­ omantic relationship functioning and career development. Last, this entry discusses the interaction of gender role conflict and its consequences for gay men.

Gender Role Orientation Gender roles are ecologically prescribed beliefs, expectations, and standards that reinforce genderrelated attitudes and behaviors. Gender roles are often viewed within the dimensions of masculinity, femininity, and androgyny. Gender roles also function as a psychological script that dictates the manner in which one navigates one’s life span (e.g., childhood, adulthood, older adulthood) and psychosocial developmental tasks (e.g., education, occupation, romantic relationships) as well as how one interacts with other people (e.g., assertive or passive communication). Gender role socialization processes and expectations have the potential to establish salient social and cultural norms for gay men. Regardless of culture, race, ethnicity, or ability status, Western ­ culture (among others) dictates that men are expected to be physically strong, dominant, competitive, and aggressive. When a man fails to adhere to these prescribed ideals or exhibits characteristics contrary to those expected by society, he will likely experience a diminished sense of masculinity.

Gender roles are also associated with how one expresses one’s sexuality and sexual orientation. Gay men, like any group of men, are likely to express their gender roles across various levels of masculinity, femininity, and androgynous dimensions. However, gender roles and sexuality are often conflated and obscured for one another. Men who are perceived to violate the traditional cultural norms of masculinity are often thought to be gay, whereas men who are perceived as overly masculine are thought to be heterosexual. However, gay men can present as masculine, and h ­ eterosexual men can present as feminine. Furthermore, gender role– related stereotypes against gay men implicitly support aspects of gender inversion theory, which is the perception that gay men act more like heterosexual women. Besides being a harmful and defeating stereotype on gay men, this perception reinforces hegemonic masculinity as the standard for all men’s gender expressions. In turn, this places considerable stress and pressure to perform as per one’s expected gender, regardless of sexual orientation.

Gay Men’s Romantic Relationships and Careers Romantic relationships and careers are two particular life arenas in which gender roles could affect gay men during adulthood. Whereas traditional gender roles may ascribe how heterosexual couples are likely to behave and relate to each other in their romantic relationships, traditional gender role expectations are not always tenable among gay men in same-sex relationships. For instance, gay men in same-sex relationships are likely to value egalitarian divisions in housework, parenting, and caretaking and do not rely on traditional gender role division in their romantic r­elationships or households. Research has also indicated that gay men in same-sex relationships are more likely to stress equity and fairness, while expressing adequate levels of tenderness, compassion, and warmth toward their romantic partner. Another common misconception is that gay men are more likely to be employed in professions that have been stereotyped as feminine (e.g., beautician, flight attendant, nurse). Instead, gay men are likely to be employed across a variety of professions. In some instances, gay men may perceive more diverse career-related options as a result of

Gay Men and Health

not adhering to traditional gender roles. Relatedly, heterosexism, discrimination, and sexual prejudice are contextual factors that have been known to influence gay men’s career choices. As such, certain professions may be avoided as a result of potentially experiencing homophobia, discrimination, or being harassed for not conforming to traditional gender roles (e.g., law enforcement, military).

Gender Role Conflict Gender role conflict occurs when a man restricts and devalues himself and others for not adequately conforming to the cultural ideals of masculinity. Gender role conflict has also been ­ operationalized as a failure to integrate socially acceptable masculine gender roles into one’s own life. According to the leading scholar Jim O’Neil, there are four dimensions of gender role conflict for men: (1) a focus on achievement, competition, and dominance; (2) avoidance of being perceived as emotional, which is usually accomplished through suppression of emotion; (3) restriction of affectionate behavior, especially toward other men; and (4) conflict between work and family. Similar to heterosexual men, gay men are likely to experience gender role conflict, and violations in gender role expectations have been shown to result in negative experiences for gay men. For instance, gay men exhibiting atypical gender role attributes may be subjected to harassment, violence, discrimination, and stigma. Research has indicated that gay men who experience high levels of gender role conflict report higher incidences of psychological maladjustment, including loneliness, depression, lower self-esteem, and general distress. Among gay men, gender role conflict is associated with certain high-risk sexual behaviors, body image concerns, and internalized heterosexism. In some circumstances, gay men who experience gender role conflict might also engage in more compensatory behaviors to ameliorate gender role violations (e.g., competitiveness in terms of body image or disordered eating habits). Franco Dispenza and Cory Viehl See also Gay Male Identity Development; Gay Men and Dating; Gay Men and Romantic Relationships; Masculinity Gender Norms; Masculinity Threats; Sexual Orientation Identity Development

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Further Readings Blashill, A. J., & Hughes, H. M. (2009). Gender role and gender role conflict: Preliminary considerations for psychotherapy with gay men. Journal of Gay & Lesbian Mental Health, 13, 170–186. doi:10.1080/ 19359700902914300 Blashill, A. J., & Powlishta, K. K. (2009). Gay stereotypes: The use of sexual orientation as a cue for genderrelated attributes. Sex Roles, 61, 783–793. doi:10.1007/s11199-009-9684-7 Dispenza, F. (2015). An exploratory model of proximal minority stress and the work-life interface for men in same-sex, dual-earner relationships. Journal of Counseling & Development, 93(3), 321–332. doi:10.1002/jcad.12030 O’Neil, J. (2008). Summarizing 25 years of research on men’s gender role conflict using the gender role conflict scale: New research paradigms and clinical implications. The Counseling Psychologist, 38, 358–445.

Gay Men

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Health

Gay men are male-identified individuals who have an attraction toward other men and develop a sexual orientation that celebrates this identity. As a group, gay men cope with unique health concerns and experiences health disparities that make them more likely to have to deal with psychological, social, sexual, and physiologic/pathogenic problems (e.g., depression, addiction, relationship dysfunction, and, most notably, HIV and sexually transmitted diseases [STDs]). This entry provides a brief historical context to gay men’s health, delves into the distinctive problems that disproportionately affect this group, reviews the demographic and social moderating factors that increase the severity of conditions, and concludes with future directions of study.

Historical Perspectives of Gay Men’s Health Homosexuality, particularly between men, has been historically met with religious, social, and institutional disapproval and punishment. With few exceptions, societies have treated men who are attracted to and/or have sex with other men as outcasts, deviants, criminals, and sociopaths. In

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fact, from the inception of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an international medical tool in 1953 until its 1974 (DSM-II) update, homosexuality was initially listed as a “sociopathic personality disturbance” and in 1968 as a “sexual deviance.” The treatment to “cure” this disturbance/deviance was often a combination of electroshock therapy, aversive conditioning, and even chemical castration. Increases in research into sexuality and sexual orientation and changing sociopolitical and medical climates helped demedicalize homosexuality; however, it was not until 1986 that homosexuality was removed entirely from the DSM-III. This time line should contextualize the relative newness of gay men’s health as a field of interest for psychologists, public health researchers, and other clinicians. With few exceptions (e.g., Alfred Kinsey, Williams Masters, Virginia Johnson), those initially interested in gay men’s health were interested only in curing the men of their homosexuality. Shortly after this demedicalization, the HIV/ AIDS epidemic emerged, disproportionately affecting gay and bisexual men. The disease ironically led to dramatic breakthroughs into gay men’s physiological and psychological health, even while it killed hundreds of thousands of sexual minority men. HIV/AIDS (and its earmarked research funding) is still responsible for generating most of the new research into gay men’s health, as either a primary or a secondary aim. Other historic impetuses have advanced research and knowledge into gay men’s health beyond HIV/AIDS. The gay rights movement, which arguably started in 1969 with the Stonewall Riots in New York, not only contributed to the demedicalization of homosexuality but also facilitated (and continues to facilitate) societal acceptance toward gay men and the destigmatization of homosexuality. The movement has made it increasingly easier over the decades for gay men to live, live openly, be in relationships, and even get married. With more positive social attitudes and less stigma, researchers are freer to conduct more in-depth studies and be received by a gay male population that is more trusting toward scholarly inquiry. So while there has been a checkered past between gay men and medical institutions, clinicians, and researchers, there has also been a dramatic increase in expedited, high-quality health

research to compensate for years of ignorance and marginalization.

Gay Men’s Health Disparities Researchers have identified specific health problems and needs unique to gay men, as compared to other sexual minorities and heterosexual men and women. Four areas have emerged as particularly impactful toward the well-being and health of gay men: (1) social adjustment and relationship foundation, (2) mental health and addiction, (3) HIV/​ AIDS and STDs, and (4) access to health care. Social Adjustment and Relationships

Gay men (and other LGB people) have generally been accepted by mainstream society. As of 2016, same-sex couples are permitted to marry in 21 countries around the world, including in the United States. This means that at an institutional level, there is virtually no distinction between heterosexual and homosexual relationships. Past research (i.e., studies that predate the dramatic increase in tolerance toward homosexuality) has shown gay men to report substantial issues with adjusting to living in a heterosexual world. The obvious manifestations included not allowing those in one’s social group to acknowledge the sexual minority status; not being able to “come out” as being gay; having strained relationships with family, coworkers, and even friends; and, as a corollary, potentially, having to feign living as a heterosexual man (which may include dating/marrying women). Moreover, gay men self-reported inconsistent ­perceptions of social, familial, and peer support, including discomfort with interacting with ­heterosexuals; reported that heterosexuals feel uncomfortable comingling with gay individuals; and even documented hate crime–related violence and assaults. It is not yet known whether the increased societal tolerance has any moderating impact on these outcomes. Further research that accounts for social maturation in ­tolerance is needed. Interpersonal romantic problems may be disproportionately impactful for gay men as well. First, there exists the inherent problem of finding other men to engage with interpersonally, romantically, and sexually when accounting for the sheer scarcity of gay men relative to the general

Gay Men and Health

population. Although the Internet has made social connections exponentially easier, for many gay men living in sparsely populated areas, the closest romantic option may be counties away. In addition, some gay men report more difficulties developing romantic relationships. While it is true that gay men report high numbers of sexual partners, the likelihood of a transition from sexual partner to romantic and sexual partner is often low. Some gay men choose not to adhere to heterosexual norms of monogamy by living sexually free lives, which some view as a characteristic of being male (i.e., evolutionarily predisposed toward wanting as many sexual partners as possible). For gay couples who are committed and practice monogamy, issues of jealousy, trust, honesty, and communication may emerge more readily, often and earlier in the relationship. Other gay couples may conform to heterosexual norms and relationship practices (e.g., monogamy, marriage, raising children), which often results in similar relationship conflicts faced by heterosexual couples, including issues related to intimacy, sex, trust, and communication.

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penetrative behaviors in which they engage. As mentioned, all men desire an increased number (and diversity) of sexual partners, regardless of sexual orientation. Among heterosexuals, social and evolutionary norms act as limiting factors for men to actualize all of their desires. Research shows that the average gay man is not limited by heterosexual factors, and there exist norms that reward, instead of penalize, frequent sexual behavioral enactment with multiple partners. In addition, gay men tend to have the riskiest sex with respect to STD/HIV infection. Viral and bacterial transmission happens when body fluids (e.g., mucous, seminal fluid/semen, blood) are exchanged. Having physiologically traumatic sex (i.e., insertive/ receptive anal intercourse) maximizes the likelihood for any or all fluids to comingle and lead to infection. These two factors coalesce (i.e., high numbers of partners engaging in traumatic sex) to create an ideal climate for transmission to occur. Condom use and risk-reducing sexual behaviors have been previously promoted interventions for gay men to reduce the spread of HIV and other STDs. These strategies have had mixed success. However, a new biomedical intervention to prevent Mental Health and Addiction HIV transmission and infection has been touted as a game-changing method that could dramatically In part and as a function of some of the social halt the spread of HIV—preexposure prophylaxis adjustment and relationship issues previously (PrEP) for HIV-negative men and treatment-asaddressed, gay men are noted to have an increased prevention (TasP/TaP) for HIV-­positive men. PrEP prevalence of social anxiety, depression, suicidal is a dual-drug regimen of tenofovir and emtricideation, and gender dysphoria/gender identity itabine, taken once a day at a s­imilar time, to act disorder. Gay men have been found to fall victim as a viral replication inhibitor. The virus cannot to addiction and dependency, in particular comtake hold in HIV-negative individuals when PrEP pulsivity toward illegal and legal narcotics, tobacco, is taken as directed. TasP/TaP is a plan to identify alcohol, and sensation-seeking behaviors such as HIV-positive men and start them on an approprisex. Many of these psychological problems and ate regimen of antiretroviral therapies to reduce behavioral issues are manifestations of low selfesteem, perceptions of low self-worth, self-­ the viral load in their blood to undetectable limits. Undetectable men are extremely unlikely to transdissatisfaction, and an inability to fit into groups mit the virus to others. With these tools (i.e., PrEP or develop meaningful social support. and TasP/TaP), HIV is attacked from both the transmission and the contraction sides. Note, these Increased Risk for HIV/AIDS and STDs biomedical options do nothing to prevent all other STDs, which have been on the rise in gay men Perhaps the most recognized health disparity to since the introduction of strategic antiviral use. affect gay men is an increased risk for STDs (most notably, HIV infection). This disparity is not a function of sexual orientation per se. It is rather a Access to Health Care result of the increased number of sexual partners The success of PrEP and TasP/TaP hinges on gay gay men accrue over time, the inconsistency with men’s education about these strategies and health which they practice condom use, and the sorts of

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care providers’ knowledge to test for HIV and ­prescribe antiretroviral therapies as needed. Therefore, access to health care institutions is paramount. The previous attitudes and behaviors of health care providers toward their gay clientele notwithstanding, there continue to be issues in the access to, and treatment by, physicians, nurses, and other medical providers. Discrimination and other instances of problematic patient-provider interactions (e.g., curtness, not wanting to physically touch a patient, dismissiveness) remain a theme reported by many gay men, particularly those who are gender atypical or who have providers who are uncomfortable or unfamiliar with minority sexual orientations. Negative health care experiences lead  to patient distrust, institutional avoidance, and patient noncompliance/treatment adherence. Future research will have to identify if the greater social tolerance toward homosexuals has or has not infiltrated the clinical medical field.

Moderators of Gay Men’s Health Issues Gay men often are treated as a homogeneous group when compared with heterosexuals or other sexual minorities by epidemiologists and health care providers. However, dramatic differences exist within the gay male demographic regarding individual health. Age, distance to a population center, and race/ethnicity and culture can amplify the severity of the problems and decrease the likelihood of quality health treatment. Age

Gay men face different health disparities throughout their life span. However, gay youth have been documented as most likely to experience problems. Psychological adjustment, social support, social anxiety, suicidal ideation, homelessness or alienation from the family, and violence are only a sample of problems that tend to affect men who are adolescents and young adults. As a function of some of these problems, drug use and abuse can also be more prevalent. From a public health perspective, HIV/STD infection remains dispro­ portionately high among young men. This is, in part, due to their inexperience with partners, poor sexual communication self-efficacy, and sexual naivety, but more important, this may be a

symptom of child/adolescent public and private school health education programs rarely accounting for minority sexual orientations and their unique needs. While some youth grow out of these problems by finding positive social and institutional outlets, others do not. Geographic Location

Urban centers serve as popular hubs for sexual minority populations such as gay men. While such hubs create a sense of community and allow health services to aggregate to solve localized gay men’s health problems, they can allow health problems (usually STDs or hate crime violence) to equally localize. However, urban centers still provide a far more positive environment for gay men from both a social and a sociomedical perspective (i.e., better social adjustment, fewer perceptions of stigma, better access to compassionate health care ­systems). Rural communities, at a minimum, will naturally produce gay youth as a function of homosexuality being a biological outcome. Yet some gay men choose to stay in, or move to, rural areas as well. Rural (and even suburban) gay youth have amplified mental health problems stemming from alienation, bullying, poor family acceptance, and poor access to other sexual minority social support systems. Older gay men in rural or suburban areas report problems in social and romantic connectedness. It must be conceded that gay men living in rural or suburban areas are less likely to encounter HIV/STDs, incidentally due to their connection issues. However, trading off sexual isolation for a decreased likelihood of acquiring HIV has its own social health implications. Although the Internet has helped decrease the social distance that gay men in rural or suburban areas used to report as severe, geographic location remains an important variable when dealing with gay men’s health. Race, Ethnicity, and Culture

The most influential, interrelated moderators over gay men’s health are race, ethnicity, and ­culture. This may be a bold statement; however, studies have consistently shown that these variables almost always provide three-way moderation, whereby the problems associated with

Gay Men and Romantic Relationships

markers such as age or rural location are further amplified if the gay men are also of color. This is, to some degree, a branch off of the macrolevel problem of institutional health and social prejudice that exists in all countries with minority populations. Individuals of color, despite sexual ­ orientation, report a higher prevalence of most health problems. These general health disparities come from lower socioeconomic status/higher poverty, poor access to education, distrust of health institutions, and less social pressure to stay healthy. Moreover, when sexual orientation is intersected with race/ethnicity and culture, particularly for gay men, social support may be weakened even more. Homosexuality is less tolerated among minority populations, particularly for minority/cultural populations that are seeded in religiosity or traditional “family values.” Such social climates make sexual orientation concealment more likely, which all but guarantees the concealment of individual health problems. It is for this reason that many of the newer health interventions and initiatives focus on gay men of color, who are documented as most in need of medical services attentions.

Research Directions The most promising future direction for research into gay men’s health is work that promulgates the education of, and adherence to, PrEP/TasP/TaP. Short of a vaccine, this seems to be the best biomedical tool to eliminate the spread of HIV ­ between sexual minority men in our time. The advancement of sexual minority rights opens the door for research on the changing attitudes of heterosexuals and how this new tolerance is i­ mpactful. Studies might see if there is a decreased prevalence of gay men’s mental health issues (e.g., social anxiety, depression) or gay youths’ perceptions of alienation and fear, or even how the ­ability to get legally married improves the general health of married gay men (as it does for heterosexuals). To evolve as a mentally and physically healthy society, no p ­erson’s health—gay or straight—should be marginalized. David A. Moskowitz See also Body Image Issues and Men; Coming Out Processes for LGBTQ Youth; Couples Therapy With

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Same-Sex Couples; Depression and Men; Evolutionary Sex Differences; Gay Men; Gay Men and Dating; Gender Dysphoria; Gender Nonconforming People; HIV/AIDS; Lesbian, Gay, and Bisexual Children; Racial Discrimination, Sexual Orientation–Based; Sexuality and Men

Further Readings Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe, S. E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84(1), 35–45. Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H. J., Lehavot, K., Walters, K. L., Yang, J., . . . Muraco, A. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653–663. Grov, C., Whitfield, T. H., Rendina, H. J., Ventuneac, A., & Parsons, J. T. (2015). Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS and Behavior, 19(12), 2234–2244. doi:10.1007/s10461​ -015-1030-1 Harvey, V. L., & Housel, T. H. (Eds.). (2014). Health care disparities and the LGBT population. Lanham, MD: Lexington Books. Kus, R. J. (2014). Addiction and recovery in gay and lesbian persons. New York, NY: Routledge. Mitchell, J. W. (2014). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research, 51(3), 316–328. Petroll, A. E., & Mitchell, J. W. (2015). Health insurance and disclosure of same-sex sexual behaviors among gay and bisexual men in same-sex relationships. LGBT Health, 2(1), 48–54.

Gay Men and Romantic Relationships Gay men in romantic relationships share many of the same qualities that heterosexual pairings do. Issues related to intimacy, sexual activity, conflict resolution, and a host of other interpersonal dynamics are equally present in a same-sex romantic dyad as one involving opposite-sex partners. However, gay men experience unique

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Gay Men and Romantic Relationships

challenges in seeking and cultivating romantic relationships, due in large part to the pervasiveness of homophobia and heterosexism in society. This entry describes the unique experiences of gay men with respect to their romantic relationships and explores topics related to representation, discrimination, secrecy, internalized homophobia, romantic networking, and marriage equality. The entry concludes with a brief discussion on alternative relationship models within the LGBTQ community.

Dating, Development, and Concealment Early courtship and dating relationships are common developmental milestones for adolescents and young adults. While early dating relationships are often difficult to navigate for all adolescents, these experiences can be even more challenging for gay men. One such challenge includes the lack of representation of gay male relationships in popular culture. Many young gay men do not have the benefit of visible role models or cultural narratives to guide their understandings of how to initiate and cultivate a same-sex relationship. Moreover, many gay men struggle with their sexual and romantic feelings for the same sex and lack access to support and guidance during the initial coming out process. Gay men who are unable to develop a positive sense of their sexual identity and romantic attractions may experience a greater sense of internalized homophobia, which, in turn, makes it ­difficult to establish healthy relationships with other men. Unlike heterosexual couplings, many gay men at all developmental stages are forced to conceal their relationships in public and within their social networks, so as to avoid discrimination from those who hold homophobic views. Such concealment may place an additional amount of stress on the relationship for both partners and limits their access to important sources of social support, such as friends and family members. Having to conceal a relationship can produce even more complications when one partner is open about their sexuality with their family and/or peer networks and the other is not. One partner may feel neglected or undervalued if he is kept as a secret from the other partner’s friends and family, which can lead to ongoing relational discord.

Social Venues for Romantic Networking Gay men face additional challenges in locating potential partners in typical day-to-day settings (e.g., school, work), as it can be difficult to safely and efficiently identify other men who are also themselves gay or bisexual. As a result, gay men often seek out LGBTQ social venues, such as gay bars and LGBTQ advocacy organizations, to meet potential partners. Gay bars have a distinct cultural significance in the history of gay male socializing and, for many years, served as a primary facilitator for gay men to find one another in order to form intimate relationships. Gay bars still play a significant role in this respect today, though physical venues are no longer the sole or even ­ primary mechanism through which gay men meet one another. Researchers have reported a rapidly increasing use of online dating websites and mobile networking apps among gay men and especially among youth and young adults. Indeed, the Internet is a useful tool for gay men seeking to form intimate connections with other men, as it helps circumvent problems related to (a) having a smaller dating pool than heterosexuals, (b) having a less visible population of prospective partners, and (c) potentially being physically harassed or discriminated against in a public setting. For these reasons, digital networking has been an especially noteworthy development for gay men seeking to connect with one another, although using websites and mobile apps to find partners has grown immensely p ­ opular in straight communities as well.

Marriage Equality The LGBTQ community has been routinely discriminated against with regard to marriage ­ equality throughout much of the world. In the ­ United States, the long-standing struggle to legalize same-sex marriage throughout all 50 states was finally achieved through the Supreme Court in June 2015. Prior to this groundbreaking decision, same-sex couples were denied many of the benefits that come with legal recognition of a nuptial union between two persons, including tax benefits, next-of-kin status for medical emergencies, and family visitation rights in hospital s­ ettings. For many gay couples, creating a union through

Gender Affirming Medical Treatments

marriage is a vitally important symbolic and economic opportunity and opens the door for gay men to express their devotion to one another in ways that were previously exclusive to heterosexual couples.

Alternative Relationship Models Because of a long history of legal, social, and ­cultural disregard of the value and legitimacy of same-sex pairings, many within the LGBTQ community have developed alternative structures, meanings, and arrangements to define their relationships. One such example includes negotiated nonmonogamy, which researchers have noted to be more prevalent among gay men when compared with the heterosexual population. While sexual exclusivity is still abundantly common in same-sex male relationships, many gay men live happy, healthy, and more fulfilling lives by negotiating various degrees of nonmonogamy and have readily embraced this relationship structure for some time. Scholars have explored the subject of nonmonogamy as both a sexual/romantic motivation and as an expression of queer politics in response to an oppressive heteronormative social structure. Some scholars have even voiced criticism of the same-sex marriage movement, suggesting that it reinforces the heteronormative view that marriage is the “ideal” standard of commitment between two persons, to which all other relationships are lesser. Moving forward, it remains to be seen how relationship models and ideological stances within the gay community will evolve with the introduction of marriage equality and a changing landscape of social acceptance. Ryan M. Wade and Gary W. Harper See also Coming Out Processes for LGBTQ Youth; Gay Male Identity Development; Gay Men and Dating; Heterosexism; Homophobia; Internalized Heterosexism; Intimacy; Marriage Equality

Further Readings Diamond, L. M., Savin-Williams, R. C., & Dube, E. M. (1999). Sex, dating, passionate friendships, and romance: Intimate peer relations among lesbian, gay, and bisexual adolescents. In W. Furman, B. B. Brown, & C. Feiring (Eds.), The development of romantic

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relationships in adolescence (pp. 175–210). Cambridge, England: Cambridge University Press. Patterson, C. J., & D’Augelli, A. R. (Eds.). (2013). Handbook of psychology and sexual orientation. New York, NY: Oxford University Press. Rothblum, E. D. (2009). An overview of same-sex couples in relationships: A research area still at sea. In D. A. Hope (Ed.), Contemporary perspectives on lesbian, gay, and bisexual identities (pp. 113–139). New York, NY: Springer. Wilkinson, E. (2010). What’s queer about non-monogamy now? In M. Barker & D. Langrdridge (Eds.), Understanding non-monogamies (pp. 243–254). London, England: Routledge.

Gender Affirming Medical Treatments Health care is often considered to be a basic human right. Transgender and gender nonconforming (TGNC) people often experience challenges in accessing culturally competent medical care. This entry begins with a discussion of the need to improve training for medical providers. This is followed by a brief description of the hormone treatment and surgical care often provided to TGNC people. It then explores the concept of medical necessity. Finally, the entry describes informed consent and harm reduction models for care. Before addressing these areas, it is important for  the reader to understand that the American ­Medical Association and the World Professional Association for Transgender Health have made statements about not pathologizing a person’s gender identity. These statements address a long history of mistreatment of TGNC people by medical providers. Historically, TGNC people have had difficulty finding care, and when they were able to do so, they often faced unnecessary barriers to access that care.

Medical Provider Training Recent studies have explored the amount and type of training that medical doctors receive prior to the completion of their degree. One study showed that students in medical school received, on average, a

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total of 1 hour (60 minutes) of training on competent practices in working with lesbian, gay, bisexual, and transgender (LGBT) people. There is ­certainly some difficulty in being able to provide a broad range of training experiences for medical students; however, the needs of LGBT people are often excluded. To address this lack of training, organizations such as the Association of American Medical ­Colleges have begun developing a host of training materials that are designed for medical educators. This includes online resources, webinars, and blogs that address a full range of culturally competent care. Readers can also find resources from the Center of Excellence in Transgender Health at the University of California at San Francisco. The Center of Excellence website includes a comprehensive listing of treatment for various clinical concerns for TGNC people. For providers who want to specialize in the treatment of TGNC people, additional training and mentorship will likely be needed to achieve a level of competency.

Medical Care Medical care for TGNC people falls into three general categories. The first category, primary care, will not be addressed in this entry due to space limitations. The other areas are hormone treatment and surgical care. Hormone Treatment

Hormone treatment (also known as hormone replacement therapy) is often one of the first steps a TGNC person will take in making a medical transition (also known as a physical transition). The kinds of treatment available for TGNC people are based on the sex they were assigned at birth. These treatments can be administered in a variety of forms (e.g., oral medication, intramuscular or subcutaneous injection, transdermal modalities). Masculinizing Hormone Treatment TGNC men (female-to-male, or FTM) who want to masculinize their bodies will take testosterone. Testosterone is a very powerful drug in a body that was assigned female at birth. Trans men can expect the following results from the use of testosterone: (a) clitoral enlargement, (b) cessation

of menses, (c) facial and body hair, (d) ­deepening of their voice, and (e) changes in musculature and fat distribution. Some of these changes are temporary in that if a person were to stop taking testosterone, the changes would revert back to a state that is in keeping with their body prior to the use of hormones. Other changes are permanent. For example, once a person’s voice deepens, it is not possible (without significant training or surgery) to raise the pitch of the voice. In addition to the desired physical changes, there can also be less desirable side effects from testosterone. This includes acne, elevated hematocrit levels, and ­cardiovascular disease risk (e.g., elevated cholesterol levels). More research is needed to fully understand the long-term effects of testosterone in trans men. Feminizing Hormone Treatment Trans women are not as fortunate as trans men when it comes to the administration of hormones. Before estrogen can have feminizing effects on one’s body, the endogenous testosterone must be addressed. Typically, this is addressed by prescribing spironolactone. This drug suppresses the effects of testosterone; as a result, trans women can experience feminizing effects from estrogen. Estrogen has effects on trans women, including the redistribution of body fat, a decrease in musculature, breast growth, the softening of skin, and (in some cases) decreased hair growth. Risks from side effects include blood clots and mood swings. Similar to TGNC men, more research is needed on the long-term effects of hormone treatment. Puberty Suppression in Adolescents Adolescents are limited in the types of medical care they can receive to affirm their gender. Some physicians will start a 16-year-old on hormone treatment. However, if this 16-year-old has already experienced puberty, there may be a need for additional surgical care that cannot take place until they reach the age of majority (18 years in the United States). Treatments have been developed that allow for suppression of the effects of puberty. This is basically the same treatment that is given to a person who has been diagnosed with precocious puberty. Gonadotropin releasing hormones (GnRH) are administered to the adolescent prior

Gender Affirming Medical Treatments

to the initiation of puberty. This effectively delays the initiation of puberty and the development of secondary characteristics. The use of GnRH treatment has been effective in allowing TGNC youth more time before they are allowed to begin a medical transition. If the adolescent later decides not to transition, the GnRH treatments are discontinued and the adolescent will begin to experience puberty. Surgical Treatment

Surgical treatment for TGNC people includes a variety of procedures that are intended to affirm a person’s gender identity. Chest and breast surgeries are often referred to as “top” surgeries. Genital surgeries are often called “bottom” surgeries. These procedures, as well as facial feminization, have been determined to be medically necessary treatment for people who are experiencing psychological distress related to gender. Similar to hormone, there are differences in the procedures based on the sex a person was assigned at birth. It is important to note that not all TGNC people will want surgical treatment. Reasons for not having surgery include the high cost of surgery, the lack of access to competent providers, and complications or displeasure with the results. Feminizing Surgical Treatments Top surgeries for trans women include facial feminization and breast augmentation. Facial feminization might include alteration of a person’s brow ridge, reduction thyroidchondroplasty (e.g., removal of prominent thyroid cartilage, also known as the Adam’s apple), and reduction rhinoplasty. These procedures are often required to change a person’s facial features to allow for positive social functioning. Some trans women are able to see significant breast growth with the administration of estrogens or progesterone. Others, however, are not that fortunate, or do not experience the kind of breast growth they had hoped for. Augmentation mammoplasty (breast augmentation) procedures are used in these cases. Like facial feminization, this procedure can help trans women fit in socially. Genital, or bottom, surgeries include orchiectomy (i.e., removal of the testes), penectomy (i.e., removal of the penis), and vaginoplasty (i.e., creation of a vagina). It is more common for trans

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women to have genital procedures than it is for trans men. This is due, in part, to the fact that until the testes are removed, TGNC women will have to take medication to stop the effects of testosterone. Another reason is that there have been significant advances in these procedures, and though there can still be surgical complications, they tend to be less problematic than they are for TGNC men. Masculinizing Surgical Treatments Chest masculinization surgery is commonly accessed by trans men. There are two basic ­techniques in use today. The first is a keyhole procedure. The advantages of this procedure are minimal scarring and the nipple and areolae being left intact. To qualify for this procedure, a person must have begun with a small chest. The double incision procedure leaves significant scarring, but trans men with large chests will need this procedure. Some surgeons have perfected a version of this procedure that leaves the nipples intact. Genital surgeries for trans men include a hysterectomy, metoidioplasty, phalloplasty, scrotoplasty, and vaginectomy. Some TGNC men choose to have a hysterectomy. In some cases, this is due to significant pain (physical or emotional) that the person experiences. The metoidioplasty and phalloplasty procedures may include urethroplasty. The urethroplasty, which can have significant complications, will allow a person to urinate from a standing position. This is a goal for many trans men. In the metoidioplasty, the enlarged clitoris becomes the phallus. The benefit of this procedure is that it retains the erotic sensation of the clitoris. The drawback is that the size of the neophallus is considered to be small. The metoidioplasty may also include a scrotoplasty. In this surgical procedure, a scrotum is created from the labia, and subsequently, the trans man will have artificial testes implanted. Phalloplasty is a multistep procedure that creates a neophallus that is considered to be most like a penis. The cost of this procedure is quite significant, financially as well as in terms of the risk of death of the tissue after the procedure has been completed.

Medical Necessity Medical necessity is a term that is used to describe the need for medical treatment. Third-party payers

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often require a determination of medical necessity before they will cover a medical procedure. The American Medical Association and the World Professional Association for Transgender Health have both issued statements about hormone treatment and surgical care being medically necessary to treat TGNC people. However, some TGNC people have health insurance plans that not only exclude care but also add a clause that states that they will not provide care “even if it is deemed to be medically necessary.”

Informed Consent and Harm Reduction There are two models for providing care that need to be addressed. The first is the use of informed consent on the initiation of hormone treatment. Providers who use an informed consent model do not require a TGNC person to secure a letter from a mental health professional assuring the medical provider that the TGNC person is a good candidate for care. Rather, the medical provider uses an informed consent process to be certain that the TGNC person has a good understanding of the effects of hormones, including desirable and undesirable effects. They also use this process to be sure that the patient has a good understanding of some implications of transition (e.g., potential loss of employment) and to ensure that they have a strong support system. Use of informed consent models for hormone treatment are becoming increasingly popular, especially in cities with LGBT health ­centers. This method ensures that the TGNC person is able to access care without having to navigate unnecessary hurdles. Harm reduction models are often employed when a TGNC person is seeking care but already has access to hormones that they are taking without benefit of medical supervision. Providers will prescribe hormones, thereby ensuring that the TGNC person has no lapse in their use of hormones. This method recognizes that it would be more harmful to stop a person from taking hormones than it would be to support them and manage their care. lore m. dickey See also Gender Nonconformity and Transgender Issues: Overview; Gender Reaffirming Surgeries; Hormone Therapy for Transgender People

Further Readings American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Washington, DC: Author. Retrieved from http://www.apa.org/practice/guidelines/ transgender.pdf Association of American Medical Colleges. (2015). Educational resources. Washington, DC: Author. Retrieved from https://www.aamc.org/initiatives/ diversity/axis/educationalresources/ Center of Excellence for Transgender Health. (2011). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. San Francisco: University of California. Retrieved from http://transhealth.ucsf.edu/trans?page=protocol-00-00 Deutsch, M. B. (2012). Use of the informed consent model in provision of cross-sex hormone therapy: A survey of the practices of selected clinics. International Journal of Transgenderism, 13, 140–146. doi:10.1080/ 15532739.2011.675233 Howard Brown Health Center. (2013). Informed consent for feminizing hormone therapy. Chicago, IL: Author. Retrieved from http://www.howardbrown.org/ uploadedFiles/Services_and_Programs/Transgender_ Health/Informed%20Consent%20for%20 Feminizing%20Hormone%20Therapy.pdf Howard Brown Health Center. (2013). Informed consent for masculinizing hormone therapy. Chicago, IL: Author. Retrieved from http://www.howardbrown.org/ uploadedFiles/Services_and_Programs/Transgender_ Health/Informed%20Consent%20for%20 Masculinizing%20Hormone%20Therapy.pdf Lambda Legal. (2012). Professional organization statements supporting transgender people in health care. New York, NY: Author. Retrieved from http:// www.lambdalegal.org/sites/default/files/publications/ downloads/fs_professional-org-statements-supportingtrans-health_1.pdf National Center for Transgender Equality. (2015). Map: State health insurance rules. Washington, DC: Author. Retrieved from http://www.transequality.org/issues/ resources/transgender-healthcare-insurance-laws Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., . . . Lunn, M. R. (2011). Lesbian, gay, bisexual, and transgender: Related content in undergraduate medical education. JAMA, 306, 971–977. doi:10.1001/jama.2011.1255 World Professional Association for Transgender Health. (2010). WPATH de-psychopathologisation statement. Retrieved from http://www.cpath.ca/wp-content/ uploads/2010/05/WPATHpatho0510.pdf

Gender Balance in Education

Gender Balance

in

Education

Gender plays a significant role in access to education and the quality of educational experiences of boys and girls as well as of men and women. Historically, males have had greater access to formal education than their female counterparts. Beginning in the latter half of the 19th century and throughout the 20th and early 21st centuries, access to education for both males and females increased, as developed and many developing countries instituted free, compulsory public education for all children. This entry provides an overview of factors that influence gender parity (i.e., equal participation of males and females) and gender equality (i.e., educational opportunities that result in equally meaningful outcomes and benefits) across all levels of education.

Factors Influencing Gender Balance While gender parity in education has improved worldwide, both developed and developing countries face challenges in achieving gender equality in education. Governmental investment plays a significant role in overall access to education and gender parity. Children in developing countries that do not provide government funding for education may not be able to attend school, while those in developed countries such as the United States may not be able to attend college due to escalating costs and lack of government support for higher education. Rural children and adults in both developed and developing countries are more likely to face challenges in educational access, with girls in remote areas of developing countries having the most limited access to schools. Cultural norms, values, and belief systems often restrict access to education for girls and women, particularly in countries where girls are expected to assume domestic responsibilities, marry, and bear children young. Restrictive gender roles prohibit or limit the educational attainment of ­ girls, and harassment, violence, and intimidation are frequently used to keep girls and women from becoming educated. Educational policies and ­practices are often unwelcoming or hostile toward girls and women at all levels of education in both developing and developed nations. Although ­

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educational parity may be reached by many girls and women, the benefits of education they receive may not be equal to those enjoyed by boys and men, especially on entering the workforce.

Primary Education By the beginning of the 21st century, the majority of UN member countries provided free, compulsory primary education (basic skills in reading, writing, and mathematics) for all children, resulting in gender parity for the majority of children. In these countries, girls outperform boys in all academic areas. The greatest threat to gender parity in primary education exists for children living in the poorest developing nations of sub-Saharan Africa and Asia, where families must pay fees to send their children to school. In many of these countries, families with limited economic resources will view sending boys to school as the priority.

Secondary Education Gender parity in secondary education (advanced reading, writing, mathematics, preparation for vocational or higher education) has been achieved in nearly one third of the world’s countries, with most countries providing between 10 to 14 years of education for their citizens. Developed and developing countries with compulsory secondary education lead in secondary education parity, while girls in developing countries that value early marriage and childbearing are less likely to enter and complete their secondary education. Gender equality issues begin to become a more prominent factor in secondary education. International studies of youth in developed countries conducted in the first decade of the 21st century indicate that while girls continue to outperform boys in nearly all academic subjects when they enter secondary education, ­ cultural norms, attitudes, and values tend to discourage girls from pursuing science, technology, engineering, and mathematics (STEM). In the early 21st century, the Organisation for ­ Economic Co-operation and Development reported that for the first time in their history, girls were completing secondary education at higher rates than boys, with significant numbers of boys in their member countries reporting that they saw no value in education and leaving school before obtaining their secondary educational

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credentials. Despite higher completion rates among girls, lack of confidence in their academic abilities was of greatest concern among girls.

Tertiary Education Many of the trends in secondary education persist in tertiary education (advanced academic and preparation for the professions). In the first decade of the 21st century, young women were entering colleges and universities in record numbers, with the United States and Great Britain reporting that for the first time in their histories more women were entering and completing university degrees than men. Despite this trend, gender equality at this level of education is difficult to attain. Men dominate in STEM fields, and women in both developed and developing nations report barriers to entering STEM and other male-dominated disciplines of business, law, and medicine. Women are encouraged to pursue feminized fields such as nursing, primary and secondary teaching, and accounting versus medicine, research, and business management. Studies of women who enter maledominated academic disciplines conducted in the late 20th and early 21st centuries indicate that they are often subject to hostility and harassment, have more limited access to mentorship than their male counterparts, and are more likely to be challenged about living up to their gender role responsibilities (e.g., homemaking, child rearing). Despite significant gender balance gains achieved in the 20th and early 21st centuries, the gender equity benefits of education remain a challenge for women. At all levels of educational achievement, males experience greater benefits from their ­education, earning higher wages and significantly higher levels of promotion and leadership positions. Within professions, men are more likely to hold positions of greater prestige with higher salaries (e.g., men are more likely to become surgeons, whereas women are more likely to become pediatricians). Sylvie Taylor See also Education and Gender: Overview; Gender Bias in Education; STEM Fields and Gender; Teacher Bias; Title IX; Women in STEM Fields, Experiences of; Women’s Issues: Overview; Workplace and Gender: Overview

Further Readings Fiske, E. B. (2012). World atlas of gender equality in education. Paris, France: United Nations Educational, Scientific and Cultural Organization. Organisation for Economic Co-operation and Development. (2015). The ABC of gender equality in education: Aptitude, behaviour, confidence. Paris, France: Author. Raftery, D., & Valiulis, M. G. (2011). Gender balance and gender bias in education: International perspectives. London, England: R ­ outledge.

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Education

The concept of gender is constantly evolving and is viewed by many as a socially constructed phenomenon, as performative, as a fluid and potentially ever-changing amalgamation of clothing, behaviors, gestures, speech patterns, and the like, subject to the milieu of which one is a member. Once thought to be essentially tied to biological sex, ­gender is now conceived as more prone to i­ ndividual choice and level of comfort and not inextricably linked to biology. This entry briefly introduces research on gender bias in education and its effects. The entry concludes with a discussion of proposed policy prescriptions.

The History of Gender Bias in Education Gender inequity is a fundamental problem facing contemporary educators. Students’ academic achievement, attendance, engagement, participation in extracurricular activities, behavior, and likelihood of committing suicide have all been linked to inequities based on gender and sexual orientation. Gender bias in education tends to occur most often as a result of adherence to the philosophy of essentialism, or the notion that there are fixed characteristics women and men possess, which influences what it means to be feminine or masculine. This philosophy perpetuates the idea that the traditionally held ideas of women as more nurturing and men as more aggressive are natural. G ­ ender bias occurs when one’s expectations and potentialities are limited because of the expectations others place on them or on members of their sex in general, or when a person makes assumptions about

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another person’s behavior, preferences, or abilities based only on their gender. Gender bias can reinforce the rigid, traditional stereotypes that girls should be passive and boys should be assertive. Gender bias can also serve to police and punish those who break from traditionally held ideas about gender. Students who do not present themselves within this feminine and masculine binary can experience difficulty in gaining acceptance from peers and adults, especially when those peers and adults adhere to traditional notions of gender. The socialization of gender within U.S. schools promotes the notion that girls and boys are not equal. Hegemonic classroom practices reflect societal inequities by reproducing and reinforcing traditional cultural and educational traditions. For example, asking girls and boys to line up by gender affirms that girls and boys should be treated differently. Girls are typically socialized toward the feminine ideal, whereby girls are praised for being pretty, being quiet, and getting along with others and boys are encouraged to be physically active, be assertive, and think independently. Assertive behavior in girls is often viewed as disruptive and seen negatively by teachers. Girls are often taught to recognize popularity as being the most important aspect of school second to educational performance and ability. Normative socialization patterns reflected in the classroom often lead to distorted perceptions of gender in young children today. But gender bias reaches beyond socialization patterns and can be evidenced in textbooks, lessons, and teacher-­ to-­ student interactions. Any attempt to teach gender equality in K–12 classrooms is intrinsically linked with specific academic content and instructional practice. A hidden curriculum discriminates and may advance bias against females in the educational system. The hidden curriculum refers to the idea that teachers interact with and teach their students in ways that reinforce stereotypical gender roles. For example, boys may receive more attention and are encouraged to be outspoken, whereas girls may be praised for their quiet, controlled behavior. Gender bias can be implicit or explicit. Elliot Eisner calls the hidden curriculum the “implicit” curriculum, because it is what students learn about the values of the school and the expectations of adults, both of which may be unintended, that are not included in the formal curriculum but that

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students learn during their school experience. Hidden or implicit curriculums can serve to reinforce existing social inequalities, such as gender bias. Gender bias in education is implicitly reinforced by textbooks. Rae Lesser Blumberg, William R. Kenan Jr. Professor of Sociology at the University of Virginia, conducted a study of gender bias in textbooks and found a consistent pattern of bias in textbooks worldwide. These findings included the following: (a) an overall underrepresentation of women and girls; (b) depictions of women and girls, pictorially and narratively, consistently as stereotypical and focusing on home and domestic roles; (c) women and girls depicted as passive ­spectators; and (d) women depicted in traditional careers.

Title IX Passed in 1972, Title IX of the Educational Amendments prohibits sex discrimination in U.S. schools. Title IX also protects all students of all genders and sexual orientations from sexual harassment. Students in federally funded institutions, public and private schools, colleges and universities, have a right to an education free from discrimination on the basis of sex, including equitable access to all academic programs, activities, athletics, course offerings, admissions, recruitment, and scholarships, and free from harassment (including assault) based on sex, gender, gender identity and expression, and sexual orientation. Title IX also protects students from discrimination in academic and nonacademic activities due to factors such as pregnancy, birth, miscarriage, and abortion and protects faculty, staff, and whistleblowers from sexual harassment, sex discrimination, and retaliation.

Single-Sex Education In the 1996 case United States v. Virginia, the U.S. Supreme Court ruled on the constitutionality of single-sex public education. Single-sex education in public schools was ruled constitutional when comparable courses, services, and facilities are made available to both sexes. The proliferation of single-sex schools began in the 2000s, after President George W. Bush weakened Title IX provisions in 2006, allowing for expanded sex segregation in schools.

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Proponents of single-sex education argue that there are differences in how boys and girls learn and behave in educational settings and further the notion that separating boys and girls, by classrooms or schools, increases students’ achievement and academic interest. Proponents of single-sex education additionally argue that by separating the sexes, teachers are better able to meet the needs of each student because students are not distracted by the “opposite” sex and can pay closer attention to the lessons. Opponents of single-sex education argue that segregation leads to increased stereotyping and limited social skills. Neuroscientist and opponent of single-sex education Lise Eliot examined decades of research on neuroplasticity and found that infant brains are highly malleable and that parents and educators impose their own gender biases on infants and young children, further affecting their future educational development. Single-sex programs and schools, such as women’s colleges, created for affirmative purposes, such as redressing past discriminations, were permissible under the original intent of Title IX. However, the expansion of single-sex education in the post-Bush era for nonaffirmative purposes serves to promote traditional gender roles and contributes to the backlash against egalitarianism in education.

LGBTQ Bias Gender bias in education greatly affects lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. In 2013, the education organization GLSEN published its National School Climate Survey and found that schools tend to be hostile places for LGBTQ students, the majority of whom experience sexual harassment and discrimination at school because they may not conform to traditional gender binaries. Consequently, many students who identify as LGBTQ avoid school ­ altogether. Gender bias also affects those students who may not identify as LGBTQ but are perceived to be lesbian, gay, bisexual, transgender, or queer. LGBTQ students who experience school-based discrimination and harassment have more negative academic outcomes and psychological struggles than their non-LGBTQ peers. Although the rates of school-based discrimination and

harassment for LGBTQ students have improved over the years, the overall school climate remains hostile for many.

STEM Bias Historically, and before Title IX in particular, in high school, girls tended to take fewer advanced courses in math and science than boys, which left them ill prepared to pursue careers in science, technology, engineering, and mathematics (STEM). A 2010 report published by the American Association of University Women found that although the number of women in STEM fields is growing, men continue to outnumber women, particularly in the roles of leader and manager. In K–12 schools, similar numbers of girls and boys take math and science courses and enter college with the goal of eventually entering STEM fields. However, fewer women than men actually complete majors in STEM fields. After graduation, men outnumber women in nearly all STEM fields. Women’s representation in STEM fields declines further at the graduate level and in the transition to the workforce. The implicit biases of teachers and counselors play a part in the disproportionate number of men in STEM fields. Many educators still associate STEM fields with males. These biases not only affect attitudes toward others but may also serve to create negative self-fulfilling prophecies for girls and women in their perceptions of their eventual success in STEM careers.

Policy Prescriptions The importance of addressing gender equity in K–12 settings cannot be understated. Teachers, counselors, and administrators must be well prepared to effectively facilitate student learning through the use of egalitarian practices. To further promote gender equity in schools, strategies for school districts to prepare school personnel, such as school leaders and school counselors, include the following: •• Conduct a Title IX compliance review to determine compliance with the law by examining school policies and procedures, course advising, sports scheduling, and facilities to ensure gender equity.

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•• Create an antiharassment policy that provides details for reporting, investigation, and resolution and policies enumerating categories to include sexual minorities. Include an antiretaliation statement and provide for prompt and equitable investigation and resolution of complaints. •• Make contact information for the Title IX coordinator easily accessible, posting publicly (e.g., on the district’s website) and making it available to students, parents, and employees. •• Provide resources and materials on Title IX to parents and students. Create and disseminate a handbook for students and parents defining harassment and providing examples of behaviors that are prohibited. •• Expand the library collection to incorporate titles that reflect gender equity in all its forms, and ensure that the curriculum reflects this as well. •• Increase student access to information regarding the LGBTQ community through curricula and library resources. •• Support Gay Straight Alliances to provide support for LGBTQ students.

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Lesser Blumberg, R. (2015). Eliminating gender bias in textbooks: Pushing for policy reforms that promote gender equity in education (Background Paper, Education for All Global Monitoring Report 2015. Presented to UNESCO, Paris). Retrieved from http:// unesdoc.unesco.org/images/0023/002324/232452e.pdf Martin, J., Kearl, H., & Murphy, W. J. (2013). Bullying and harassment in schools: Analysis of legislation and policy. In M. A. Paludi (Ed.), Women and management: Global issues and promising solutions: Vol. 2. Signs of solutions (pp. 29–51). Santa Barbara, CA: Praeger. Pahlke, E., Hyde, J. S., & Allison, C. M. (2014). The effects of single-sex compared with coeducational schooling on students’ performance and attitudes: A meta-analysis. Psychological Bulletin, 140(4), 1042–1072. Sadker, D., Sadker, M., & Zittleman, K. R. (2009). Still failing at fairness: How gender bias cheats girls and boys in school and what we can do about it. New York, NY: Scribner. United States v. Virginia, 518 U.S. 515 (1996). U.S. Department of Education, Office for Civil Rights. (2010, October). Dear colleague letter: Harassment and bullying. Retrieved from http://www2.ed.gov/ about/offices/list/ocr/letters/colleague-201010.pdf

Jennifer L. Martin and J. A. Beese See also Bullying, Gender-Based; STEM Fields and Gender; Title IX

Further Readings Eliot, L. (2010). Pink brain, blue brain: How small differences grow into troublesome gaps—and what we can do about it. New York, NY: Houghton Mifflin Harcourt. Elliot, E. W. (1979). The educational imagination. New York, NY: Macmillan. Hill, C., Corbett, C., & St. Rose, A. (2010). Why so few? Women in science, technology, engineering, and mathematics. Washington, DC: American Association of University Women. Retrieved from http://www .aauw.org /files/2013/02/Why-So-Few-Women-inScience-Technology-Engineering-and-Mathematics.pdf Klein, S. (Ed.). (2010). Handbook for achieving gender equity through education (2nd ed.). New York, NY: Routledge. Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2013). The 2013 national school climate survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: GLSEN.

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Gender bias in hiring practices is directly evidenced through experimental studies simulating hiring practices and through field studies of actual hiring. Indirectly, gender bias can be observed through occupational sex segregation (women and men being found disproportionately in different occupations) and differential starting salaries. In addition, the U.S. Equal Employment Opportunity Commission continues to investigate yearly thousands of cases of disparate treatment (i.e., purposeful discrimination) and disparate impact (i.e., unintentional discrimination) based on gender. Although discrimination based on sex (gender) is illegal in the United States, based on Title VII of the Civil Rights Act of 1964, there is ample evidence that gender bias in hiring is still occurring. Gender bias can target both men and women; however, historically in the United States and the rest of the world, it disproportionately negatively affects women. ­Gender bias can result from purposeful prejudice such as the mind-set that “women belong in the home,” to

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unfair and job-irrelevant selection tests (e.g., pullups for a security guard position), or from more subtle effects of cultural gender stereotypes and roles. The focus of the remainder of this entry will primarily be on the latter.

Gender and Work Roles Virginia Schein has illustrated the “think-manager, think-male” stereotype with research starting in the 1970s and continuing into the 2000s and across multiple countries. Her research illustrates that we have stereotypes about jobs (e.g., management) and men and women. Although there is strong congruence between our stereotypes of management and men, this is not so for our stereotypes of women. Alice Eagly’s research has further explored the impact of role congruity in hiring. Not only do we have stereotypes regarding what it takes to be competent at an occupation, we also have stereotypes regarding how masculine (e.g., leadership, hard sciences, engineering) or feminine (e.g., nursing, child care, elementary education) certain occupations are. Role congruity theory suggests that when there is congruence between the stereotypes about a person (in this case based on gender) and the stereotypes about the occupation, there will be a positive hiring bias; however, if there is incongruence, there will be a negative bias. Thus, a woman applying for the role of an engineer may be disadvantaged compared with a male due to stereotype incongruence. Although this theory would predict negative bias targeting both genders based on the occupation, most studies have found that the effect is mostly found in women applying for masculine occupations. In fact, some studies have found that men are actually seen as a “model minority” in many feminine occupations and actually experience a positive bias in these incongruent situations, in direct contrast to the experiences of women.

Experimental Studies Although there have been inconsistencies in examining gender bias in all hiring situations, two themes have clearly emerged from the experimental literature. The first is that although women are not always disadvantaged in hiring situations compared with men, they often are, and this bias is

more likely when stereotypes of the occupation or the person are involved. The second is that these effects have become more subtle when comparing studies from the 1980s, 1990s, and 2000s, but the bias is still present. Typical experiments involve participants (often a student in a controlled setting) rating equally qualified male and female candidates for a job (e.g., résumés, transcripts, work samples, or live or video interviews). When the job is seen as more congruent with masculine traits (e.g., management, engineering, law enforcement), the female candidates are often less likely to be hired and are rated as a poorer fit. In addition, if the participants are primed with masculine or feminine stereotypes prior to making a decision, they are more likely to make stereotypical decisions often negatively affecting women candidates. Similarly, field studies have found the same bias in real-world hiring situations.

Field Studies Field studies forgo experimental control for using real-world hiring processes. Typical studies will have research confederates (men and women with the same qualifications and coached to respond to questions in a similar way) interview for positions or send doctored resumes to multiple actual job openings. The outcomes of interest in these studies are generally hiring or callback rates. Mirroring the experimental studies, equally qualified women are less likely to be hired, asked to be interviewed, or receive a callback from an interview compared with men, especially in fields perceived as more masculine. In addition, in the case of interview studies allowing additional confederates to observe the interview (commonly done out in the open in many service industries), there are observable differences in verbal and nonverbal treatment of women. Women applying for roles that are incongruent with the stereotypes of women are talked to less by, receive less eye contact from, and are kept at a further physical distance from the interviewer compared with men.

Solutions Research has helped determine when gender bias in hiring is more likely and the potential methods for reducing such bias. To ward against overt

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prejudice and unfair selection tests, companies can actively monitor their gender hiring rates and comply with the U.S. Equal Employment Opportunity Commission recommendations. For gender bias based on gender roles, our reliance on stereotypes occurs quickly but serves as a heuristic to save time. Thus, in situations where the interviewer is distracted or rushed, such stereotypes are more likely to have an impact. Therefore, encouraging or training hiring personnel to cognitively engage in the hiring process can reduce the impact of stereotype-based bias. Hiring decisions that are focused on clearly defined job requirements and objective measures of those skills and abilities in the applicant over subjective in-person interviews are less likely to exhibit gender bias. If interviews are to be used, the inclusion of rater error training (i.e., making people aware of their biases) and frame of reference training (i.e., teaching raters to tie their rating to the objective aspects of the job) have also been shown to reduce bias. Finally, research has found that a strong organizational culture supporting diversity in hiring and accountability of those making the hiring decisions can have a positive impact on reducing bias. Joel T. Nadler See also Career Choice and Gender; Gender Discrimination; Gender Segregation; Institutional Sexism; Sexism

Further Readings Eagly, A. H., & Carli, L. L. (2007). Through the labyrinth: The truth about how women become leaders. Boston, MA: Harvard Business Press. Nadler, J. T., & Stockdale, M. S. (2012). Workplace gender bias: Not between just strangers. North American Journal of Psychology, 14, 281–292. Schein, V. E. (2001). A global look at psychological barriers to women’s progress in management. Journal of Social Issues, 57, 675–688.

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Research

Psychological theories and research are sexist to the extent that they incorporate stereotypic thinking about gender and produce and promote gender

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inequality. In this regard, gender bias refers to the development of theories or the conduct of research in which greater attention or value is given to the life experiences of one gender. Gender bias interferes with psychology’s goal to provide scientific and useful information about human behavior; however, gender-biased research may be used to set policy or to justify discriminatory behavior. Gender bias in research reflects widely held beliefs about men and women and may reify those beliefs as scientific fact. One aspect of gender bias is the acceptance and endorsement of the stereotypic view of men and women as polar opposites, with males as superior to females. A basic gender assumption in research is the gender binary, the model of gender based on a two-category system, men and women. The binary model for understanding gender does not account for the experiences of transgender and gender nonconforming people. This entry examines some of the recurring forms of gender bias in research.

Historical Perspective In the 1970s, a series of psychologists criticized psychology as sexist and called on psychology to more carefully provide information about the lives of women. Since then, critics have identified numerous gender biases in the existing psychological literature. In the 1980s, Carolyn Sherif, a feminist psychologist and president of Division 35 of the American Psychological Association (APA), appointed a task force to address sexist bias in psychology and to make suggestions to eliminate such bias. Although guidelines were developed, and were officially adopted by the APA, the instructions for avoiding gender bias are not included in textbooks on the conduct of research. Suggestions are intended to produce gender-fair research using traditional scientific methods. The assumption is that a truly neutral science will produce unbiased knowledge, which in turn will serve as a basis for a more just social policy.

Androcentric Bias Androcentric (male-centered) bias refers to putting males at the center of one’s analysis and viewing women as “other” or as deficient. One form of gender and androcentric bias in research is the

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neglect of women’s lives and experiences. Feminists have criticized psychology (and other disciplines) for not studying the lives and experiences of women. For example, early feminist research identified experiences of women previously neglected in psychology, including widespread gender discrimination and violence against women. Topics such as rape or housework had been considered either taboo or too trivial to study, marginal to more central and prestigious issues, such as leadership, achievement, and power. Other topics previously neglected include menstruation, motherhood, women’s friendships, and women’s body image. Topics of interest to men such as achievement motivation and aggression were researched as ­studies of human behavior, even though often only male subjects were studied. The assumption is that achievement motivation is not relevant to women. This is a form of androcentric and sexist bias; men are seen as representing humans, and assumptions are made about women. When women are later examined within the established research paradigms, and demonstrate differences from men, their behavior is often viewed as deficient or substandard; researchers have subscribed to the androcentric perspective that men’s behavior is standard or normal. For example, after David McClelland reported his research on achievement motivation using (male) Harvard students, researchers of subsequent studies on women’s motivation, in which the measures of achievement motivation developed did not predict women’s success, tended to view women as having motivation deficits such as (excessive) need for approval or motivation to avoid success, rather than recognize the barriers to women’s success that existed in business and other arenas. Feminist research challenges the androcentric construction of women’s lives and questions androcentric or sexist frameworks or assumptions. Feminists have criticized research that characterizes women as having deficits; such research has typically accepted androcentric assumptions regarding male behavior as standard, or as preferred ways of behaving. Conclusions about human behavior based on evidence taken from narrow (e.g., male, European-American, educated, and middle-class) samples of human populations continue and reflect multiple biases. There is an ongoing need to critically examine asymmetrical and

inequitable constructions of the cultural masculine over the cultural feminine and to challenge the value placed on the behavior of middle-class ­European Americans over others (e.g., poor people, people of color).

The Experimental Method Psychological research on women often contains another source of bias—the lack of attention to social context. In laboratory research, the behavior of the respondents is separated from error or extraneous influences to examine the impact of the identified variable. The experimental paradigm is based on the assumption that the respondents’ social status, history, beliefs, and values are not affecting their behavior in the research. The result is to detach people’s action from social roles or institutions. However, the factors eliminated may be important determinants of behavior. By stripping behavior of its social context, psychologists rule out the study of sociocultural and historical factors and implicitly attribute causes to factors inside the person. For these reasons, the experimental method has been viewed as inherently biased—and critiqued as inauthentic—and reductionist and removed from the social context in which the behavior actually occurs. Critics have exposed the laboratory experiment as a social context in which the (male) experimenter controls the situation, manipulates the independent variable, observes women as the “objects” of study, and evaluates and interprets their behavior based on his own perspective. From this critical perspective, the traditional psychological experiment is a replication of the power dynamics that operate in other social and institutional settings. The interests and concerns of the research subjects are subordinated to the interests of those of the researcher and the theorist. The controlled and artificial research situation may elicit more conventional behavior from participants, may inhibit self-disclosure, and may make the situation “unreal” to the participants.

Considering Roles, Status, Power, and Context Feminists exposed the (gender) power dynamics that operate in many aspects of women’s lives,

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including in research, and have challenged existing explanatory accounts of women’s experiences. One goal of feminist research then is to attend to the power dynamics in the conduct of research, to expose invisible or concealed power dynamics. The behavior seen as characteristic of women has sometimes been reassessed as the behavior e­ videnced by people with low(er) power and status. One problem with research on sex/gender differences is to view differences between groups of men and women as due to sex or gender. The term sex difference implies that the difference between men and women is a biologically based difference since sex is a biological category system. The term gender difference is used when there is the possibility that sociocultural factors have contributed to the production of a difference between men and women. Most researchers recognize the difficulty of discovering the origin of gender differences in biology versus culture, although some effort continues to focus on this distinction. Men and women have different experiences, play different roles, and are unevenly distributed across social contexts. To not confuse sex with roles, or context, it is important to ensure that the men and women in the research are equivalent. Comparing the speech patterns of women homemakers with those of male corporate managers will result in observed differences in speech, but are those differences about gender or roles? Within roles and contexts, differences between men and women’s behavior are usually minimal. For example, women and men who are employed as engineers often speak using similar terminology ­ and style. Despite increasing sophistication in the understanding of gender as a function of context, roles, and power, gender differences continue to be constructed as being about the characteristics of the women in the research (i.e., essentialism). The experimental approach that emphasizes a distant and decontextualized approach to traditional research results in studying women apart from the circumstances of their lives. Social and cultural ­factors including discrimination, violence, sexism, and others’ stereotypes are eliminated from ­consideration by the view of the researcher. Subsequently, researchers are likely to attribute observed behavior as due to women’s traits or natural dispositions.

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The Difference Model In psychology and in our culture, there is a tendency to emphasize and exaggerate the differences between men and women. Research that “finds” a sex difference is more likely to be published, publicized, and cited than research that refutes the existence of a difference between men and women. Furthermore, research is often constructed to produce sex differences. For example, the research on sex differences in math ability has been carefully constructed to produce differences (i.e., the use of standardized tests administered to large samples of students in adolescence). Differences between boys and girls are not found in classroom grades or examinations. Moreover, research that supports the status quo and the view of women as less than men is more likely to be funded, conducted, published, and widely cited. Gender bias affects the design and conduct of research and may also influence the interpretation and distribution of the research results.

Challenging the Gender Binary Previous conceptions of men and women as polar opposites have been challenged and discarded. Even when differences between men and women are documented, the research findings cannot be and are not interpreted as indicating that men and women are polar opposites of each other. Researchers are encouraged to refer to the other sex/gender rather than the opposite sex/gender. Even research that does not assume gender differences between men and women continues to view gender as a binary category system, with the mutually exclusive categories of boys or girls, men or women. Researchers also assume that gender identity of the individual corresponds to the sex assigned at birth. Participants involved in research are most frequently asked to indicate their sex or gender using the binary/forced choice of male or female. Research in psychology has been gender biased in that it has failed to acknowledge or represent individuals with different gender identities, despite the demonstrated existence of many variations of gender identity and gender expression, including people who identify as either man or woman, neither man nor woman, a blend of man and woman, or a unique gender identity.

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Research and Transgender Individuals The earliest research recognizing transgender issues tended to be clinical in nature. This early research has been viewed as biased in that the clinical language, the labeling of transgender individuals as pathological, the focus on gender dysphoria and gender identity disorder, and the focus on prevention and intervention contribute to the stigmatization of transgender individuals. In earlier decades (1960s), the clinical treatment of transgender individuals also maintained the gender binary, based on the dichotomous perspective of gender. The goal of sex reassignment was to assist males to become women and females to become men, and the effectiveness of sex reassignment was evaluated on the basis of how well transsexuals were able to function as members of the “opposite” sex. Newer research has moved from questions of psychopathology and comorbidity to a more holistic approach that examines the experiences of transgender individuals and the sociopolitical issues affecting their lives and health. Empirical research on transgender individuals has broadened to examine health disparities. Questions regarding the causal factors influencing gender identity are addressed as opposed to what causes gender identity disorder. Scholarship increasingly examines the implications of transgenderism for an understanding of sex, gender, and sexuality. Current research suggests that there are systematic differences among various groups of transgender and gender nonconforming people. One way of understanding these variations is to understand the development of a transgender identity and develop models of the process. Some of these models of developing a transgender identity argue against the dichotomous approach to gender. One approach calls for people to affirm their unique identity and experience life outside the boundaries of the gender binary. Rather than starting a new life as a member of the other sex, some individuals began to claim a transgender or transsexual identity that continues beyond the transition or sex reassignment phase. Thus, members of the transgender community do not easily fit into the gender binary, and the use of gender binary questions in research does not fit for many transgender and gender nonconforming individuals. Some transgender and gender nonconforming individuals

refer to themselves as genderqueer in an attempt to avoid being categorized in accordance with the prevailing gender binary.

Recommendations for Researchers The APA Guidelines for Psychological Practice With Transgender and Gender Nonconforming People recommend that researchers discontinue the practice of having respondents provide their gender using a binary question. Psychologists conducting research are encouraged to provide a range of options for capturing demographic information about gender so that transgender and gender nonconforming individuals may be in­­ cluded and accurately represented. Some experts suggest that researchers use a two–step method, first asking for sex assigned at birth and then following with a question about gender identity. Depending on the size of the sample, and the focus on the research, gender identity may have multiple options or be open ended. As understanding of gender moves from a model of biologically based polar opposites with males as superior to gendered behavior that is influenced by roles and contexts to multiple gender identities that do not conform to a gender binary, research must adopt different methods of capturing and conceptualizing gender. Maureen C. McHugh See also Ethics in Gender Research; Gender Bias in the DSM; Gender-Biased Language in Research; Institutional Sexism; Sexism

Further Readings American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Retrieved from http://www .apa.org/practice/guidelines/transgender.pdf Denmark, F. I., Russo, N. F., Frieze, I. H., & Sechzer, J. A. (1988). Guidelines for avoiding sexism in psychological research. American Psychologist, 43(7), 582–585. McHugh, M. C., Koeski, R. D., & Frieze, I. H. (1986). Issues to consider in conducting non-sexist psychology: A guide for researchers. American Psychologist, 41(8), 879–890. Riger, S. (1992). Epistemological debates, feminist voices: Science, social values and the study of women. American Psychologist, 47(6), 730–740.

Gender Bias in the DSM Shields, S. (1975). Functionalism, Darwinism, and the psychology of women: A study in social myth. American Psychologist, 30, 739–754. Weisstein, N. (1971). Psychology constructs the female: Or, the fantasy life of the male psychologist. Boston, MA: New England Free Press.

Gender Bias

in the

DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification system of psychiatric disorders published by the American ­Psychiatric Association (APA). The impact of gender stereotypes and debate regarding the sensitivity to gender-related issues remain some of the most controversial issues in each revision of the manual. This entry describes the DSM and the impact of conceptions of gender on its editions. It also reviews potential sources of bias relating to gender in the creation and implementation of diagnostic criteria. Last, it describes how more recent conceptions of gender have affected relevant diagnoses within the DSM.

History of the DSM The need for a classification system for psychiatric diagnoses arose in the late 19th century. At that time, researchers and clinicians in the United States were interested in cultivating census data to discover the prevalence rates of mental illness and in improving communication among professionals. Several different classification systems were advanced through the first half of the 20th century, including one developed by the U.S. Army after World War II. The APA published the first edition of the DSM in 1952 as an attempt to provide a common language to professionals working within the mental health field. Seven editions (including revisions of the third and fourth versions) of the DSM were published between 1952 and 2013. The first two editions of the DSM were heavily influenced by the psychodynamic perspective of psychiatric disorders. The DSM-III, published in 1980, was unique in its goal to be atheoretical (i.e., not favoring one theory of etiology over another) and to provide clear, explicit diagnostic criteria for disorders, which had been lacking in previous

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versions. In addition, the DSM-III introduced the multiaxial system for diagnoses. The multiaxial system required professionals to separate personality disorders from other psychiatric disorders and to specify related medical conditions, psychosocial stressors, and general functioning. Although the multiaxial system was not fully maintained, the subsequent revisions of the DSM did maintain the emphasis on explicit and behavior-based ­symptom descriptions to ensure that different professionals would reach the same diagnosis when presented with the same information. Empirical research in psychiatry and the psychological sciences were growing in popularity as well, and following the DSM-III, subsequent revisions were based largely on research findings and massive literature reviews. Prior to each revision, several task forces comprising researchers and c­ linicians examined the literature for any necessary changes to improve the diagnostic accuracy of the criteria listed in the DSM. In each revision, certain disorders were removed, added, or revised, all in response to empirical evidence. The creation and maintenance of psychiatric diagnoses can have a great societal impact, as a formal diagnosis can indicate medical, legal, and societal implications.

Gender and Diagnoses One of the more controversial aspects of the DSM is its potential for gender bias. Researchers and clinicians who claim that the diagnostic manual is biased often cite the difference in prevalence rates for certain disorders, such as borderline personality disorder, which is diagnosed far more often in women than in men. Results from epidemiological studies have found that this type of gender-based prevalence is common across many diagnoses, suggesting that the rates or manifestation of certain disorders is influenced by gender. For example, women are more likely to be diagnosed with depression disorders, anxiety disorders, panic disorders, phobia disorders, somatization disorders, conversion disorders, eating disorders, pain disorders, borderline personality disorder, and schizoaffective disorder, among others. Men, on the other hand, are more likely to receive diagnoses of substance abuse disorders, sexual disorders, intermittent explosive disorder, and antisocial, paranoid, and schizoid personality disorders. The difference

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in prevalence rates is robust and supported across age and geographic location. There is considerable controversy surrounding the difference in prevalence rates. It is possible that the disproportionate prevalence rates might reflect genuine differences in the number of men and women who exhibit certain diagnoses. This can often occur if the development of the disorder is influenced by sexually specific biological differences such as hormones. Interestingly, rates of diagnoses for childhood disorders are far more comparable between boys and girls. For many disorders, it is only in late adolescence and adulthood that large differences in diagnostic rates appear. This is not necessarily contrary to the biological hypothesis, as the difference in rates might be influenced by biological changes in puberty. Alternatively, the disproportionate prevalence rate might be due to gender specific social environments. For instance, men might develop certain disorders due to environmental influences that are more likely to occur for men. However, many researchers argue that the disproportionate prevalence rates either result from or are influenced by criterion bias or assessment bias. Criterion bias suggests that diagnostic criteria within the DSM are based on inaccurate or discriminatory information. Assessment bias suggests that the application of these criteria is biased. For instance, clinicians’ interpretations and treatment decisions might be affected by clinicians’ gender bias. Criterion Bias

The gender-based differences in the prevalence of diagnoses could be due to faulty or biased theoretical constructs. Specifically, the development of diagnostic criteria might be influenced by social bias or discrimination. In a criticism of earlier editions of the DSM, some researchers suggested that the largely all-male task force perpetuated a masculine bias that led to the labeling of stereotypical female behavior as pathological. For instance, the diagnosis of hysteria has been widely accepted as an example of gender bias. The diagnosis has a long and complicated history that likely began in ancient Egypt. Hysteria was diagnosed exclusively in women and was characterized by bizarre physical and mental symptoms thought to be caused by a wandering uterus. Plato, a philosopher in Ancient Greece, wrote that the diagnosis was caused when

a woman was discontented by an inability to bear children. The “hysteric” woman has been described in the literature as difficult, labile, manipulative, suggestible, attention seeking, and seductive. It was the most commonly diagnosed disorder among women in the 18th and 19th centuries. As views of the traditional gender roles changed in the 1960s and 1970s and women began assuming more active roles in a society previously reserved only for men, hysteria declined in popularity and was no longer used as a diagnostic category. One of the common criticisms of hysteria is that the diagnosis equated feminine characteristics with abnormality. In the late 20th century, the relationship between gendered characteristics and pathology received increased attention. In the 1970s, a seminal study led by Inge Broverman examined the impact of gender on the clinical judgments of mental health professionals. Broverman and her colleagues asked 79 mental health professionals to describe a mature, healthy adult. The adult was male, female, or unspecified. The results showed a large overlap between the descriptions of a healthy adult and a healthy male, with different characteristics listed for female adults. The authors concluded that clinicians operated using a double standard and that the general standard of health was primarily masculine. The findings are often cited as evidence that clinicians are more likely to pathologize women. Although some researchers have cited methodological limitations of the study, such as the small sample size, the study has become one of the most frequently cited on gender bias and spurred subsequent research regarding potential gender bias in the DSM. The literature that followed in the 1980s and 1990s largely focused on personality disorders. Although the research base is inconsistent, multiple researchers have noted that many of the personality disorders tend to emphasize gender-related constructs, such as dependence in women and aggression in men. While this gender specific emphasis might overpathologize individuals of a specific gender, it could also lead to underdiagnosing others. For instance, if the criteria for depression are based on a female model, the existing criteria might not be sensitive enough to diagnose men who experience depression. Alternatively, a gender bias in diagnostic criteria can be based on unrepresentative research. The diagnostic criteria for somatization disorder are based on literature that has almost

Gender Bias in the DSM

exclusively utilized female participants. The 1,116 individuals studied for the DSM-III were all female. A similar bias existed for males regarding conduct disorder. The authors of subsequent versions of the DSM have attempted to expand the literature base, a goal that is difficult in some areas. There is evidence to support the idea that women seek mental health treatment more frequently than men. Therefore, some clinical samples may be overrepresented by female subjects, thus resulting in artificially inflated prevalence rates among women than among men. Although the historical diagnosis of hysteria was replaced by the relatively more gender neutral diagnosis of conversion disorder, a similar controversy was sparked with premenstrual dysphoric disorder. Evaluation of this controversial diagnosis began prior to the DSM-III-R. Proponents of the diagnosis believed that the inclusion of the disorder represented an increased understanding of the sometimes extreme physical and emotional difficulties that women can experience as a result of their menstrual cycle. They argued in support of the attention and financial support that women could receive with the existence of a formal diagnosis. Opponents interpreted the inclusion of the disorder as representative of increased stigma against the female experience; while hormones can also affect a man’s behavior and emotional functioning, only behavioral and emotional changes due to female hormones are pathologized as a mental disorder. The DSM-III-R task force chose to place the diagnosis in the appendix for further study under the title of Late Luteal Phase D ­ ysphoric Disorder. Despite the continued concern of stigma that could result from the diagnosis, since the 1980s, thousands of articles have been published on this general topic, many on the existence of disabling symptoms that are present in a small fraction of women. Premenstrual dysphoric disorder was again considered and ultimately included in the DSM-5. Assessment Bias

Although it is possible that some diagnostic criteria might be biased, an alternative explanation of the differential prevalence rate is that diagnostic criteria are differentially applied. Research has also shown that bias can exist either consciously or unconsciously among evaluating clinicians. For

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instance, several studies have indicated that clinicians are more likely to diagnose women with borderline personality disorder and men with antisocial personality disorder, even when the women and men present with identical symptoms. Similarly, research has found that both men and women who were rated higher on measures of femininity were more likely to receive a diagnosis of depression than those who did not appear as feminine. In addition, research has suggested that men and women may differentially endorse symptoms, which would also lead to different rates of diagnoses. There is likely considerable overlap between criterion and assessment bias. Clinicians’ expectations regarding gendered behavior might be exacerbated by criteria that are biased due to societal standards of gender. Studies have shown, in fact, that women who behave aggressively and exhibit anger are far more likely to be considered pathological, but men who display the same behavior are considered normal. In fact, there is notable overlap between the diagnostic criteria and presentation of histrionic personality disorder and narcissistic personality disorder; however, given a female and male who are displaying the same attentionseeking behavior, research indicates that the females are significantly more likely to be diagnosed with histrionic personality disorder, whereas the men receive diagnosis of narcissistic personality disorder.

Concept of Gender in the DSM Over time, revisions have been made to the DSM that suggest a growing, evolving understanding of gender bias and gender identity in general. Most notably, beginning with the DSM-III, there appeared to be an acknowledgment that gender is much more complex than biological sex (i.e., male vs. female) and that an individual can identify with certain gender characteristics not usually associated with his or her biological sex. For example, the DSM-III included the diagnoses of transsexualism for adolescents and adults, gender identity disorder of childhood, and atypical gender disorder. A revision of the DSM-III (DSM-III-R) removed atypical gender identity disorder and added gender identity disorder of adolescence or adulthood, nontranssexual type and gender identity disorder not otherwise specified. The DSM-IV collapsed most of these various diagnoses into one

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general diagnostic category, gender identity disorder. Essentially, the inclusion of gender identity disorder in the earlier versions of the DSM was seen as a positive development because many individuals seeking sex reassignment surgery were unable to undergo the procedure unless they were given the diagnosis. Thus, the diagnosis ensured both medical and legal recognition. In addition, including the diagnosis in the DSM encouraged increased research and improved treatment. However, by labeling such nontraditional gender identity as a mental disorder, it inherently suggests that this type of identity is abnormal. In fact, several critiques in the literature compare the inclusion of gender identity disorder in the DSM with the inclusion of homosexuality in earlier versions of the DSM; simply categorizing it as a mental disorder and thus implying that it is abnormal introduces bias and stigma. In 2013, prior to the publication of the DSM-5, the APA published a summary of the changes and acknowledged that in its interpretation of psychiatric diagnoses, the DSM can affect individual and societal assumptions about disorders, and therefore affect stigma. When the authors of the DSM-5 replaced gender identity disorder with gender dysphoria, they emphasized that to meet the diagnosis an individual had to report significant emotional distress regarding some aspect of his or her gender identity. This change was meant to lessen the stigma, suggesting that only those who were experiencing significant disruptions in their lives should be given the disorder. Simply identifying with a nonbiologically based gender is insufficient. Another related change was the replacement of the word disorder with the word dysphoria, in an attempt to distance the diagnosis with the concept of disordered. An alternative concern, highlighted by the Sexual and Gender Identity Disorders Work Group, was that the elimination of a disorder relating to gender concept would jeopardize access to care, including counseling, hormonal and surgical treatment, and social and legal services. Individuals who do not experience emotional distress and are therefore unable to receive the diagnosis are also unlikely to receive insurance payments to assist with sex reassignment surgery. This has many arguing that the change to gender dysphoria does not, in fact, represent a major improvement in

reducing bias and stigma. The controversy regarding the impact and relevance of gender in the DSM is far from resolved, as the published literature regarding gender and the impact of gender on diagnoses continues to evolve. Rebecca A. Weiss and Christina Massey See also Anxiety Disorders and Gender; Behavioral Disorders and Gender; Biological Sex and Mental Health Outcomes; Depression and Gender; Mania and Gender; Mental Health and Gender: Overview; Personality Disorders and Gender Bias; Substance Use and Gender

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Broverman, I. K., Broverman, D. M., Clarkson, F. E., Rosenkrantz, P. S., & Vogel, S. R. (1970). Sex-role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34, 1–7. Davy, Z. (2015). The DSM-5 and the politics of diagnosing transpeople. Archives of Sexual Behavior, 44, 1165–1176. doi:10.1007/s10508-015-0573-6 Eriksen, K., & Kress, V. E. (2008). Gender and diagnosis: Struggles and suggestions for counselors. Journal of Counseling & Development, 86, 152–162. doi:10.1002/ j.1556-6678.2008.tb00492.x Garb, H. N. (1998). Studying the clinician: Judgment research and psychological assessment. Washington, DC: American Psychological Association. Hartung, C. M., & Widiger, T. A. (1998). Gender differences in the diagnosis of mental disorders: Conclusions and controversies of the DSM-IV. Psychological Bulletin, 123, 260–278. doi:10.1037/ 0033-2909.123.3.260 Kaplan, M. (1983). A woman’s view of DSM-III. American Psychologist, 38, 786–792. Ussher, J. M. (2013). Diagnosing difficult women and pathologising femininity: Gender bias in psychiatric nosology. Feminism & Psychology, 23, 63–69. doi:10.1177/0959353512467968 Widiger, T. A. (1998). Invited essay: Sex biases in the diagnosis of personality disorders. Journal of Personality Disorders, 12, 95–118. Widiger, T. A., & Spitzer, R. L. (1991). Sex bias in the diagnosis of personality disorders: Conceptual and methodological issues. Clinical Psychology Review, 11, 1–22.

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Conformity refers to the level of change in ­behavior or thinking based on pressure, real or perceived, from another person, a group, or society. Levels of conformity can range from lower levels to higher levels with a variety of reasons for conforming or not conforming to the pressure. With regard to gender, gender roles oftentimes subconsciously dictate conformity; people may make decisions based on the pressure to behave according to their assigned birth sex or gender. This entry introduces the topic of conformity as it relates to gender by establishing why people join groups, reviewing perspectives of conformity, discussing the extremes of conformity, and concluding with information on the evolution of gender conformity.

members are expected to conform to that structure for the better benefit of the group. For example, a person may be a part of a committee to further identify ways of recycling in the community. Each group member is expected to conform to expectations that support a healthy environment as well as the “rules” of the group such as group meetings, positions within the group, and activities, among others. Interpersonal pressures occur when others have an expectation of the person or a request to the person and the person feels pressured to conform to the expectation or request. Societal, group, or interpersonal pressure to conform varies based on the characteristics of the individual. Such characteristics include but are not limited to gender, race, ethnicity, sexual orientation, culture, age, religion, socioeconomic status, and demographic location.

Groups and Conformity

The Extremes of Conformity

Groups can be classified as structured or unstructured; structured groups are governed by a framework of the organization, whereas in unstructured groups the group is formed based on commonalities between persons such as hobbies and interests. Some groups are formed because of identities and interests (e.g., groups based on racial/ethnic background, religion). Sometimes, groups form because they feel marginalized in greater society (e.g., women, LGBTQ people); meanwhile, sometimes, people with dominant group identities belong to such groups without even recognizing such differences (e.g., heterosexual people, cisgender people). The “pressure” to change our thinking patterns or behaviors that we experience or perceive comes from groups, another person, or society. From a societal perspective, laws are created to maintain order; those who do not abide by the laws are not conforming and may be subject to an arrest and subsequent legal involvement. Society also has unwritten “rules” or norms; these are the expected behaviors within a group or society. Norms and laws seem similar, but a person can break a norm without breaking the law. For example, a person could walk down the sidewalk the wrong way or be on a cell phone in the library; these may be violations of a rule or norm but obviously not ­ ­illegal. Groups may have a structure, and group

Early philosopher Aristotle identified that to be virtuous, a person must have a mean between two extreme states. In this, the “mean” implies average; therefore, according to Aristotle, people should be around the mean between two extremes to be ­virtuous. With regard to conformity, being around the mean allows a person to conform to chosen groups or expectations and to make individualistic choices that do not conform. On one extreme, social psychologist Irving Janis identifies groupthink; this is where members of a group are overly willing to concur with one another. Although this may sound like a positive, too much conformity does not lead to innovative ideas, professional growth, or the ability to provide honest feedback on an issue. On the opposite extreme, some argue that if there were no conformity, the world would be in complete chaos. Laws would not be followed, groups would not need to be formed, and decisions would be made solely based on each person’s individual needs.

Gender Conformity

Evolution of Gender Conformity Essentially, gender roles are the expected behaviors of each person based on their gender, including, but not limited to, variables such as employment, family, and social, cultural, and prosocial activities. Historically, gender roles were strict; the expectations for

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genders were very prominent, and those who deviated could be ostracized. Today, gender roles are still present; however, deviation is more acceptable and in many cases celebrated. Women are encouraged to enter into career fields that were once deemed “too masculine,” and men are encouraged similarly. Women and men are often able to explore or experiment with gender in how they dress or what their interests are. Furthermore, it is important to recognize how gender conformity can affect different social identity groups. Gender conformity within particular racial, ethnic, cultural, or religious groups may influence how children are raised, how relationship dynamics are formed and continue, what types of careers people enter, and how people express emotions or communicate. Gender conformity in certain families and communities can also influence whether or not a lesbian, gay, bisexual, or queer person feels comfortable in exploring their sexual orientation identities. Finally, because of gender conformity, transgender people may feel pressured to not come to terms with their gender identities. Conversely, if they do choose to identify as transgender, they may feel compelled to undergo gender affirming medical therapies in order to conform to the other end of the gender binary. Finally, the focus of cultural competency and diversity in psychology has been a primary focus in educational programs and among academics; this focus has improved psychological care by better understanding the cultural variables that include gender-related issues. Celebrating that there are multiple ways to identify with, and perform, gender allows for individuals to connect with their truest and most authentic selves. Greg Bohall See also Cultural Competence; Gender Nonconforming Behaviors; Gender Roles: Overview; Gender Stereotypes; Gendered Behavior; Identity Construction; Nature Versus Nurture; Role Models and Gender

Further Readings Aronson, E. (2012). The social animal (11th ed.). New York, NY: Worth. Brinkman, B. G., Rabenstein, K. L., Rosen, L. A., & Zimmerman, T. S. (2014). Children’s gender identity development: The dynamic negotiation process

between conformity and authenticity. Youth & Society, 46(6), 835–852. doi:10.1177/0044118X12455025 Good, J. J., & Sanchez, D. T. (2010). Doing gender for different reasons: Why gender conformity positively and negatively predicts self-esteem. Psychology of Women Quarterly, 34, 203–214. doi:10.1111/ j.1471-6402.2010.01562.x Henslin, J. M. (2014). Sociology: A down-to-earth approach (11th ed.). New York, NY: Pearson.

Gender Development, Theories of Societal gender typing circumscribes many aspects of our lives. The development of gender has the potential to profoundly affect who we are, who we identify as, and how we live our lives. Gender development is defined as a person’s developmental process of identifying their gender identity and their gender role. Gender identity is a person’s concept of being a male or a female. Gender role is the sum of the behaviors, attitudes, and preferences that are considered to be appropriate for female and male members of a particular society at a specific time. Thus, gender roles are bound by the culture in which the male or the female person inhabits. Various psychological theories have attempted to explain the process of gender development, a process that encompasses development from the fetal stage to gender identity s­ olidification years later. As the first to present a unified theory of gender, sexual, and personality development, Sigmund Freud has had a profound and lasting influence in the discipline of psychology. Indeed, his work Three Essays on the Theory of Sexuality was in its fourth edition by 1920. According to Freud’s psychoanalytic theory, the initial object of identification for both boys and girls is the mother. This initial identification changes to erotic attachment toward their opposite-sex parent. At the same time, children experience jealousy, resulting in conflict. This conflict is resolved, around age 3 to 5 years, through subsequent identification with the same-sex parent, allowing children to embody the qualities and characteristics of the same-sex parent. While Freud theorized that it is this process of identification that results in gender development, little empirical evidence supports this theory.

Gender Development, Theories of

Given the lack of empirical support for the psychoanalytic theory, other theories have developed to explain the process of gender development. The most common and supported theories are the cognitive developmental, biological, socialization, and social-cognitive theories. While the developmental cognitive process takes center place according to the cognitive developmental theory, the biological theory gives primacy to hormonal influences and gender-linked heritable traits. Third, the socialization theory posits that children develop gender schemas, which in turn result in the development of gender stereotypes, which result in gender development. Last, the social-cognitive theory attempts to combine these disparate theories in order to provide a holistic picture that allows for an interaction between biological resources and sociostructural influences that result in the construction and instantiation of human behaviors, thoughts, and emotions.

Cognitive Developmental Theory of Gender Development The cognitive developmental theory, which is closely aligned with theories of basic cognitive development, consists of three central ideas: gender identity, gender stability, and gender consistency. Gender identity occurs through the child’s self-identification as a boy or a girl. Gender stability is developed when the identification with one specific gender remains the same over time, and gender consistency is achieved through the understanding that gender identity remains constant regardless of changes in outward appearance (e.g., hairstyle, clothing) or choice of activity. Gender stability is typically reached by the age of 6 years, when the child adopts gender-typed behaviors. The fundamental aspect of the cognitive developmental theory is the child as the main actor. The child, through meaning making, actively constructs gender categories. Initiation of the construction is not begun by the external forces of socialization. Instead, it is the child who initiates the gender construction. Because of this, children’s involvement in learning about gender, and their inferences about what they believe to be true, is critical to the cognitive developmental theory. As such, much of the research on the cognitive developmental theory of gender development has

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included investigations into the knowledge structures about gender in children, the stereotypes that children hold about ­people of different genders, and children’s understanding of what gender categories are. Research on gender categories has also included impression formation, the ways in which children process and remember gendered information, and changes in selective attention in terms of gendered differences.

Biological Theory of Gender Development The biological theory of development emphasizes the role of genetic and hormonal influences in gender development. According to this theory, gender development begins at the fetal stage, where males and females are exposed to different levels of testosterone. Research indicates that prenatal testosterone influences children’s subsequent sex-typed toy, playmate, and activity preferences. For example, when neonates are exposed to high levels of testosterone, females engage in reduced femaletypical play and increased male-typical play. In addition, adult women who had been exposed to high levels of testosterone in utero showed lowered prevalence rates for heterosexual orientation and identification with the female gender. Shortly after infants are born, males experience an increase of testosterone, while females experience an analogous rise in estrogen. According to preliminary evidence, this initial androgen surge may be related to a set of diverse later outcomes in infancy, including differences in social stimuli preferences, as well as differences in language processing and the development of the visual system. In addition, female infants lacking an adequate amount of gonadal steroids show lower performance on both female- and male-typical tasks but not on sex-neutral ones. While many of these findings are preliminary, and attempts to replicate somewhat inconsistent, they provide interesting insight into the possible effects of early hormonal exposure on gender development. In addition to the research on the role of gonadal hormones, biological theory of gender has also investigated the relation between neural differences in males and females and the development of sexual identity. Findings in this area include the third interstitial nucleus of the anterior hypothalamus, which is typically larger in males than in

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females. In homosexual men, however, the third interstitial nucleus of the anterior hypothalamus may be smaller than in heterosexual men. A similar difference was found in the isthmus of the corpus callosum, which is larger in homosexual men than in heterosexual men (both right-handed). However, while sex-related differences have also been found in male-to-female transsexuals and in women compared with nontranssexual men, it is not clear whether this difference is the result of hormone treatments received as adults. In conclusion, while some neural differences may be shaped by genetic and gonadal hormonal factors, brain development may also be shaped by environmental influences, including adult and childhood experiences. Thus, while research findings provide evidence of biological differences, the degree of ­ causality has yet to be fully understood.

Socialization Theory of Gender Development The third theory of gender development posits that socialization, rather than cognitive or biological influences, is responsible for gender development. For example, gender schema theory focuses on the notion that schemas about gender are formed after gender identity (the ability to label oneself as a boy or a girl) is achieved rather than after gender constancy is achieved. Then, once a child has mastered gender identity, they develop associations between themselves and gender stereotypes. Indeed, refuting the cognitive theory of gender development, research evidence shows that children start to form gender stereotypes before they achieve gender constancy. Thus, according to the gender schema ­theory, children form organized knowledge structures, or schemas, about gender and gender-related concepts. These schemas pertain to themselves and to others. In turn, children use these schemas to direct their thinking, beliefs, and behaviors. Repeated use of these schemas over time influences children’s thinking and behavior, which perpetuates gender development as a child repeatedly attempts to remain consistent with their gender identity. The gender stereotypes that result from socialization are theorized to be attributable to four potential sources: (1) parental, (2) peer, (3) institutional, and (4) self-socialization. Parental

socialization can form stereotypes around many different factors, including emotional behaviors. Mothers tend to emphasize emotional and dependent behavior for girls, but they encourage their boys to be more autonomous and less emotional. Parental socialization seems to have more negative effects for boys, as parents tend to see boys participating in stereotypically female activities as more threatening than girls who participate in stereotypically male activities. Parents also act as models for their children, as boys often look up to their fathers and girls to their mothers. In peer socialization settings, other children tend to react negatively to gender inconsistent behaviors. Children are inclined to conform to their gender’s stereotypical behavior to avoid these negative reactions. In institutional settings, such as schools, teachers may perpetuate gender stereotypes further by placing emphasis on gender labels in the classroom and having negative reactions to gender atypical behavior. Last, self-socialization occurs as children tend to behave in ways that will benefit them. For example, if conforming to a gender stereotype leads to praise and recognition, a child might start behaving in a ­gender stereotypical manner. However, if conforming to a stereotype leads to negative views of oneself, a child may go against the stereotype. The motivational factor that drives conformity to stereotypes plays a significant role in whether or not stereotypes truly have an influence on gender development. While gender schema theory does not take into account the “motivational mechanism” that drives conformity to stereotypes, it lays down a framework for how stereotypes have the potential to influence gender development and outlines avenues for future research.

Social-Cognitive Theory of Gender Development Social-cognitive theory incorporates both social and cognitive influences that lead to gender development. Also borrowing from evolutionary theories, social-cognitive theory states that while evolved informational processing systems provide the capacity for certain characteristics, it is the sociostructural influences that affect and, in turn, are affected by biological resources that result in the regulation as well as the creation of human

Gender Development, Theories of

emotions, beliefs, and behaviors. Social-cognitive theory emphasizes three different systems that play a role in gender development: (1) personal, (2)  behavioral, and (3) environmental. All three factors interact with one another to perpetuate development. For example, through observation and modeling of the environment, children form personal schemas and beliefs. They then act out their beliefs in their behavior, and then the environment responds to either confirm or reject the belief. Environmental influences differ from person to person, changing in response to parental factors, peer relations, socioeconomic status, and so on. After certain interactions, they even construct their own environments that influence these systems further. In different environments, the interactions between these three systems may be different, further creating a complex system that perpetuates gender development differently for everyone. As such, gender stereotypes can emerge through ­models and observation of the environment (more prominent in infants), enactive experiences (the results of one’s behavior), and direct tuition (parents, teachers, and others who directly teach one how to behave). Social-cognitive theory differs from cognitive developmental theory in that the latter proposes a set of predetermined and sequential steps in gender development that all children are believed to follow. While social-cognitive theory agrees with cognitive theory in that all people are believed to have the capacity for the set of predetermined steps, the former suggests that it is the environmental factors that inform whether these patterns are f­ollowed or not. In addition, while both social-cognitive and socialization theories place emphasis on the influence of environmental factors, social-­cognitive theory places more influence on motivational factors. Socialization assumes conformity to stereotypes, without allowing for motivational influences that may result in differentiation from typical patterns that may create or perpetuate the desire to stray from stereotypes. Social-cognitive theory also helps explain ­cultural differences in gender norms around the world, because the complex and iterative interaction of the individual to society provides room for social change. It does not, however, explain rapid social changes. Other limitations include missing details about the ways in which the three systems

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(environmental, behavioral, and personal) interact with one another and contribute to gender development. More research is needed to fully understand the interactions, their independence or dependence, and the motivational factors that result in conformity or counterconformity.

Patterns of Gender Development While these four major theories of gender development emphasize different aspects of psychology and give primacy to different sets of factors, commonalities do exist in the developmental pattern of gender identity. For the most part, research shows that children tend to follow similar developmental pathways in the understanding of categorization and the solidification of identity. Studies have shown that infants as young as 3 to 4 months can differentiate between male and female faces. And by 6 months, infants can discriminate faces as well as voices by sex. By 10 months, infants form associations between males and females and stereotype-consistent objects as being associated with each gender, such as girls to dolls and boys to cars. Most children develop the use of gender labels in their speech between 18 to 24 months. Stereotypes tend to emerge as early as the second year of life, and as early as preschool, boys and girls tend to prefer their own sex for play partners. It is thought that children at this age tend to segregate by sex in play partners and prefer their own sex more than the other sex because of positive identification. Gender stereotyping generally peaks at 5 or 6 years of age, becoming rigid. Children, who are highly impressionable at this age, seek cues about gender forming stereotypes from impressions, opinions, and observations. It is thought that gender flexibility often returns later, and this flexibility allows children to challenge stereotypes and become less rigid. It is this similar and common pattern found in gender development that has led to the development of theories that attempt to explain these common experiences. In the face of this common ­pattern, it is in the exceptions to the commonly found pattern, and attempts to understand the whys and the hows of this pattern, that the four major theories differ. Matthew Klubeck, Kathryn Fuentes, and Chu Kim-Prieto

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Gender Discrimination

See also Biological Theories of Gender Development; Cognitive Theories of Gender Development; Existential Theories of Gender Development; Gender Role Conflict; Gender Role Socialization; Gilligan’s Moral Development Theory; Kohlberg’s Stages of Moral Development

directed against men. This entry examines the nature and origins of gender discrimination and provides a historical view of its causes and effects, as well as some strategies to combat it.

Further Readings

Gender discrimination can be blatant or subtle. To fit the definition, it simply is treating someone differently based on the primary criterion of gender. The treatment does not have to be unfavorable; for example, offering a male subordinate rather than an equally competent woman a complicated task to perform is discriminatory. Discrimination does not have to be deliberate; one could, for example, unconsciously favor a woman over a man when selecting someone to meet with clients, because of a feeling that women are better at handling diplomatic tasks. Gender discrimination can manifest itself in policy, as in discriminatory hiring practices; it can manifest itself in society, as in the perception that females are inferior to males in mathematics and science (the empirical evidence to the contrary notwithstanding); and it can manifest itself in culture, as when female entertainers are valued ­ more for their looks than for their abilities. Perhaps one of the most salient features of gender discrimination is that it is often not apparent or is taken for granted.

Baldwin, D. A., & Moses, L. K. (1996). The ontogeny of social information gathering. Child Development, 67, 1915–1935. Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106(4), 676–713. Freud, S. (1940). The development of the sexual function. In An outline of psychoanalysis (pp. 152–156). New York, NY: W. W. Norton. Golombok, S., & Fivush, R. (1994). Gender development. New York, NY: Cambridge University Press. Hines, M. (2011). Gender development and the human brain. Annual Review of Neuroscience, 34, 69–88. doi:10.1146/annurev-neuro-061010-113654 Hornik, R., & Gunnar, M. R. (1988). A descriptive analysis of social referencing. Child Development, 59, 626–634. Martin, C., & Ruble, D. (2004). Children’s search for gender cues: Cognitive perspectives on gender development. Current Directions in Psychological Science, 13(2), 67–70. Martin, C., & Ruble, D. (2010). Patterns of gender development. Annual Review of Psychology, 61, 353–381. doi:10.1146/annurev.psych.093008. 100511

Gender Discrimination Gender discrimination is the unfair treatment of a person, based on the sole criterion of his or her gender. It is based on prejudice—the judgment of a person’s worth based on his or her being a member of a certain class, race, religion, or gender—but differs in that the discrimination refers to an action or withholding of an action. Thus, having a negative view of women in the workplace is prejudice; refusing to hire a qualified woman for a position is gender discrimination. It should be noted that gender discrimination, though historically and at present primarily directed against women, can also be

Examples of Gender Discrimination

Gender Discrimination in Human History For the vast majority of human history and continuing in a significant number of cultures today, females have been the targets of gender discrimination. Almost all traditional cultures, as well as modern cultures until quite recently, have treated women as inferior. They were and still often are seen as weak both physically and emotionally, unstable, intellectually inferior to men, and incapable of making rational decisions. This has led to females being treated as inferior beings, having less worth than men, and therefore not entitled to the same rights that are being enjoyed by men. This has manifested itself in ways ranging from denying women the vote to female infanticide. Only very recently has gender discrimination become a recognized concept. Treating women differently has historically been seen only as natural,

Gender Discrimination

much as racial discrimination was once argued to be an expression of the natural order of things. Thus, denying women the right to vote was justified because they were seen as having minds different from the minds of men, and therefore being incapable of making good decisions on issues such as policy and governance. The same rationale could be seen in the workplace, where jobs other than menial ones or those seen as “women’s work” were denied to women because they were viewed as not having the intellectual capacity to handle more complicated work. Gender discrimination has been lessened in society only recently. Women’s suffrage is all but universal in the world. Many nations have laws, often quite strict, that forbid gender discrimination in the workplace, in jurisprudence, and in the political arena. However, this progress is uneven. The United States has enjoyed steady progress in eliminating gender discrimination, but that progress is incomplete; for example, the Equal Rights Amendment, which was passed by Congress in 1972, never received the ratification by 38 states needed for it to become law. The United States was one of the last modern industrialized Western nations to allow women’s suffrage, in 1920. Gender discrimination in the workplace, though illegal, persists in the United States.

Psychological Origins of Gender Discrimination: In-Groups and Out-Groups Discrimination, in all its forms, is based on identifying an individual as a member of a group and the identification of that group as different from one’s own and, therefore, not deserving of the same treatment as that afforded to one’s own group. This is often referred to as in-group/out-group bias. Perhaps the most fundamental division into groups in human experience is that between men and women. In-group/out-group bias has most often manifested itself in human history at the tribal level. Strangers are treated with suspicion, and whatever laws one’s tribe may observe apply only to the members of one’s tribe. Thus, it may be taboo to kill a member of one’s own tribe but perfectly acceptable to kill an outsider. As societies grew and multiplied, the same basic worldview always applied. The world was divided into “us” and

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“others.” This continues today, even when, and sometimes especially when, one’s “tribe” includes several million people. It may seem paradoxical to identify a member of the opposite sex as the “other.” After all, such a person may also be a member of one’s own tribe/ society. However, in a complex society, in-groups and out-groups often overlap. One could simultaneously identify another person as, for example, a Protestant (in-group), an African American (outgroup), a U.S. citizen (in-group), and a Democrat (out-group). Whether someone views another person as an in-group or out-group member is often, therefore, contextual.

The Opposite Gender as an Out-Group For most of history, men and women have worked separately. In many instances, they have socialized separately as well. Both workplaces and social gathering places are nuclei for the formation of groups. Therefore, men and women frequently belong to different social and work groups even if they are spouses or mutual family members. This can lead to in-group bias in that one regards the members of  one’s work group or social group as more worthwhile—and therefore worthy—than one’s ­ own spouse or opposite-gender family member. Almost by definition, in-group bias leads to discrimination. If one regards an out-group member as inferior in some way to one’s in-group, then one may consider that the laws, rules, and, most important, moral precepts that apply to one’s own group do not apply to that outsider or others like him or her. In the case of gender discrimination, the discriminating person may feel perfectly comfortable treating a person of the opposite gender in a way that he or she would never consider treating a person of his or her own gender. In modern U.S. society, one can observe genderbiased in-groups forming with informal sports teams, political organizations, activity groups, therapy and support groups, and even such seemingly innocuous associations such as book clubs and bowling leagues. Whenever a group is formed, the definition of which is the exclusion of another group (“women’s club”), the potential exists for in-group bias and, if that definition is gendered, gender discrimination.

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Evolutionary and Psychological Basis for In-Group Bias and Discrimination The major reason why discrimination and ingroup bias are so persistent in human society is that they have been adaptive; that is, they have been part of an evolutionarily sound strategy for humans to use. In the first primitive societies, identifying another person as a member of one’s group or an outsider, friend or foe, was often a matter of life or death, and the decision had to be made quickly. The default way to regard a stranger was with suspicion and hostility or, if the encounter happened close to one’s settlement or family, outright aggression. This effect continued into the formation of complex societies. For example, it is the reason why soldiers and policemen wear uniforms. One knows at a glance whether a stranger is one of the “good guys” or not. In human societies both primitive and modern, it is psychologically important for one to “belong.” This is another way of saying that one wishes to reinforce one’s standing as a member of the ingroup. Frequently, the most convenient way to do this is to attack a member of an out-group. One can see this manifested in diverse ways such as bullying, gang culture, or even the Nazis’ persecution of the Jews. The reason, then, why discrimination is so rampant in human society is that at a fundamental level, it feels good to discriminate. The following are some of the strategies that individuals, groups, and societies can use to combat gender discrimination.

Methods Used to Combat Gender Discrimination Legislative Measures

At the macrolevel of society, the most common way to attempt to prevent gender discrimination is to make it illegal. Thus, gender discrimination is illegal in the United States, most of Europe, and many other nations. Civil rights legislation has usually included language making it illegal to discriminate on the basis of sex or gender, race, or national origin. However, making something i­ llegal does not prevent it; for example, racial discrimination is widespread in the United States more than 50 years after civil rights legislation was enacted.

One problem with much present antigender discrimination legislation is that it does not carry particularly severe penalties. Furthermore, it is often difficult to prove that a violation has occurred, making the laws difficult to enforce—it is often a case of one person’s word against another’s. Thus, a person or business may feel ­comfortable in maintaining discriminatory policies, knowing that the possibility of punishment is low and the said punishment will not be severe. Litigation

Possibly the most effective method to combat gender discrimination is through the civil courts. It has been well established through recent court decisions that gender discrimination causes real and substantial financial damage to the person who is a victim of it. Courts have often granted substantial financial awards to persons who were the targets of gender discrimination. The key is that civil decisions, unlike criminal decisions, do not require proof beyond a reasonable doubt; they only require a preponderance of evidence. Thus, it is generally easier to win a case for damages than to prove that the crime of discrimination has occurred. Also, while proving that one’s civil rights have been violated may be satisfying, no actual compensation will accrue to the victim as a result (unless the court orders it). Education

As mentioned earlier, discrimination in all its forms has been deemed appropriate and natural for the vast majority of human history. In the case of gender discrimination, it remains appropriate and natural for much of humanity, even in the relatively enlightened population of the United States. Thus, to eradicate gender discrimination, it is not enough to make it illegal, nor is it enough to make it painful (lawsuits). Society must also feel that it is simply wrong. To that end, fighting discrimination is now an important part of pedagogy, even at an early level. Moral and ethical values can be inculcated at a very early age. It is just as important for children to know why a rule exists as it is for them to obey it. At the other end of the spectrum, almost every university has strictly enforced antidiscrimination

Gender Dynamics in Clinical Supervision

rules in place. Gender discrimination is taken seriously, and authorities make every effort to prevent and, if necessary, punish it. At universities in particular recently, sexual harassment and sexual assault have become major issues. Sexual harassment and sexual assault are actually forms of gender discrimination, in that one treats members of the opposite gender with less regard than one would treat one’s own gender. The efforts of university authorities to combat this are centered on education. William G. McDonald See also Gender Bias in Education; Gender Bias in Hiring Practices; Workplace and Gender: Overview

Further Readings Abrams, K. (1989). Gender discrimination and the transformation of workplace norms. Vanderbilt Law Review, 42, 1183–1248. Brewer, M. B. (2007). The social psychology of intergroup relations: Social categorization, ingroup bias, and outgroup prejudice. APA PsycNet. Retrieved from http://psycnet.apa.org/psycinfo/2007-11239-030 Crocker, J., & Luhtanen, R. (1990). Collective self-esteem and ingroup bias. Journal of Personality and Social Psychology, 58(1), 60–67. Kobrynowicz, D., & Branscombe, N. R. (1997). Who considers themselves victims of discrimination? Individual difference predictors of perceived gender discrimination in women and men. Psychology of Women Quarterly, 21(3), 347–363. Landrine, H., Klonoff, E. A., Gibbs, J., Manning, V., & Lund, M. (1995). Physical and psychiatric correlates of gender discrimination. Psychology of Women Quarterly, 19(4), 473–492. Rudman, L. A., & Goodwin, S. A. (2004). Gender differences in automatic in-group bias: Why do women like women more than men like men? Journal of Personality and Social Psychology, 87(4), 494–509.

Gender Dynamics in Clinical Supervision With an increased understanding that gender is fundamental to the supervisory relationship,

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scholars have turned their attention to gender issues in clinical supervision. In fact, besides race, gender appears to be one of the most frequently addressed cultural topics in supervision. Interestingly, the conceptualization of gender in clinical supervision l­iterature seems to have changed over time. Early literature on gender issues in supervision tended to focus on gender as a biologically determined variable; recently, scholars have conceptualized gender as socially constructed and inextricably tied to societal attitudes, values, and belief systems. This entry discusses the influence of gender on the supervisory process in counseling and psychotherapy.

Early Emphasis: Gender as a Categorical Variable Theoretically, sex role stereotypes and gender roles were noted to likely influence the process of supervision. As such, the issue of gender matching between the supervisor and the supervisee has drawn some attention. Empirically, researchers have found mixed results. Some authors saw ­gender differences as affecting trainee expectations as well as strategies and supervisory styles. For instance, Mary W. Hicks and Thomas A. Cornille found that when female supervisors supervised female trainees, these trainees experienced supervision as more collaborative and relationally focused. Conversely, male supervisors in supervisory dyads were seen to engage in a more task-oriented style of supervision. Moreover, studies have suggested that gender differences between supervisors and trainees contribute to communication problems, the devaluation of trainees, and significant impasses in supervision. Although limited, there is evidence suggesting that supervisees prefer to work with a supervisor of the same gender. In contrast, several studies have either failed to find gender matching influencing the structure of supervision, supervisee skill development, or working alliance ratings or suggested a negative impact. For instance, Stephen R. Wester, David L. Vogel, and James Archer Jr. found male interns to rate the supervisory alliance lower when matched with male supervisors. Yet other studies have revealed that supervisees consider supervisor care and concern, as well as their clinical and supervisory experience as more important than supervisor-supervisee gender matching.

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Moreover, interpersonal power based in the evaluative role in supervision has been identified as a critical variable.

Gender and Power in Supervision The evaluative function of supervision gives the supervisor an important source of interpersonal influence. However, this evaluative function also signifies the hierarchical nature of the supervisory relationship, which can further complicate gender relations in clinical supervision. Specifically, interpersonal power, a critical factor in supervision, can  be significantly influenced by gendered interactions. Power in supervision is categorized into expert, referent, and legitimate. Expert power refers to the display of specialized knowledge and skills, confidence, and rationality. Referent power, derived from interpersonal attraction, is based on a supervisee’s perceptions of similarities with the supervisor’s values, attitudes, opinions, and experiences. Last, legitimate power is a result of perceived ­trustworthiness—that the supervisor is a socially sanctioned provider of services who is not motivated by personal gain. James E. Robyak and colleagues found that when compared with female supervisors, male supervisors reported greater preference for referent power. Moreover, Lynda M. Sagrestano indicated that males tended to respond differently than females in conversations when they were in positions of power. For instance, Y. Barry Chung, Joseph A. Marshall, and Laurie L. Gordon’s 2001 study revealed that male supervisors gave lower ratings and less positive feedback when the hypothetical supervisee was female; the hypothetical supervisee’s gender had no significant effect, however, on female supervisor evaluation and feedback for the supervisee. In their 1990 analysis of audiotaped supervision sessions, Mary Lee Nelson and Elizabeth L. Holloway found that both male and female supervisors were less likely to encourage or support their female trainees’ assumption of power in the supervision session as compared with their male trainees’. Regardless of their biological sex, supervisors did not reinforce the female supervisees’ attempts to assume the expert role. Moreover, compared with male trainees, female trainees were more likely to relinquish their power in deference to their supervisors.

Darcy H. Granello, Patricia M. Beamish, and Tom E. Davis found similar results in 1997. The ­supervisors in their study asked for opinions and suggestions from male supervisees twice as often as they did from female supervisees. Besides, these researchers also found that male supervisees in ­longer supervisory relationships were told what to do by their supervisors less often and were able to generate their own responses more often. Conversely, female trainees in similar supervisory r­elationships were ­ told what to do by their supervisors more often and were able to voice their own opinions less often than their male counterparts. These empirical findings raise concern about the lack of equal status between male and female trainees and can disempower women in the ­ supervisory process and negatively influence their professional identity.

Postmodern Stance of Gender in Supervision Researchers have shifted away from conceptualizing gender as a categorical variable and moved toward viewing gender as socially constructed and intricately related to societal attitudes, values, and belief systems. In 2012, arguing for a more complex understanding of gendered interactions, Susan L. Rarick and Nicholas Ladany suggested that scholars examine supervisor-supervisee gender attitude matching, rather than simply focusing on biological sex matching. Based on the writings of Julie Ancis and Ladany, Janet E. Helms, and Ladany, Christopher S. Brittan-Powell, and Raji K. Pannu, Rarick and Ladany identify four types of gender attitude matches: (1) progressive (i.e., liberal supervisors working with traditional ­ ­trainees), (2) parallel-high (i.e., liberal supervisors working with liberal trainees), (3) parallel-low (i.e., traditional supervisors working with traditional trainees), and (4) regressive (­i.e., liberal trainees working with traditional supervisors). The authors found that supervisors in progressive dyads rated their supervisory style as significantly more task oriented than did supervisors in ­parallel-high dyads. Perhaps the utilization of a more task-oriented style of supervision by progressive dyads is intended to help trainees at lower levels of gender identity to progress to a higher level. Beyond gender attitudes, researchers have also focused on understanding the role of

Gender Dynamics in Clinical Training

gender-related events in supervision. Genderrelated events were operationalized as supervision incidents that pertain to either the trainee’s or the client’s sex, gender, or stereotypes and assumptions concerning gender roles and expectations. In 2007, Jessica A. Walker, Ladany, and Lia M. Pate-­Carolan found that supportive gender-related events in supervision focused on integrating gender into clinical work, processing gender-related feelings, and considering gender roles and expectations in professional development. Nonsupportive genderrelated events focused on gender stereotypes, inappropriate behavior, and dismissal of the trainee’s efforts to discuss gender. Kristin N. Bertsch and colleagues extended this research in 2014, identifying four types of gender-related events: (1) gender discrimination, (2) gender identity interactions, (3) attraction, and (4) power dynamics. In addition, gender discrimination incidents seem to negatively influence the supervisory working alliance and supervisees’ perceptions of supervisors’ genderrelated multicultural competence. Gender undoubtedly exerts influence on the expression of power in and the structure of the supervisory process. Scholars in the area of feminist supervision have been more explicit about how to both empower and educate by proposing a number of behaviors on the part of the supervisor, such as rejecting essentialist notions of gender, fostering a sense of commitment to women’s issues and activism, and making central the ways in which sexism and other forms of oppression inform clinical training and practice. Most important, addressing gender issues in clinical supervision requires “leveling the playing field” (Ladany et al., 2005, p. 159). Beyond awareness of their own gender attitudes, supervisors should engage supervisees in discussions about the social construction of gender and actively share power with the supervisees. Arpana G. Inman and Linh P. Luu See also Feminist Therapy; Gender Dynamics in Clinical Training; Gender Dynamics in Group Therapy; Gender Dynamics in Psychotherapy; Sexual Orientation Dynamics in Clinical Supervision

Further Readings Ancis, J., & Ladany, N. (2010). A multicultural framework for counselor supervision: Knowledge and skills. In N.

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Ladany & L. Bradley (Eds.), Counselor supervision (4th ed., pp. 53–95). New York, NY: Routledge. Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Allyn & Bacon. Bertsch, K. N., Bremer-Landau, J. D., Inman, A. G., DeBoer Kreider, E. R., Price, T., & DeCarlo, A. L. (2014). Evaluation of the critical events in supervision model using gender related events. Training and Education in Professional Psychology, 8, 174–181. doi:10.1037/tep0000039 Holloway, E. L., & Wolleat, P. L. (1994). Supervision: The pragmatics of empowerment. Journal of Educational and Psychological Consultation, 5, 23–43. doi:10.1207/s1532768xjepc0501_2 Inman, A. G., Hutman, H., Pensde, A., Devdas, L., Luu, L., & Ellis, M. (2014). Current trends concerning supervisors, supervisees, and clients in clinical supervision. In C. E. Watkins Jr. & D. L. Milne (Eds.), The Wiley international handbook of clinical supervision (pp. 61–102). Chichester, England: Wiley. Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An interpersonal approach. Washington, DC: American Psychological Association. doi:10.1037/10958-000 Rarick, S. L., & Ladany, N. (2012). The relationship of supervisor and trainee gender match and gender attitude match to supervisory style and the supervisory working alliance. Counselling and Psychotherapy Research, 13, 138–144. doi:10.1080/14733145.2012.732592

Gender Dynamics Training

in

Clinical

This entry summarizes key concepts and empirical research findings to date on how psychology educators and trainers can facilitate understanding of gender-related influences in effective p ­sychology practice. The pervasive and often unrecognized influences of sexism, heterosexism, and cisgenderism in educational, supervisory, and therapeutic dynamics are highlighted at individual, interpersonal, and systemic levels. As an e­lement of the broader multicultural training of psychologists and other mental health professionals, gender competencies development requires continual and ­conscious analyses of the influences of cultural contexts as well as how gender identities intersect with one’s other identities of privilege and oppression.

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Gender Competencies Development for Effective Practice Multicultural competencies development is a key clinical/counseling training objective for preparing psychologists and other mental health care professionals to effectively serve a wide range of diverse people and to promote social welfare. As one dimension of diversity, gender is a component of multicultural competencies training. Genderrelated influences are among the factors that may play a role in both clients’ and therapists’ perceptions of and expectations for therapy. Gender competencies aim to develop awareness, knowledge, and skills for understanding the gender-related influences that hinder and facilitate effective counseling and psychological practice. Effective practice in mental health care requires an understanding of clients at individual, interpersonal, and systemic levels. Clients belong to multiple identity groups, and therapists need to ­ understand how their clients’ gender-related identities influence and interact with their other identities (e.g., regarding race, ethnicity, age, sexual ­orientation, social class, health and ability status, religious affiliation). Relevant to their mental health concerns, some of the clients’ salient identities may afford them social positions of power, while other salient identities may make them vulnerable to prejudice and discrimination. Likewise, therapists have their own multiple identities of power and oppression, which may influence their perceptions of and therapeutic work with their clients. Thus, effective practice requires therapists to understand the complex influences of their ­clients’ and their own intersecting identities in their work together. Furthermore, the influences of intersecting identities on therapeutic dynamics are likely pervasive and are often unconscious influences of power (i.e., taken-for-granted or privileged identities) and oppression (e.g., identities subject to discrimination). Lack of awareness of these influences can hinder effective clinical practice.

Definitions of Gender, Gender Identity, and Sexual Orientation Developing gender competencies in clinical training includes acquiring relevant knowledge of g­ enderrelated terms as a foundation for understanding

the influences of potential gender-related biases. According to psychotherapy guidelines, the following are the definitions of gender, gender identity, and sexual orientation. Gender

Although many scholars consider the definition of gender as more socially constructed than a more biologically determined definition of sex, the terms gender and sex are often conflated in psychological research, training, and practice. Yet typically dichotomous definitions of sex, as male or female, focus on physiological, hormonal, reproductive, and genetic features. In addition, intersex refers to a person with atypical combinations of the biological features usually used to distinguish as male or female. In comparison, gender refers to the attitudes, feelings, and behaviors associated with an individual’s biological sex according to one’s culture. Definitions of gender are based on socially constructed ranges of gender-related values, beliefs, expectations, and societal hierarchies. Thus, gender is influenced not only by biological factors but also by interacting historical, economic, sociopolitical, and cultural factors. For example, beyond viewing gender as a biological or demographic status variable, psychological practice and training may focus on the dynamic influences in the therapeutic process of gender socialization, such as assuming roles in conflict with the gender norms or expectations of the client’s, therapist’s, and trainer’s cultural contexts. Gender Identity

Gender identity is defined as one’s sense of oneself as cisgender or transgender—that is, as conforming or not conforming with the cultural gender norms corresponding to one’s biological ­ sex, respectively. Components of gender identity, as it is socially constructed, may be more fluid and influenced by contexts at the individual and institutional levels. For example, by expressing oneself through clothing, communication patterns, or interests, one may behave in family or employment contexts in ways that are, or are not, consistent with culturally prescribed gender roles or with one’s gender identity. Some transgender individuals may undergo a transition process to change from

Gender Dynamics in Clinical Training

their designated sex at birth to more closely reflect their gender identity; this may include steps that are personal (e.g., using a different name and new pronouns or dressing differently), medical (e.g., undergoing hormone therapy or surgical procedures), or legal (e.g., changing one’s name or sex on legal documents). Sexual Orientation

The definition of sexual orientation refers to the sex of those to whom an individual is attracted sexually and romantically. Typically, categories of sexual orientation include attraction to members of the opposite sex (heterosexuals), the same sex (homosexuals, gay men, or lesbians), or both sexes (bisexuals). Research suggests that for some people sexual orientation is more fluid than conforming to these distinct categories and thus occurs more on a continuum.

Gender Biases and Discrimination Influences in Clinical Training Relevant to understanding how gender dynamics may influence more helpful and effective therapeutic practice, therapists need to develop gender competencies in their therapeutic work that include conscious and constructive analyses of the influences of sexism, heterosexism, and cisgenderism. Sexism

Sexism is defined as stereotyping, prejudice, or discrimination, typically against women, on the basis of sex. At its core, the biased assumptions underlying sexism are that women are inferior and subordinate to men. Pervasive influences of sexism on women—at personal, interpersonal, and ­systemic levels—include social, political, legal, and economic inequity with men. Sexual objectifications of women are examples of more overt expressions of sexism. Yet research has demonstrated that implicit sexist biases operate ­unconsciously and automatically for most people. Influences of implicit sexist biases on interper­ sonal dynamics, for example, include evidence that the contributions acknowledged in group dynamics, as well as evaluations of competencies, are frequently biased in favor of men and against

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women. One implication for clinical training is that educators need to pay attention to the power dynamics in class discussions in order to elicit and acknowledge the contributions of both men and women. Another implication for training is that clinical supervisors need to consciously take into consideration the tendency to evaluate the competencies of men more favorably over those of women. Cisgenderism

As noted previously, cisgender refers to individuals whose gender identity conforms with the cultural gender norms that correspond to their ­ biological sex. Cisgenderism is defined as prejudice that denies, ignores, denigrates, or stigmatizes expressions of gender identity that do not conform with cultural gender norms. Transgender individuals are often targets of cisgenderism. The range of discrimination against transgender people includes implicit gender bias as well as overt discrimination and violence. In addition, cisgender assumptions and biases related to restrictive gender role expectations likely limit healthy psychosocial ­ development in cisgender men and women. Some U.S. scholars note that cisgenderism exists in everyone, cisgender and transgender individuals alike. This is because most people are raised and live in a predominantly cisgender society, with l­ittle or no ­positive recognition of noncisgender identity, experience, or expression. Cisgender assumptions and biases may limit therapists and clinical trainers from effectively recognizing and addressing, for example, pressures to conform to cultural gender role expectations, the increased risks for (including discrimination and violence against) gender nonconforming individuals, and the need for ­ ­clinical knowledge to effectively help transgender individuals in the process of transitioning. Heterosexism

Heterosexism is defined as prejudice or discrimination against homosexual or bisexual ­people. Historical legacies (e.g., in psychiatric diagnosis) as well as some current views and institutions (e.g., some religious and political groups) have condemned homosexuality as immoral, criminal, or sick. Despite more recent progress in social

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justice, negative and hostile attitudes regarding nonheterosexual people continue to pervade societal customs and institutions and further persist in implicit biases. Similar to the influences of cisgenderism, unexamined heterosexist assumptions and biases may limit the effectiveness of psychology practice and training. For example, therapists, educators, and clinical supervisors need to effectively recognize and constructively address heterosexist stigma in the following: cultural gender expectations about romantic attraction, increased risks for discrimination and violence against homosexual and bisexual individuals, and the clinical knowledge needed to effectively help these individuals in the process of considering sharing with others and/ or guarding privacy or secrecy about their sexual orientation. The pervasive and often unrecognized influences of sexism, cisgenderism, and heterosexism in the therapeutic dynamics of clinical training ­operate at individual, interpersonal, and systemic levels. In addition to recognizing gender-related ­ intrapsychic and interpersonal concerns in therapeutic and training relationships, counselors and trainers need to consider the influences that affect their therapeutic understanding of gender-related external factors within social, cultural, economic, familial, and political contexts. For example, in counseling with a young cisgender female client and her ­ lesbian partner who live together, their relationship concerns may be influenced by their economic context (e.g., paying rent at a significantly high proportion of their combined income in the expensive city where they are employed in occupations without gender pay equity), the political context (e.g., in a legal same-sex marriage yet living in a state without relevant legal protections in employment, housing, or health care), and familial and cultural contexts (e.g., coming from differing racial, ethnic, and religious backgrounds, with differing gender role expectations for women and differing support for their sexual orientation).

Facilitating Gender Competencies in Clinical Training Domains Effective practice and training in counseling and psychotherapy require conscious and constructive consideration of gender dynamics in therapeutic, teaching, supervisory, and mentoring relationships.

Drawing from multicultural, feminist, social j­ ustice, and clinical supervision frameworks, scholars have outlined methods for professional counseling and psychology educators and trainers to promote the development of gender competencies. In the clinical training domains of classroom education and supervised practice, gender competencies may be developed in relevant knowledge, self-awareness, and skills. Knowledge Component

In clinical training curricula and programs, knowledge regarding gender influences in ­assessment, diagnosis, case conceptualization, and ­intervention approaches—including ethical attention to the propensity for gender biases and discrimination—needs to be expanded and inte­ grated. Foundational knowledge bases and theoretical approaches to mental health practice need to be expanded to integrate gender competencies as a key component of clinical training. For example, courses on the history of psychology should include the contributions of women as well as of people of color and other intersecting identities that are marginalized or excluded. The content of the curriculum should include a constructive ­critique of the dominant models of theoretical approaches to psychotherapy and clinical supervision that are limited in attention to gender ­dynamics and cultural contexts. This includes consideration of constructive alternative approaches to clinical theory, research, and practice—for example, approaches focused on transforming knowledge through analysis of gender-related influences in personal attitudes, intersecting identities of privilege and oppression, advocacy, and community outreach. Self-Awareness Component

Both trainers and trainees need to consciously attend to developing self-awareness of their own as well as their clients’ gender-related identities, values, attitudes, role expectations, expressions, ­ contexts, conflicts, and biases. As a means to gain a more complex understanding of effective therapeutic processes, clinical training needs to include systemically developing habits of practice for selfreflection to examine gender-related influences. Through coursework and supervised clinical

Gender Dynamics in Clinical Training

practice, examples of methods to facilitate gender competencies in self-reflective practice with trainees include experiential learning exercises, journaling, and mapping genograms. Trainers and trainees can use these methods to explore their own gender identity development and the range of gender-related roles, values, and power dynamics in their own family and work systems. They can also focus on better understanding and addressing gender-related countertransference or biased reactions elicited in therapeutic, educational, and supervisory relationships and processes. Effective faculty and clinical supervisors can serve as constructive role models for self-reflective practice in clinical training dynamics—for example, in ­self-disclosing about their experience and understanding of the complexities of their gender identities, as well as exploring how similarities ­ and differences with their trainees and clients may hinder or facilitate their developing therapeutic understanding with each other. The necessary process of constructively exploring gender and other multicultural dynamics in clinical training, nonetheless, consists of difficult dialogues that commonly elicit strong feelings (e.g., anger, anxiety) and defensive resistance reactions. Faculty and clinical supervisors have dual roles in both supporting and evaluating their trainees’ evolving competencies. Trainers need to develop skills for balancing these roles in ways that constructively use (not exploit) their power to help trainees tolerate their strong emotions and ­critically engage in these difficult dialogues. For example, in classroom discussions and clinical supervision groups or dyads, trainers can explicitly agree to work together with trainees to promote respect, safety, and trust in exploring gender dynamics. Trainers must incorporate space and time to mutually express thoughts and feelings in these difficult dialogues in ways that empathically support exploration and effectively challenge blind spots. In particular, trainers should give voice to marginalized individuals and aim to prevent revictimization of those whose identities are vulnerable to discrimination. Skills Component

Multicultural competencies generally, and gender competencies particularly, can be ­

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increasingly developed through clinical training and ­lifelong education. Targets for clinical skills development that incorporate knowledge and selfawareness of gender influences in effective therapeutic assessment and intervention include ­ the following: (a) assessing the meaning of nonverbal cues, (b) enhancing empathic understanding of gender issues, and (c) considering how covert processes of gender biases and discrimination may surface in therapeutic and training settings. To effect therapeutic change in mental health care practice at systemic levels, clinical skills training that i­ntegrates gender competencies is also needed in community outreach and social justice advocacy. Further research is needed on clinical t­ raining initiatives at the program and broader professional organization levels to assess and promote understanding of gender dynamics and competencies for effective mental health care outcomes. Margo A. Jackson and Eleanor R. Smith See also Gender Nonconformity and Transgender Issues: Overview; Gender Role Conflict; Gender Roles: Overview; Gender Stereotypes; Heterosexism; Multiculturalism and Gender: Overview

Further Readings American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. doi:10.1037/0003-066X. 58.5.377 American Psychological Association. (2007). Guidelines for psychological practice with girls and women. American Psychologist, 62, 949–979. doi:10.1037/ 0003-066X.62.9.949 American Psychological Association. (2011). Revised competency benchmarks for professional psychology. Washington, DC: Author. Retrieved from http://www .apa.org/ed/graduate/competency.aspx American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67, 10–42. doi:10.1037/a0024659 Cole, E. (2009). Intersectionality and research in psychology. American Psychologist, 64, 140–180. doi:10.1037/a0014564 Enns, C. Z., & Forrest, L. M. (2005). Toward defining and integrating multicultural and feminist pedagogies. In C. Z. Enns & A. L. Sinacore (Eds.), Teaching and

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social justice: Integrating multicultural and feminist theories in the classroom (pp. 3–23). Washington, DC: American Psychological Association. Ladany, N., & Friedlander, M. L. (2014). Sex and gender in professional psychology education and training. In N. J. Kaslow & W. B. Johnson (Eds.), The Oxford handbook of education and training in professional psychology (pp. 419–436). New York, NY: Oxford University Press. doi:10.1093/oxforedhb/ 9780199874019.013016

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Social categories, stereotypes, norms, and roles, including gender, can shape a person’s identity, perspective, sense of self, and daily lived experiences and become an integral part of the person’s learned behavior. Social categories structure and frame various interactions between humans. The effects that gender has on group dynamics can contextualize some presenting behaviors in group therapy. In many instances, these consequences are insidious, and some people may not detect them. In addition, gendered expectations, the gender composition of a group, and the gender of the mental health professional facilitating the group can have implications for group therapy. Many scholars have accepted gender as a social construct that falls on a spectrum, and gender studies research supports the idea that gender is not binary or dichotomous but a continuum on which many people fall. Because gendered expectations and roles can factor into group dynamics, awareness and consciousness about how one’s own gender identity, presentation, and expression as well as one’s own struggles could be influencing the work that one engages in are important. The  American Psychological Association’s guidelines for psychological practice with transgender and  gender nonconforming (TGNC) people, with women and girls, and with lesbian, gay, and bisexual clients instruct counselors and other ­ mental health professionals to consistently and ­ continuously recognize their own worldview and perspective and how they influence the work they do with these groups.

The goal is that a mental health professional with clarity around gender and social justice issues will be able to pick up on a maladaptive behavior and address it to alter the behavior before it insidiously stunts the progress that participants could make. Psychologists want to avoid causing any harm, especially if it is unintended and unconscious, stemming from lack of knowledge about how these many different categories affect one’s life. To be most effective and supportive, consciousness about how dynamics are altered by identities and biases is needed. Gender as a social construction facilitates biases and prejudgments. For therapists, self-reflective work is important to understand and identify the biases that exist within themselves. Self-reflection and awareness of their own worldviews and perspectives link directly to the type of work that mental health practitioners will be doing in a group, because having undiscovered insidious biases becomes a risk. Lack of awareness could externalize itself and cause harm to already marginalized and underserved people. Power dynamics, authority, and social structures could influence participants’ interactions and their willingness to self-disclose in group sessions. Research in social psychology reminds us as human beings, specifically those who are clinicians, that human behavior needs to be contextualized based on the situation or circumstance that the person is in. A person’s sociocultural environment has some power to influence human actions or decisions. Many times, humans behave in ways that, consciously or not, are conforming to the roles and expectations set by social categories. This entry discusses the role that gender plays in therapy groups, including those comprising only males, only females, mixed genders, and TGNC populations.

All-Male Groups All-male groups, in line with heteronormative gendered expectations, seem to be more individualistic and focused on self-actualization. In comparison with females, males are more likely to be praised for independence and assertiveness. Many men tend to be problem focused and to think practically and pragmatically. Self-reliance, physical strength, and courage are qualities that are

Gender Dynamics in Group Therapy

considered desirable and praiseworthy in men. Unlike all-female groups, all-male groups might gravitate toward presumably tangible goals that are more likely to have set measures of achievement. Contextualizing this into Western patriarchy, and the standards that have been set, these are characteristics that are stereotypically attached to masculinity and have been particularly valued and praised in comparison with more stereotypically feminine traits, which could be considered communal. Masculinity could influence some men’s interactions. Some men consider that expressing a broad spectrum of various emotions that could be interpreted as weakness, especially around other men, is taboo. Men can exhibit stereotypically masculine emotions, such as anger, impatience, assertiveness, and being competitive, with more social acceptance than more feminine emotions, such as a­ffection, dismay or distress, and vulnerability. Heteronormative gendered expectations shape the belief that, in many cultures and circumstances, women should take care of and provide emotional support and nurturing for men. Nurturing and caretaking are considered feminine, and women are more likely to do the emotional labor that would benefit some men. Many men report more comfort self-­disclosing meaningful and deeply personal information to women as opposed to men. The adverse reaction to this is that men are supposed to be strong and therefore should be able to take care of themselves as well as take care of women.

All-Female Groups All-female groups, in line with heteronormative gendered expectations, tend to have higher levels  of empathy in comparison with all-male groups. Listening; being understanding; expressing ­emotions such as compassion, kindness, and gentleness; and conveying a sense of empathy are characteristics and skills to which some women have been socialized, based on femininity and feminine standards in Western patriarchy. These characteristics and skills facilitate identifying with other group members. Women who have received the message from childhood that they are supposed to be gentle, sensitive, and compassionate are likely to externalize this socialization through empathy. These qualities could be helpful in

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creating a space of emotional support and healing in a balanced environment such as group therapy. In contrast, this tendency could manifest itself as a disconnection from their own emotions to support others. Some women may be so preoccupied with being helpful that they disconnect themselves from how they are feeling and from a ­functional way of coping with their own emotions. The overwhelming duty of helping and supporting others may externalize itself in some women, constantly leaving themselves last on their priority lists. Some participants may feel as though they are deviating from heteronormative gender norms by participating in group therapy because women are expected to be the caretakers, not someone who takes care of themselves or lets others take care of them.

Mixed-Gender Groups Mixed-gender groups, or groups with both female and male identified members, seem to have the most positive therapeutic outcomes. Participating in mixed-gender groups has been shown to be beneficial as doing so exposes participants to a healthy balance between stereotypical gender roles and expectations. The intersection of masculinity and femininity introduced to the group by the group members facilitates an environment that may challenge some participants to encounter and experience different worldviews or perspectives. This combination of gender roles and characteristics could lead to meaningful and transformative work for both men and women because, arguably, there is a balance and proportionate equivalence between the gendered characteristics exhibited in the group. Masculinity brings forth the tendency to be more independent and assertive. Some men’s focus gravitates toward achievements and goals in part because this is what current social structures value. Femininity gravitates toward interdependence and communal tendencies. Many men are socialized with and possess a set of characteristics and skills for which many women are not usually praised. Men tend to model qualities such as autonomy and self-affirmation, which women could potentially benefit from adopting. Some women are socialized with skills such as emotional identification, compassion, and warmth, which men could potentially benefit from modeling.

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Introducing and interacting with these different perspectives allow for all genders to learn and grow from one another. The unique opportunity for femininity and masculinity to merge in a functional way allows for various outcomes, including healing, processing of violence, and interacting with possible out-group members, to form relationships that are not influenced by social norms and gendered roles. Many men experience new ways to engage with others, and many women acquire new skills such as self-determination and autonomy.

there could be racialized issues that come up because of marginalization based on race and class. For all-female groups, this internalized racial oppression could be fused with internalized misogyny or internalized sexism. Although these categories are all socially constructed, this does not mean that mental health professionals are exempt or able to deny the severity of the effects that these biases and prejudices could have on how they perceive themselves and how others perceive them.

Transgender and Gender Nonconforming Populations

The therapist’s own gender identification also factors into gender dynamics in group therapy, as it can have unique effects on the way gender influences the group. Under the assumption of ­ heteronormativity, the therapist could be a male facilitating an all-male group, an all-female group, or a mixed group; or the therapist could be a female facilitating an all-female group, an all-male group, or a mixed group. Each combination has its own unique challenges within the group. For example, females facilitating all-male groups may face challenges such as men questioning their position or feeling threatened by the power dynamic. Masculinity and issues of control could surface. For males facilitating mixed-gender groups, interesting power dynamics may also arise. Because of gendered roles, women in the group may silence themselves, and men may control the discussion.

TGNC people are heavily underrepresented in research, and much work is yet to be done with this population. Some of the issues that may arise are based on the therapist’s knowledge of identity. Some mental health practitioners may lack insight and consciousness regarding gender identity. Others may need to increase their competency to work with individuals who identify as gender nonconforming, including awareness of cissexism, transphobia, and assumptions of heteronormativity, so that their therapy groups are accepting and functional. The American Psychological Association’s guidelines note that therapists have to challenge and shift the biases and prejudice they have about gender. Internalized transphobia could factor in how participants communicate and interact in group therapy. Because of TGNC people’s lived experiences, suicide, homelessness, lack of family support, and depression or other severe mental health concerns, among others, are issues that will likely be discussed. Coming out and constantly confronting microaggressions and macroagressions, having their gender and gender expression questioned, and having their experiences invalidated become very relevant and points of unity for these groups.

Racialized Issues For all of these groups, internalized racial oppression and internalized gendered oppression could be a factor. For groups that include people of color,

Therapist Gender Identification

Monica Cristina Murillo Parra and Kevin L. Nadal See also Gender Dynamics in Psychotherapy; Men’s Group Therapy; Sexual Orientation Dynamics in Group Therapy; Women’s Group Therapy

Further Readings Bender, A., & Ewashen, C. (2000). Group work is political work: A feminist perspective of interpersonal group psychotherapy. Issues in Mental Health Nursing, 21(3), 297–308. doi:10.1080/ 016128400248103 Currat, T., & Michel, L. (2006). Groups and gender: The effects of a masculine gender deficit. Group Analysis, 39(1), 133–142. doi:10.1177/0533316406062320

Gender Dynamics in Psychotherapy Ewashen, C. J. (1997). Devaluation dynamics and gender bias in women’s groups. Issues in Mental Health Nursing, 18(1), 73–84. doi:10.3109/ 01612849709006541 Giammattei, S. V. (2015). Beyond the binary: Transnegotiations in couple and family therapy. Family Process, 54(3), 418–434. doi:10.1111/famp.12167 Greenfield, S. F., Cummings, A. M., Kuper, L. E., Wigderson, S. B., & Koro-Ljungberg, M. (2013). A qualitative analysis of women’s experiences in singlegender versus mixed-gender substance abuse group therapy. Substance Use & Misuse, 48(9), 772–782. doi:10.3109/10826084.2013.787100 Holmes, L. (2011). Gender dynamics in group therapy. Group, 35(3), 197–207. Kring, B. (2011). Discussion of “gender dynamics in group therapy” by Lucy Holmes. Group, 35(3), 215–218. Reading, R., & Rubin, L. R. (2011). Advocacy and empowerment: Group therapy for LGBT asylum seekers. Traumatology, 17(2), 86–98. doi:10.1177/1534765610395622 Schmid, M. M. (2001). Gender differences and similarities in dominance hierarchies in same-gender groups based on speaking time. Sex Roles, 44(9–10), 537–556. doi:10.1023/A:1012239024732 Thomas, N. K. (2014). The personal is political: Gender stereotypes in the unconscious life of groups: Commentary on “Consciousness-Raising in a Gender Conflict Group.” International Journal of Group Psychotherapy, 64(1), 77–81. doi:10.1521/ijgp.2014 .64.1.77 Walker, L. S. (1981). Are women’s groups different? Psychotherapy: Theory, Research & Practice, 18(2), 240–245. doi:10.1037/h0086085

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person. A person’s gender is often a readily identifiable characteristic, and this perception of gender may be a significant dynamic even before psychotherapy begins. Assumptions based on gender and identifiers such as gender presentation may emerge as soon as the client makes an initial appointment. To increase the likelihood of a positive therapy outcome, therapists should be aware of how factors such as gender role socialization and gender presentation may influence the clienttherapist interaction. In this entry, the gender dynamics of help seeking, therapeutic alliance, diagnosis, and interventions in psychotherapy are reviewed.

Gender and Help Seeking Multiple studies from industrialized countries report that women are more likely to recognize and report emotional distress than men, and to seek mental health services more frequently than men. Among women, lesbian, bisexual, and transgender women have higher rates of mental health service utilization than heterosexual women. In many countries, males delay professional mental health care until their symptoms become acute. In more than 25 studies examining male gender role conflict and help-seeking behaviors, males reported negative attitudes about seeking help. Males seek help for various health care needs significantly less frequently than females, which is related to gender socialized values such as idealized stoic masculinity.

Gender and Therapeutic Alliance

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Gender dynamics in psychotherapy refers to the influence of gender socialization and gender roles in the therapeutic process. The complex interplay of gender with intersectional identities, such as age, disability status, sexual orientation, social class, race, and ethnicity, influences the therapeutic relationship between the client and the therapist. Gender represents a salient and immediate trait that influences the social perception of a

Psychotherapists are expected to work with clients of all genders. Yet several studies have found that clients express a preference for same-gender psychotherapists. Researchers have sought to better understand whether practices such as gender matching between the therapist and the client lead to more positive outcomes. Some studies indicate that clients perceive female therapists as forming a more effective therapeutic alliance than male therapists. Clients of both genders perceive their female therapists as more empathic and less judgmental than male therapists. Several studies have noted that clients attended more treatment s­ essions

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when there was client and therapist gender matching. A client may perceive greater understanding by a therapist who relates to his or her lived experiences. Yet gender may not be the most salient ­identity variable of a client’s life experience; thus, gender matching may not address pertinent concerns. For example, a genderqueer lesbian woman may not have life experiences that are similar to those of her cisgender (where gender identity matches the sex assigned at birth), heterosexual female therapist. While some male clients may feel understood and validated by a male therapist, other male clients may feel threatened by a male therapist. Various studies examining whether features such as therapist gender, ethnicity, theoretical orientation, or level of training significantly influence positive outcomes in psychotherapy have been inconclusive. However, studies indicate that c­ lients’ perceptions of the therapeutic alliance are positively correlated with beneficial psychotherapy outcomes. Establishing a strong therapeutic alliance with clients of all genders remains an integral goal in the provision of mental health services. An understanding of gender in psychotherapy is incomplete without consideration of transgender, transsexual, gender nonconforming, and genderqueer individuals. Transgender individuals have historical and current experiences of oppression by therapists and medical professionals. Transgender individuals may seek psychotherapy for gender-related procedures. The gatekeeping role ­ that therapists play involves important dynamics of power, privilege, and oppression. These power dynamics influence the trust and alliance in the therapeutic relationship. Understanding gender and transgender microaggressions is an important part of psychotherapy as therapists are influenced by sexist and transphobic socialization in the dominant culture. Gender microaggressions are comments, behaviors, and indignities that intentionally or unintentionally communicate negative, derogatory, or hostile slights and insults to a person related to the person’s perceived or actual gender. Transgender microaggressions may involve assumptions of a gender binary, the assumption of sexual pathology, or assumptions about reproductive choices. Examples of gender or transgender microaggressions

include a therapist assuming that male clients are emotionally insensitive or a therapist not using client-preferred pronouns, respectively. Microaggressions may commonly enter the therapeutic realm. Therapists need to be attuned to the client’s experiences and address microaggressions in a clinically responsive manner. To promote positive psychotherapy outcomes, therapists must address relational ruptures and ­microaggressions to maintain the integrity of the ­therapeutic relationship.

Gender and Diagnosis International studies indicate significant patterns of gender differences in diagnosis. The World Health Organization reports that interactions between the social and biological aspects of gender contribute to significant differences in symptoms of mental health disorders. Differential exposure to gender-based situations, including violence, childbirth, infertility, trauma, combat, or hazardous work conditions, may significantly affect mental health. Prior to adolescence, girls and boys experience depression at similar rates. During adolescence, girls become increasingly more likely to experience depression than boys. This depression gender gap persists throughout the female life span until menopause, with adult women nearly twice as likely as adult men to be diagnosed with a depressive disorder. Women are also twice as likely as men to receive a diagnosis of agoraphobia or other anxiety disorders. In addition, up to 70% of clients diagnosed with an eating disorder are female. Given the high mortality rates associated with eating disorders, this represents a clinical crisis ­ among female clients. Women are also more likely to be diagnosed with co-occurring disorders. National studies report that men are twice as likely to be diagnosed with substance abuse disorders. Although more women than men attempt suicide, men are four times as likely as women to die by suicide as they tend to utilize more lethal means. Improving clinical treatment requires integration of gender analysis in understanding the epidemiology of mental illness. Gender socialization and therapist biases influence assessment and diagnosis in psychotherapy. Historically, female psychotherapy clients were

Gender Dynamics in Psychotherapy

primarily treated by male therapists with diagnostic tools devised by men. Norms based on ­cisgender male experiences produced inadequate or distorted understanding of female and transgender mental health. The work of Sigmund Freud illustrates the historical foundations of such gender bias. Freud assumed that all women were inferior to males and led lives dominated by reproductive functions. When Freud’s female clients confided about sexual victimization, he interpreted these events as “fantasies.” A landmark shift in the psychotherapy treatment of females culminated in a 1975 task force report of the American Psychological Association that identified the inequities perpetuated in psychotherapy treatment, such as fostering traditional sex roles, devaluation of women, sexist application of psychoanalytic concepts, and sexualization of female clients. Therapists need to consider the sociocultural and contextual influences that are linked to gender as important considerations in the assessment, diagnosis, and treatment of a client. Therapists of varying genders have reported differing views of what constitutes normal mental health for males and females. Culturally responsive diagnosis includes evaluation of the connection between gender role socialization and the presenting problems. A skilled psychotherapist must tailor unique treatment plans for clients who may share a diagnosis yet require different interventions. For example, an adult White male wrestler whose eating disorder was triggered by career demands will require different interventions from those of a teenage Asian girl whose eating disorder began during adjustment to immigration and parental divorce. Diagnosis and treatment planning for transgender clients must consider the daily stressors of ­living within a heteronormative culture. Transgender individuals often endure social harassment such as microaggressions, school bullying, workplace discrimination, physical assault, verbal abuse,  sexual violence, homelessness, and hate crimes. Their intrapsychic difficulties may include depression, body image dissatisfaction, body dysphoria, sexual difficulties, and suicide. Their rates of major depression may be five times higher than those in the general population. The realities of trauma need to be carefully considered given the socially oppressive realities of heteronormativity

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and rigid conceptions of a gender binary. The Diagnostic and Statistical Manual, fourth edition, text revision (DSM-IV-TR), and its previous versions stigmatized transgender individuals via the labeling of “gender identity disorder”; the DSM-5 and the International Classification of Diseases and Related Health Problem, 10th revision (ICD-10), have shifted toward “gender dysphoria” and emphasize that gender nonconformity itself is not a disorder. Current professional standards recommend a nonpathologizing approach in clinical practice, focused on the distress of gender incongruence.

Gender Affirmative Psychotherapy In the late 1990s, studies of gender and psychotherapy shifted from focusing on gender matching of the therapist and the client toward the examination of additional factors that influence gender competence. Gender competence refers to psychotherapist skills that facilitate more effective treatment outcomes for clients of a specific gender. Psychotherapists’ gender competence accounts for some variance in psychotherapy outcomes, although the reasons are inconclusive. A parallel area of research on multicultural competency ­ indicates that clients’ perceptions of therapist microaggressions may be a core facet of lower c­ lient satisfaction and psychotherapy outcomes. Affirmative psychotherapies emphasize work that validates lived experiences, questions the status quo, and supports both personal and community health. Transgender affirmative therapy considers the oppressive and socially constructed nature of the gender binary and involves a nonpathologizing approach to understanding the experience of gender. Transgender affirmative therapy includes the use of appropriate (gender neutral or client preferred) pronouns, addressing strengths and ­ resiliencies along with concerns and distress, clarification of the therapist’s role (particularly if a client is seeking recommendation for a gender­ related medical procedure), therapist advocacy, and knowledge of resources for community support and transfriendly professional referrals. Transgender affirmative therapists are allies and develop specialized knowledge of transgender identity development and the medical, legal, and social aspects of the transition process.

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Rigid, gender-based expectations from the dominant culture affect the health of both women and men. Women have often been socialized to question and devalue themselves in deference to men. Feminist therapies help clients address problems that are rooted in disempowering social norms, conceptualizing clients from a contextual and egalitarian viewpoint. Likewise men have usually been socialized since childhood to conform to a narrow definition of masculinity. Expressions of gender role conflict and relational distress in men are often limited to anger, aggression, isolation, or substance use. Such symptom manifestations are acceptable under a masculinity ideology that drives men to avoid intimacy and healthy emotional expression. Gender-aware therapy and gender role journey therapy are two examples of therapeutic approaches that explicitly integrate feminist exploration of social gender roles into treatment. These synthesized approaches facilitate macrosocietal analysis of clients’ gender-related experience so that clients of all genders may assert awareness and control over the ways in which sexism and other oppressions contribute to their psychological symptoms. Further research is needed to elucidate the interplay between client and therapist gender, psychotherapist gender competence, and the complex influence of additional intersectionality factors on psychotherapeutic dynamics and outcomes.

Clinical Guidelines The socialization of gender roles exerts a powerful influence on both the client and the therapist in psychotherapy. Therapists are urged to consider their own gender socialization and to reflect on biases that may affect the therapeutic alliance, diagnosis, and outcomes in psychotherapy. Therapists need to remain cognizant of how intersecting identities such as race, class, disability, age, and sexual orientation interact with gender. Cisgender therapists should be aware of how their socialization obscures the magnitude of oppression in the daily lives of transgender clients. Transgender individuals often experience a disruption of social support during the transition process, and therapists can assist clients to build an affirmative community. Transgender therapists will benefit from examination of their own internalized

transphobic or sexist beliefs and values, as well as the meanings they associate with their own transgender identity development. Multicultural psychology has evolved toward the concept of culturally responsive practice. Culturally responsive care is an approach to psychotherapy that demands therapist self-awareness, values the exploration of social influences and power structures, and practices recalibration throughout the psychotherapy process. It is the professional responsibility of the therapist to remain attuned to microaggressions, gender role conflicts, and biases that may impair the ­psychotherapy process. Any therapist, no matter how competent, cannot be free of external social influence. Culturally responsive and client-driven treatment applies qualitative information about each unique client and balances it with therapist self-awareness, social context, power analysis, ­client feedback, and evidence-based practices. Helen Hsu and Kayoko Yokoyama See also Feminist Therapy; Gender Expression; Gender Identity; Gender Roles: Overview; Microaggressions; Transgender People

Further Readings American Psychological Association. (2007). Guidelines for the psychological practice with girls and women. American Psychologist, 62(9), 949–979. doi:10.1037/ 0003-066X.62.9.949 American Psychological Association. (2015). Guidelines for the psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 949–979. doi:10.1037/a0039906 Austin, A., & Craig, S. L. (2015). Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21–29. doi:10.1037/a0038642 Brown, L. (2010). Feminist therapy. Washington, DC: American Psychological Association. Lundberg-Love, P. K., Nadal, K. L., & Paludi, M. A. (Eds.). (2012). Women and mental disorders (4 vols.). Santa Barbara, CA: Praeger. O’Neil, J. M. (2015). Men’s gender role conflict: Psycho­ logical costs, consequences, and an agenda for change. Washington, DC: American Psychological Association. World Health Organization. (2002). Gender and mental health. Geneva, Switzerland: Author.

Gender Dysphoria

Gender Dysphoria Gender dysphoria refers to a state of psychological distress or discomfort associated with having an experience of gender that does not match one’s gender assigned at birth. The term was coined by Norman Fisk in 1973 to explain what drove some individuals to seek professional help to align their gender presentation and sex characteristics with how they perceived themselves. Since then, it has appeared in numerous publications about transsexualism, transgenderism, and gender nonconformity and has remained at the center of discussions about diagnosis and standards of care for individuals seeking gender-related treatments. Gender dysphoria differs from transsexualism, transgenderism, and gender nonconformity. While it is common for transsexuals and transgender and gender nonconforming (TGNC) people to experience or report having experienced gender d ­ ysphoria at some point in their lives, not all persons claiming these identities or describing atypical developmental histories are gender dysphoric. Many report being comfortable with their gender regardless of whether it meets social expectations. This entry briefly discusses the typical age of onset and developmental course of gender dysphoria, symptoms and criteria for diagnosing the condition based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), etiological explanations, and treatments.

Onset and Course Gender and sex are related but separate constructs. Sex refers to genetic, chromosomal, hormonal, anatomical, and other physical characteristics that differentiate human beings into male-, female-, and intersex-bodied people, whereas gender has to do with role preferences, behaviors, self-perception, and self-identification with a gender category. It is often assumed that biological sex determines future gender expression and gender identity in children; thus, infants are typically assigned a gender that matches their sex the day they are ­ born. From that point forward, newborns begin to be socialized as either a girl or a boy. It is not uncommon for children to show interest and engage in activities that fall outside the

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socially acceptable range of behaviors for their gender—even in societies where gender roles are fairly restrictive and inflexible—but most develop a gender identity (i.e., a sense of themselves as gendered beings) that is congruent with the gender they were assigned at birth. Only a small percentage of children experience a mismatch between their gender identity and assigned gender. Gender identity is established in early childhood, somewhere between ages 2 and 4 years, and it is often during this developmental period that signs of gender dysphoria are observed for the first time. Some children, sometimes as young as 2 or 3 years old, are convinced that they are not a boy or a girl like they were told and become very upset when others try to persuade them otherwise. If their cross-gender identification persists and they are not allowed to express gender congruently with how they perceive themselves, they may become chronically distressed, depressed, or even suicidal, in which case a gender change to allow them to interact with others in their preferred gender may be recommended to alleviate gender dysphoria. A common developmental pattern in less severe cases is for children to continue to be gender nonconforming but grow up as gay or lesbian in their assigned gender, becoming involved in social groups in which gender can be expressed in nonconventional ways without pressure to conform to stereotypical gender norms. Other children may repress their cross-gender interests, learn to behave in ways that meet others’ expectations, and grow up to fulfill major gender role obligations, such as getting married and building a family, oftentimes in heterosexual relationships. Gender dysphoria does not always become apparent to others in childhood. Sometimes parents find out about their children’s gender distress in adolescence or even in adulthood, at which point they may either be completely surprised or recognize that signs of the dysphoria were there all along. Romantic partners, friends, coworkers, and others may also be surprised when they find out that a person they interact with on a regular basis is gender dysphoric. Gender dysphoria typically waxes and wanes until it drives individuals to take steps to live their lives congruently with how they perceive themselves. Some make permanent physical and/or social changes to live completely in their preferred

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gender, whereas others find alternative ways to manage the dysphoria, such as living partially in their preferred gender and partially in their assigned gender. Many TGNC adults who had lived in their assigned gender for decades before making a change often report a long history of untreated gender dysphoria—typically since childhood— with times when it did not interfere with their functioning and other times when it caused them emotional anguish and despair.

Diagnostic Criteria In 2013, gender dysphoria was introduced into the DSM-5 as a diagnostic category with specific criteria for identification of cases that reach clinical significance. Gender dysphoria replaced gender identity disorder—a controversial diagnosis that had received extensive criticism for overpathologizing the life experiences of TGNC people. Gender dysphoria differs from gender identity disorder mainly in its focus on distress rather than identity, and it does not assume pathology in naturally occurring variations of gender. Gender dysphoria is recognized in children when a child expresses cross-gender or alternativegender identification (i.e., a gender that is neither stereotypically male nor female) and there are behavioral indicators of cross-gender preferences, such as cross-dressing and cross-gender role-play. A small percentage of children with gender dysphoria may also express a dislike for their ­ ­sexual anatomy or a desire for having sex characteristics that do not match their assigned gender (anatomical dysphoria). Five symptoms, in addition to cross-gender or alternative-gender identification, are required for the condition to reach clinical ­significance based on the DSM criteria. In addition, there must be evidence of clinically significant distress or impairment in functioning, and  the symptoms must be present for at least 6 months. Similarly, gender dysphoria in adolescents and adults is recognized when an individual expresses cross-gender or alternative-gender identification and reports clinically significant distress or impairment in functioning for at least 6 months. Two additional symptoms are required for the  condition to reach clinical significance (as opposed to five for children). Adolescents and

adults with gender dysphoria are more likely than children to experience anatomic dysphoria. They can describe subjective experiences with greater detail and p ­ recision and may or may not have a history of cross-gender or gender nonconforming behaviors. Therefore, clinical assessment of gender dysphoria in adolescents and adults is based on self-perception, desires, and convictions rather than on behaviors or preferences (e.g., a conviction that one has the typical feelings and reactions of the other gender, a desire for the primary and secondary sex characteristics of the other gender). People can be gender nonconforming and not have gender dysphoria (e.g., “tomboyish girls” and “feminine boys”). Gender dysphoria is distinguished from simple gender nonconformity by the presence of incongruence between the preferred and the assigned gender and the presence of clinically significant distress or impairment in ­ functioning. Gender dysphoria may or may not be associated with a disorder of sex development. It is often comorbid with anxiety and depressive disorders across the life span and with oppositional defiant disorder in adolescents. There also seems to be a higher prevalence of autism spectrum disorders in children with gender dysphoria than in the general population.

Etiological Explanations Several biological and environmental factors have been implicated in the causation of gender dysphoria, but there is no consensus among experts about the relative contribution of these factors and no single theory that helps define and understand the condition. Biological theories that have received the most empirical support emphasize the role of prenatal hormones in the sex differentiation of the brain. Sex differentiation occurs in the brain at a critical period in the uterus when the presence or absence of testosterone creates certain conditions needed for the brain to continue to develop as either male or female. The female brain develops without testosterone, as the default condition, while the male brain requires sufficient amounts of testosterone for brain development to proceed on a different course. Biological theorists argue that a discrepancy between genital and brain sex differentiation in the fetus could explain the mismatch

Gender Dysphoria

between sex and gender that is present in gender dysphoria. Empirical support for this theory comes from studies on neuroendocrine regulation in transsexuals, atypical gender behaviors and crossgender identity in individuals with abnormal ­perinatal endocrine histories, and neurobiological differences in the structure and function of the brain of transsexuals. Research on the biology of gender dysphoria shows promise. Early theories emphasizing the role of environmental factors were rooted in the psychoanalytic and social learning traditions. Psychoanalytic theorists argued that certain characteristics of the parents and the nature of their interactions with the child could cause the child to identify with the parent of the opposite gender. Similarly, social learning theorists pointed to the role of parents in gender socialization, arguing that lack of appropriate role modeling and ineffective use of reinforcements and punishments could cause children to learn gender behaviors that are incongruent with their assigned gender. Studies examining parental factors presumed to correlate with gender dysphoria have found some positive results, but in most instances, study findings were either inconclusive or insufficient. A perspective emphasizing environmental factors that has been gaining popularity since the mid-2000s brings together elements of feminist thinking with multicultural psychology and LGBT health research to argue for the role of broad societal forces in creating the conditions that cause TGNC people to become dysphoric. Confusion and distress about one’s gender are seen as a natural consequence of living in societies that stigmatize normal variations of gender and marginalize TGNC individuals. From this lens, gender dysphoria can be said to result from having to negotiate between internal psychological demands and external pressures to conform to social expectations that feel unnatural or at odds with self-perception. Over time, through the process of socialization, these external pressures become internalized, creating distress from within the individual even when one’s public identity and behaviors meet social expectations. This perspective provides a compelling explanation for gender dysphoria and has received substantial empirical support but does not explain why some individuals have a mismatch between their experienced and assigned genders.

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Treatments Treatments for adults with gender dysphoria aim at helping them live in their preferred identity. There are several treatment options, and individuals may pursue one, a few, or all of the treatments available depending on their goals. Medical and psychological options include hormone therapy to feminize or masculinize the body, various types of surgeries to change primary and secondary sex characteristics (e.g., breasts, genitalia, facial features), and psychotherapy to assist with the social aspects of the gender change, such as helping individuals overcome challenges at work and maintain the support of their families. Other options include community-based supports, electrolysis and laser treatment for hair removal, and voice therapy to help with developing new communication skills. Service providers participating in the treatment of individuals with gender dysphoria are encouraged to work collaboratively to coordinate care while addressing different aspects of the care plan. While there is consensus on how to treat gender dysphoria in adults, treatment of gender dysphoria in children remains controversial and subject to heated professional debate due to divergent views on treatment targets and lack of empirical evidence to support the existing approaches. There is concern that affirming children’s expressed gender and supporting social transition before puberty will increase the chances that they will persist in their cross-gender identification, which some professionals consider an undesirable outcome. Those who maintain this position argue in favor of treatments aimed at redirecting children to their assigned gender. Critics of this approach consider reaching satisfaction in a TGNC identity a valid treatment target and argue that efforts to redirect gender can be as harmful as trying to reorient sexuality, which has been shown to have negative psychological effects on gay and lesbian people. Alternatively, two other approaches are proposed. One involves affirming the child’s expressed identity, helping the child make a social transition, and supporting the use of hormone blockers to delay the onset of puberty when appropriate. The other involves neither encouraging nor discouraging cross-gender identification, allowing gender development to unfold naturally until it reaches ­stability, and supporting the child and the parents as they

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navigate the social challenges. A criticism of this approach is that it does not directly address the gender dysphoria. Cristina L. Magalhães and Ellen S. Magalhães See also Gender Identity; Gender Identity Disorder, History of; Gender Nonconformity and Transgender Issues: Overview; Gender Variant Role Expression in Childhood; Transsexual

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Washington, DC: Author. Retrieved from http://www.apa.org/practice/guidelines/ transgender.pdf Cohen-Kettenis, P. T., & Gooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research, 46(4), 315–333. doi:10.1016/S0022-3999(98)00085-3 Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., . . . Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people (Version 7). International Journal of Transgenderism, 13(4), 165–232. doi:10.1080/15532739.2011.700873 Drescher, J. (2013). Controversies in gender diagnoses. LGBT Health, 1(1), 10–14. doi:10.1089/lgbt .2013.1500 Drescher, J. (2015). Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD. International Review of Psychiatry, 27(5), 386–395. doi:10.3109/09540261.2015.1053847 Lev, A. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. Binghamton, NY: Haworth Press.

Indicators of individual quality of life and socioeconomic status collected in nations around the world generally find that those for female gender are notably disadvantaged compared with those for male gender. In the past decades, social scientists have collected data on the inequalities women face at home, in the workplace, and in their personal relationships. In addition, researchers have conducted studies to better understand the genesis of gender difference and the societal forces that result in gender inequality across various domains. This entry reviews the major ways in which the genders lack equality, examines the ­ factors that perpetuate gender inequality, and d ­ iscusses theoretical models that create gender equality.

Current State of and Data on Gender Equality Workplace Outcomes: Employment, Income

Equality between genders has emerged on the forefront of social justice issues because of its global salience: It affects individuals’ education, political power, and work life. The lack of equality between men and women in the workplace begins with the underemployment of women. In the United States, about 82 women are employed for every 100 men. While some regional variation exists, the underemployment of women exists globally. Once employed, women also face differences in employment outcomes. The wage gap— the average salary a woman earns compared with a man—is 78% in the United States. Put another way, men earn 112% for every dollar that a woman earns. A similar gap exists in the United Kingdom and other European nations. In general, eastern Europe shows a higher wage gap, while northern Europe shows a smaller one. The wage gap in the Middle East, South America, and East Asia is also high, ranging from 20% to 60%.

Gender Equality

Education

Gender equality occurs when individuals are treated equally, have equal access to goods and services, and have equal status and power. While gender equality is a goal that many strive for, inequality has been more common historically and globally.

In education, gender equality has made greater progress. With progress has also come nuanced understandings. For example, boys tend to perform better than girls on standardized tests, while girls tend to outperform boys in the classroom. Moreover, girls tend to show stronger literacy and

Gender Equality

language skills, while boys tend to demonstrate stronger mathematical skills. These differences are noticeable in early childhood and tend to become more prominent later in children’s education careers. While women are more likely to attend college and graduate at a higher rate than men in North America and western Europe, this is not the case in South Asia and sub-Saharan Africa.

Roots of Gender Inequality Lack of gender equality has been justified through biological essentialism, which asserts that sex differences in physiological and psychological traits are biologically predetermined and define the differing roles that men and women have. For ­ example, proponents of this theory may believe that gendered personality characteristics, such as nurturance, are the result of survival essentials in early human development. Essentialism also implies that these characteristics (and consequently the roles that accompany them) are unlikely to change over the course of time: Men will always be more l­ogical and a better fit for powerful decision-­ making roles, and women will always be more emotional and unfit for these positions. Biological essentialism contrasts with the gender similarities hypothesis, which posits that ­psychological differences between men and women are relatively small and are largely the result of societal forces. While essentialism implies that because males and females are essentially different and therefore equality is unattainable, gender similarities theory implies that gender equality could be achieved through societal changes. Theorists believe that any physiological or psychological differences are minor and do not preclude gender equality. For example, individuals involved in women’s liberation pursue changes in public policy and social norms that would make it easier for women to move upward in organizations. A recent metasynthesis of 106 meta-analyses on gender differences found that most effects were either small (46%) or very small (39%). Results indicated that almost 80% of the observed gender differences overlap, providing strong support for the gender similarities hypothesis. Gender differences are created by the society people live in. Gender roles are imposed on men and women at very early ages. Children’s books,

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for example, provide information about gender norms and differences to children starting at a young age. Even books that purport to promote gender equality do so unidimensionally. For example, a so-called nonsexist message usually revolved around female characters taking on male attributes and roles while remaining feminine in personality, domestic roles, and leisure. These themes reflect the notion that women gain power and status by emulating men and that these emulations are approved only if women remain feminine. These children’s books reflect social values that are imprinted on the children who read them. This means that as gender roles change over the years, women and men change their preference to follow their perceived gender roles. For example, job advertisements containing more masculine wording attract more male applicants, with women finding these jobs to be less appealing. In addition, this effect was mediated by the perception of belongingness, not perception of skill.

Current Status of Gender Equality Several theoretical perspectives help in understanding what gender equality may look like. For example, relative resources theory holds that women’s specialization in domestic responsibilities was a natural response to men’s economic and labor advantage. That is, women specialized in domestic responsibilities because only men were able to contribute to the household through ­earnings. Theories like these emphasize the interconnectedness of inequality: When a group is disadvantaged in one area, inequality will come about in other areas as well. Indeed, data linking greater rates of domestic violence to greater economic inequality support this theory. This suggests that the reverse may also be true: As societies become more equal in some areas, they may also become more equal in other domains. In this case, gender equality could be depicted as men and women having equal and interchangeable roles. For example, as barriers preventing women’s advancement in the workplace are removed, men will have more opportunities to specialize in domestic responsibilities. The foundation for this model of gender inequality is that the roles of men and women are indistinguishable. Both genders

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can fulfill either the role of the “breadwinner” or the role of the “homemaker.” A second model of gender equality suggests that men and women may become equal in terms of contributions, responsibilities, and opportunities but not necessarily have interchangeable roles. This model accounts for the relatively small genetic differences between genders and emphasizes that gender roles may be different but this should not result in differing status across roles. In the area of education, for example, men’s and women’s proficiencies differ across subject areas: Men tend to excel in mathematical fields of study, and women tend to excel in linguistic fields. If these differing areas were to become equally valuable and provide an equal level of opportunities, men and women could be considered equal in this area. This model differs from the first in stating women could attain equality while also maintaining that the genders may be fundamentally different. It is important to note that perceptions of progress toward gender equality differ by gender: Men tend to believe that more substantial progress has been made toward gender equality relative to women, with men tending to use the past as a benchmark (e.g., “Look at how far we’ve come”) and women tending to use the future as a benchmark (e.g., “Look at how far we still have to go”). Finally, in recent years, there has been a move to advocate for “gender equity” instead of “gender equality.” While equality connotes that people are treated in identical ways, equity recognizes that historic injustices and systemic oppression have prevented certain groups from achieving in equal ways. As a result, efforts can be made to correct those injustices in order to provide true and genuine fairness. For instance, while efforts can be made to ensure that women have equal opportunities in career choice, financial opportunities, educational opportunities, and others, it is important for psychologists and others to understand why systems are still not level playing fields and how opportunities are still not equal. ­Furthermore, it is crucial to acknowledge how intersectional identities may also influence gender inequality or gender inequity—particularly for women of color, LGBTQ women, women with disabilities, and women with multiple marginalized identities. Michael DiStaso, Michael Larkin, Chu Kim-Prieto, and Cole Playter

See also Equal Pay for Equal Work; Equality Feminism; Gender Discrimination; Institutional Sexism; Patriarchy; Sexism

Further Readings Davies, L., Ford-Gilboe, M., & Hammerton, J. (2009). Gender inequality and patterns of abuse post-leaving. Journal of Family Violence, 24, 27–39. Diekman, B. A., & Goodfriend, W. (2006). Rolling with the changes: A role continuity view on gender norms. Psychology of Women Quarterly, 30, 369–389. Diekman, B. A., & Murnen, K. S. (2004). Learning to be little women and little men: The inequitable gender equality of nonsexist children’s literature. Sex Roles, 50, 373–385. Diekman, B. A., & Schneider, C. M. (2010). A social role theory perspective on gender gaps in political attitudes. Psychology of Women Quarterly, 34, 486–497. Eagly, H. A., Diekman B. A., Johanneses-Schmidt, C. M., & Doenig, M. A. (2004). Gender gaps in sociopolitical attitudes: A social psychological analysis. Journal of Personality and Social Psychology, 87, 796–816. Evans, D. E., & Diekman, B. A. (2009). On motivated role selection: Gender beliefs, distant goals, and career interest. Psychology of Women Quarterly, 33, 235–249. Fuwa, M. (2004). Macro-level gender inequality and the division of household labor in 22 countries. American Sociological Review, 69, 751–767. Gaucher, D., Friesen, J., & Kay, C. A. (2011). Evidence that gendered wording in job advertisements exists and sustains gender inequality. Journal of Personality and Social Psychology, 101, 109–128. Hook, J. L. (2006). Care in context: Men’s unpaid work in 20 countries, 1965–2003. American Sociological Review, 71, 639–660. Hyde, J. S. (2005). The gender similarities hypothesis. American Psychologist, 60, 581–592.

Gender Expression Gender expression is how one expresses one’s gender to the world through appearance and behavior. Gender expression is critical to understand because most humans express their gender(s), but it is others’ perceptions of gender expression that directly influence interpersonal communication and behavior and, in turn, social, emotional, and physical outcomes. This entry introduces the concept of

Gender Expression

gender expression and discusses its spectrums, influencing factors, and related controversies.

Differentiating Gender Expression From Biological Sex The distinction among gender identity, gender expression, and biological sex is often misunderstood. As a fundamental component of gender, gender expression is closely related to both gender identity and biological sex. Gender identity is a  person’s internal feeling or identification as a woman, man, or some other gender. Gender expression is how one exhibits one’s gender to ­others, and how others interpret the expression. In the United States, biological sex is assigned at birth based on the external appearance of an infant’s genitalia and is designated on the birth certificate as male or female. Although this is a rare occurrence, some humans are born with ambiguous or atypical combinations of sex characteristics (e.g., chromosomes, gonads, or genitals); consequently, these individuals cannot be distinguished as either female or male. This condition is referred to as intersexuality. Gender expression is predominantly based on societal and cultural norms for gender. The majority of people in society express their gender in a manner that conforms to a range of gender norms for the biological sex they were assigned at birth. However, it is critical to acknowledge that one’s gender identity and/or gender expression may or may not align with one’s biological sex at birth. Moreover, some people do not outwardly express their gender identity. For example, a person who is born as a male but feels like a woman may not express their gender as a woman. Therefore, it is best for individuals to avoid making assumptions about a person’s gender identity based on external appearance and personal gender expectations. Individuals may choose not to outwardly express their gender identity for fear of negative repercussions. For instance, transgender people and g­ ender nonconforming people often endure a disproportionate burden of discrimination and violence compared with cisgender people.

Gender Expression Spectrums Gender expression is a fluid construct that consists of two primary spectrums. The first spectrum is the

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degree to which an individual expresses ­masculinity. Masculine characteristics are generally ­considered instrumental (e.g., active, ambitious, competitive, mathematical, self-­confident). The ­second ­spectrum is the degree to which an individual exhibits femininity. Feminine characteristics are generally deemed expressive (e.g., ­affectionate, considerate, excitable, sensitive, understanding). It is well accepted that an individual will fall somewhere along each of these spectrums, with an infinite number of possible combinations for gender expression. Therefore, an i­ ndividual’s gender expression can include any combination of ­feminine, masculine, or gender neutral characteristics. For example, a person who exhibits many characteristics socially accepted as masculine and at the same time exhibits few to no characteristics that are deemed feminine by society might be labeled as hypermasculine. Conversely, an individual who exhibits many socially acceptable feminine traits and few to no socially acceptable masculine traits may be referred to as hyperfeminine. An individual who expresses a high degree of both masculine and feminine characteristics is commonly referred to as androgynous. David Bowie, Annie Lennox, and Tilda Swinton are examples of celebrities who have presented themselves as androgynous. In recent years, the United States has experienced a slight cultural shift to degendering names (e.g., Alex), products (e.g., cologne/perfume, clothing, jewelry), and settings (e.g., dormitories, restrooms), which indicates that expectations for gender expression are becoming more flexible. This cultural shift may partly be attributed to the fact that women in the United States have transitioned into many of the primary institutions and roles of society. Society is not as rigid as it was in the past with regard to gender categories and expectations, and as a result, there has been an increase in gender variant expressions. While intolerance and discrimination do exist, overall, Western society has become more accepting of nonbinary gender expressions.

Manifestations of Gender Expression Gender expression includes all of the actions and external characteristics that are socially categorized as either masculine or feminine and may be  ­ exhibited through one’s attire, hairstyle,

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accessories, speech, makeup, mannerisms, and movement, among others. For instance, individuals in the United States may physically exhibit masculinity by growing facial hair, maintaining a short hairstyle, and/or lifting weights to visibly increase muscle size and tone. An individual may physically exhibit femininity in the United States by wearing a dress, skirt, bra, or high heels and/or wearing or carrying specific accessories (e.g., purses, hair clips, jewelry). Shaving armpit and leg hair is also a feminine expectation in the United States. Although hairstyles have become less gendered since the 1960s, long hair is generally considered feminine; consequently, most women grow their hair longer than men. In addition, personal preference regarding how other people refer to them by name or pronoun is also considered gender expression. For example, a person who identifies as transgender may use zie as a neutral pronoun. Gender expression also includes methods to change the appearance of secondary sex characteristics. Examples of this include packing, binding, tucking, and padding. Gender expression is dynamic and can change across time. It can change for an individual on a daily basis or in different situations or contexts. For instance, a woman may wear loose-fitting sweat pants and a hoodie without makeup or jewelry to the gym, which might be perceived as masculine or gender neutral. However, in a social atmosphere with friends, the woman may wear a dress, high heels, and makeup—expressions that are generally considered feminine. While an individual’s gender expression can vary based on time or context, most individuals can identify a range on the masculine and feminine spectrums where they feel most comfortable expressing their gender regularly. The selected range may differ between the individual who is expressing their gender and the person who is interpreting the individual’s gender. Furthermore, gender expression is not crosscultural, meaning that cultural norms for gender expectations can differ substantially from one culture to the next. An essential component of gender expression is how others perceive an individual’s gender, which is largely shaped by social and cultural norms. Therefore, certain characteristics that are viewed or accepted as feminine, masculine, or neutral within one culture may not be evaluated in a similar fashion in another culture.

For instance, skirts are popular garments that are viewed as feminine in the United States. However, in ­Scotland, many men wear kilts, which are kneelength, skirt-like garments and are perceived as masculine.

Controversies Related to Gender Expression Given that gender is a fluid, psychocultural construct, it is problematic to assign gender based on biological sex. A major barrier to a more inclusive Western society is the presumption that biological sex, gender expression, and sexual orientation should align with a binary system/model. For instance, Western society often assumes that boys and girls are opposites, which conflates biology, gender identity, and gender expression. A binary system does not consider any context that is not wholly male or female. For instance, a person who is transitioning in gender identity may struggle with whether to use the men’s or the women’s restroom. Furthermore, a binary system generally reinforces the idea that one’s sexual orientation may be determined based on one’s gender expression. For example, Western society often assumes that males who express gender in a way that is perceived as more feminine and females who express gender in a manner that is perceived as more masculine are gay or lesbian, respectively, regardless of whether or not the person identifies as gay or lesbian. Some individuals do not wish or intend to adhere to society’s standards for masculinity or femininity. A gender nonconformist is an individual who expresses gendered traits that are stereotypically associated with members of the opposite biological sex. Gender nonconformists typically endure much criticism and discrimination because their appearance and/or behaviors do not fit within the binary system. Males who express gender in a way that is perceived as more feminine are often called “sissy,” “pansy,” or “faggot.” Females who express gender in a manner that is perceived as more masculine may be labeled as “butch” or “dyke.” Although gender is widely accepted as a binary construct in Western society with two categories—man or woman—other genders are accepted in many parts of the world, including genderqueer, two spirit, and genderless identities.

Gender Expression

A person whose gender identity and/or gender expression is different from the biological sex they were assigned at birth is referred to as transgender. The term may include, but is not limited to, transsexuals, cross-dressers, genderqueer individuals, and other gender variant people. Genderqueer and transsexual people live as a gender that does not match the biological sex they were assigned at birth all of the time. Cross-dressers and drag performers express a gender that does not match their biological sex assigned at birth only part of the time. Transgender people may identify as male-to-female or female-to-male. Some people who ­ identify as transgender will undergo a gender transition, which may or may not include hormone therapy, sex reassignment surgery, and other medical procedures. Individuals who do not conform to societal norms for gender expression often experience negative physical and psychological outcomes. Specifically, transgender and gender nonconforming individuals endure a disproportionate degree of aggression, bullying, hazing, sexual coercion, social exclusion, and workplace discrimination. This may partly explain the high rates of anxiety, depression, and suicide among these populations. In light of these outcomes, many human rights activists have advocated for antidiscrimination legislation that includes gender expression as a protected category.

Socialization Agents This perceived social pressure to conform to societal standards for masculinity and femininity may be exerted by a variety of socialization agents, including parents, siblings, other family members, peers, teachers, and the media. Conforming to the gender that is associated with a person’s biological sex is oftentimes reinforced at a young age, sometimes even before birth. A prime example of this is the inaccurately termed gender reveal party, where expecting parents use specific colors to symbolize the gender of their baby based on the biological sex of the preborn child. In the United States, pink is commonly used to represent females, and blue is typically used to represent males. Gender specific colored items are commonly purchased before the child is born. For example, parents may receive blue clothes for their preborn male child. Interestingly, for many

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centuries, both male and female children wore knee-length white dresses until around the age of 6 years because these garments were easy to bleach. In the United States, gender specific colors were not introduced until a few years before World War I. Parents often select gender specific names based on the biological sex of the preborn child. By the age of 3 years, many children begin to exhibit awareness of gender stereotypes by connecting specific objects and behavior with a certain biological sex. For instance, a 3-year-old female may scold a 2.5-year-old male for playing with her dolls, insisting that dolls are only for girls. Young children sometimes indicate that they feel social pressure to conform to the biological sex they were assigned at birth. Parents often encourage their children to conform to attire, play practices, and behaviors that are deemed gender appropriate—this may be because they fear that their child’s behavior is not socially acceptable and will become permanent. For instance, parents may promote playing with certain toys such as dolls, tea sets, and stuffed animals for female children and action figurines, sports equipment, and play weapons for male children. Parents may encourage their children to wear (or avoid wearing) specific colors (e.g., pink) or garments (e.g., dresses). Teachers may model gendered expectations to children through verbal and nonverbal communication, personal appearance, and curriculum materials. Mass media also reinforce the gender binary through characters who conform to traditional gender stereotypes. In summary, humans express varying degrees of “femaleness” and “maleness” in their attitudes, mannerisms, attire, and behavior. It is crucial for humans to recognize that gender expression is socially, culturally, and psychologically constructed; this insight is necessary for society to become more cognizant of how perceptions influence personal communication and behavior. Greater awareness about gender expression may serve as a catalyst to promote a more inclusive society. Hannah P. Catalano See also Androgyny; Cisgender; Gender Fluidity; Gender Identity; Gender Nonconforming People; Gender Pronouns; Gender Stereotypes; Gender Versus Sex; Transgender People

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Further Readings Brill, S., & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San Francisco, CA: Cleiss Press. Herdt, G. (Ed.). (1994). Third sex, third gender: Beyond sexual dimorphism in culture and history. New York, NY: Zone Books. Herdt, G., & Polen-Petit, N. C. (2014). Gender and identity: Process, roles, and culture. In Human sexuality: Self, society, and culture (pp. 291–320). New York, NY: McGraw-Hill. Hyde, J. S., Krajnik, M., & Skuldt-Niederberger, K. (1991). Androgyny across the life span: A replication and longitudinal follow-up. Developmental Psychology, 27(3), 516–519. Kennelly, I., Merz, S., & Lorber, J. (2001). What is gender? American Sociological Review, 66(4), 598–605. Trier-Bieniek, A., & Leavy, P. (Eds.). (2014). Gender and pop culture: A text-reader. Rotterdam, Netherlands: Sense.

Gender Fluidity This entry defines two concepts of gender fluidity: (1) a process of changing gender identification over time and (2) an identity label. This entry first describes these two conceptualizations and then discusses how they relate to and diverge from theories of gender development. The entry then discusses the relationship between gender fluidity and sexual orientation to elucidate the complexity and intersectionality of these two constructs. It then provides perspective on the navigation of interpersonal relationships and broader gendered assumptions of Western societies by gender fluid individuals. The entry concludes by considering the potential that the construct of gender fluidity has for enhancing a psychological understanding of gender, providing general directions for how gender fluidity may evolve.

Gender Fluidity as a Construct There are several common misconceptions about gender, including the following: (a) that one’s gender will correspond with one’s sex assigned at birth, (b) that one’s sense of gender will remain constant over the life span, and (c) that gender

identity remains stable throughout short time frames (e.g., day to day, week to week). This entry focuses primarily on the constancy and stability of gender over shorter and longer time frames. Gender fluidity is difficult to define, as it may look different for each individual. Gender and sex are considered to be separate, but often correlated, constructs. Sex indicates biological features, including reproductive organs, hormones, and chromosomes, that often establish classifying an individual as male or female. Gender is defined as a social construct that influences expectations of an ­individual’s internal identity, behaviors, and experiences based on notions of masculinity and femininity. Gender identity is defined as one’s ­ internal sense of feeling like a man, like a woman, as both a man and a woman, neither as a man nor as a woman, or somewhere on a spectrum between a man and a woman. Gender expression is how a person communicates gender to the outside world—for example, how they dress, talk, do their hair, wear makeup, and gesture. Cisgender is a term used for individuals whose sex assigned at birth is congruent with their gender identity; transgender is a term used for individuals whose sex assigned at birth is incongruent with their gender identity. Fluidity within the context of this entry is defined as internal identity, behaviors/expressions, and experiences that fluctuate and change over a period of time. Gender fluidity occurs with both cisgender and transgender individuals. For both cisgender and transgender individuals, gender fluidity related to gender expression can manifest in a multitude of ways. Often, this fluidity in gender expression manifests primarily in clothing choice or length of hair. While it can be an unconscious process, many individuals will make a conscious decision about whether they want to be perceived as masculine, feminine, or androgynous in the shorter term. In U.S. culture, a person who identifies as a man and wears a pink shirt or a skirt would be considered to express himself on a spectrum of femininity. If he wears these clothes on a daily basis, he would not be considered fluid in his gender expression. However, if every other day he changes from wearing more stereotypically masculine clothing (e.g., sports jerseys or blue button-down, collared shirts), his gender expression would be considered fluid.

Gender Fluidity

While conformity to gender role norms and the way individuals express their gender identity may change over time, gender fluidity can also relate to the internal experience of one’s gender (one’s gender identity) changing over time. This experience of identity change can occur a variable number of times across the life span, may happen across a range of time periods (e.g., daily, monthly, once over the course of several years), and may be between two or more genders. The experience of gender fluidity may not have any regularity, predictability, or readily identifiable precipitators; however, there is an identifiable shift from one felt sense of gender to a different felt sense of gender (e.g., from woman to genderqueer, from agender to man, from woman to man, from one genderqueer identity to a different genderqueer identity). In the previous paragraph, gender fluidity was discussed only in the context of expression, without the addition of identity. However, individuals may change their physical expression and the way in which they engage to make congruent their internal sense of self, their external presentation, and others’ perceptions of them. Gender dysphoria (distress derived from gender incongruence) is often experienced by individuals who do not feel a sense of harmony between identity and expression. For some individuals, gender fluidity may reflect only a process, whereas for other individuals, the use of the label gender fluid represents a stable identity. Individuals who identify as gender fluid may experience a felt sense of different genders at different times and unite their experience of different genders through identifying as gender fluid. There are also individuals who use the term gender fluid to describe their gender identity and who are comfortable with a wide range of gender expressions and will present as different genders at different times without a shift in their internal felt sense of gender. Whereas both cisgender and transgender individuals are often gender fluid in their expressions and behaviors, individuals who identify as gender fluid are often considered to embody an identity that is within the transgender umbrella.

Gender Development Most Western cultures conceptualize sex and ­gender as interchangeable concepts, as well as considering

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that male/female and man/woman are the only two gender options. In addition to long-standing notions that there are only two sex and gender options, researchers theorized stage models of how gender identity and expression develop over time. Lawrence Kohlberg theorized that prior to the age of 2 years, children do not use gender to categorize themselves or others and when asked, may respond as being both male and female. Around the age of 2 years, children enter the first stage—“gender identity.” Children begin to label themselves at this age and tend to support this classification by a person’s physical characteristics (e.g., if a person has short hair, that person must be male). Around the ages of 3 to 4 years, children enter the “gender stability” stage. According to Kohlberg, children at this age understand that gender is fixed and stable (e.g., if one is a female at the present time, one will remain a female later in life, the reverse being true for males). However, this gender stability does not translate for the p ­ resent—only for later on in life. For example, a child who has been socialized as a girl may believe that if she plays with a truck it is possible to change into a boy, but that she will be a woman later on in life. The third stage in Kohlberg’s model indicates that children enter into “gender consistency” at around the age of 5 years. Children at this stage understand that socialized gender behaviors will not transform the individual from being male to female or from being female to male, and they also come to understand that gender is an underlying, unchanging aspect of identity. Although Kohlberg’s theory was published in the 1960s, these theories remain at the crux of current research and thought that gender is fixed and stable throughout the life span. Fluidity in gender expression occurs in the majority of the population at least several times over their life span. However, identifying as gender fluid is not as common.

Gender Fluidity and Sexual Orientation Although gender and sexual orientation are different constructs, they are often interconnected. Historically, sexual orientation has referred to ­ attractions, behaviors, and fantasies directed toward men (heterosexual for women, gay or bisexual for men) or women (heterosexual for men, lesbian or bisexual for women). Individuals

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who identify as gender fluid may struggle with finding identity labels to accurately capture their sexual orientation. Because sexual orientation is typically based on the individual’s gender identity and the gender identities of those of sexual interest, this construct can often become complex for gender fluid individuals. For example, sexual orientation labels may change for a gender fluid individual based on the individual’s current gender identity; if an individual is solely attracted to men and identifies as gay on one particular day, this individual may also identify as heterosexual on another day when identifying as a woman. However, these switches in sexual orientation labels often do not occur in tandem with switches in gender; more often than not, individuals who identify as gender fluid will adopt a sexual orientation label that embodies sexual fluidity (e.g., queer, pansexual, demisexual).

Gender Fluidity and Navigating Interpersonal Relationships and Society Traditional Western conceptualizations of gender can make navigating familial and other interpersonal relationships, as well as day-to-day life, more challenging for individuals who experience gender fluidity. Gender fluid individuals may fear that family and friends will not understand their experience of their gender and may in turn reject them. Coming out to others can also become a more complex process for gender fluid individuals than for other gender minorities as the changes they experience in their felt sense of gender may result in them having to “come out” to the same people as a different gender multiple times across their lifetime or at different points during the day. Social and medical transition may also be more complex for gender fluid individuals as they may not be working to manifest a singular fixed sense of identity and may instead transition with variable regularity between different genders, ­pronouns, names, and physical presentations. Hormonal and surgical interventions may or may not be a necessary part of facilitating their broader transition process. Depending on how gender fluidity manifests for the individual, it may be nearly impossible for that individual to make identification documents and various personal records align with the individual’s felt sense of gender because of the static, binary

gender categories used in such documentation. The compulsory binary classification of gender may induce gender dysphoria in gender fluid individuals and can make processes as simple as making a transaction at a bank difficult, while drastically exacerbating the stress associated with situations such as visiting the doctor or having an encounter with law enforcement.

Gender Fluidity and Expanding Conceptualizations of Gender Gender fluidity is a recently emerging construct in the psychological literature and challenges traditional conceptualizations of gender identity as singular and fixed. This challenge to singular and fixed gender identity is an incredible opportunity to broaden and deepen the field’s understanding of gender and should be acted on accordingly. There are large gaps in knowledge related to the identity processes of those who experience gender fluidity, how they conceptualize their experience of gender, and how their experience of gender relates to their understanding of themselves and their sense of well-being more broadly. In addition, gaps also exist that warrant exploration of the impact that living in societies with binary, singular, and fixed conceptualizations of gender has on gender fluid individuals and the ways in which gender fluid individuals cope with the structural and potential interpersonal difficulties created by such conceptualizations. Finally, current knowledge is limited on how gender fluidity is understood and manifests cross-culturally and how different cultural contexts may affect the health and life outcomes of individuals who experience gender fluidity. Overall, there are large gaps that must be addressed in the area of gender fluidity, which holds the potential to redefine the ways in which humans will understand gender identity. Stephanie Budge and Joe Orovecz See also Cisgender; Gender Development, Theories of; Gender Identity; Gender Stereotypes; Genderqueer

Further Readings Ault, A. (1996). Ambiguous identity in an unambiguous sex/gender structure. Sociological Quarterly, 37, 449–463. doi:10.1111/j.1533-8525.1996.tb00748.x

Gender Identity Budge, S. L., Rossman, H. K., & Howard, K. A. S. (2014). Coping and psychological distress among genderqueer individuals: The moderating effect of coping and social support. Journal of LGBT Issues in Counseling, 8, 95–117. doi:10.1080/15538605.2014.853641 Burdge, B. J. (2007). Bending gender, ending gender: Theoretical foundations for social work practice with the transgender community. Social Work, 52, 243–250. doi:10.1093/sw/52.3.243 Halberstam, J. (1998). Transgender butch: Butch/FTM border wars and the masculine continuum. GLQ: A Journal of Lesbian and Gay Studies, 4, 287–310. doi:10.1215/10642684-4-2-287 Linstead, S., & Pullen, A. (2006). Gender as multiplicity: Desire, displacement, difference and dispersion. Human Relations, 59, 1287–1310. doi:10.1177/ 0018726706069772

Gender Identity While the question of what it means to be male or female may seem like a simple question with a simple answer for some, the construct of gender is both complex and nuanced. In fact, it has been said that there are as many different genders as there are human beings, yet most people are taught to divide the human population in two: male and female. Gender identity can be a difficult concept to define without first defining gender itself. Most broadly, gender can be defined as the state of being male or female. When examined more closely, gender represents a multitude of states and experiences. Gender has three primary components: (1) physical, (2) social/cultural, and (3) internal/­sensate, also termed gender identity. Gender identity can be conceptualized as an individual’s subjective sense of oneself as a gendered person (e.g., male, female, or another gender entirely). Gender identity is sometimes ­ conflated with gender expression, gender socialization, and sexual orientation. This entry explores the ways in which gender identity is distinct from, and interacts with, these other elements of human experience. First, the basic components of gender are reviewed. Subsequently, the relationship between gender identity and sexual orientation, the effects of socialization and culture on gender identity, and models of gender identity development are discussed. The entry concludes with

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information about oppression faced by gender nonconforming individuals and a discussion of cisgender privilege.

The Three Components of Gender Physical Markers of Gender

Physical markers of gender are often used to denote one’s sex, a term used to refer to biological features (e.g., chromosomes, hormones, sex organs) used by many to label a human as a male or a female at birth. Gendered physical markers include phenotypes (i.e., observable characteristics) such as primary sex characteristics for reproduction (e.g., genitals, internal reproductive organs) and secondary sex characteristics that typically distinguish male from female (e.g., relative size, body hair, body fat distribution, vocal pitch, musculoskeletal differences). Genotypes (e.g., genes and chromosomes) and the presence or absence of various hormones also fall into the category of gendered physical markers. Given the variety of structures related to organic components of gender, it is perhaps not surprising that only two gender categories misrepresent the genetic and physiological diversity that actually exists in humans and many other species. For example, there is considerable variability in physical markers within the biologically defined population of females, such as the ability to bear children, the presence of a uterus, and the absence of a penis. Apart from the obvious problems with defining a group by an absence of a body part, the glans penis and the clitoris are analogous structures in both form and function. Both exist along a range of sizes. Because of this, medical providers sometimes struggle to make gender assignments of newborns based on external genitalia, which can result in use of measurement benchmarks that can be somewhat arbitrary. Use of these specific measurement standards to define a clitoris versus a penis in infants can be especially problematic when it results in cosmetic surgical interventions before the child is old enough to consent to such a procedure. While an in-depth discussion of the extensive physiology that has been implicated in understanding human gender is beyond the scope of this entry, it is important to remember that there is no 1:1 relationship between physical markers of gender and gender identity.

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Although the remainder of this entry will continue to refer to biological sex, it is worth noting that some argue that the concept of sex is socially constructed. In other words, social forces have deemed physical markers as indicators of “male” or “female,” two categories created by humans to classify humans into two categories with considerable in-group heterogeneity. In addition, a significant segment of the population does not fall into either sex category because they possess various combinations of sex characteristics (i.e., intersex). Although prominent in modern day, the two-sex model has not existed in all cultures throughout time. For instance, the Ancient Greeks did not distinguish between males and females but rather considered all humans to be in one category with the recognition that there was variability among physical markers. In addition, several Indigenous cultures throughout the world recognize the existence of more than two genders. Social/Cultural

Gender expression, gender role, and gender presentation all refer to the behaviors used by an individual to communicate a gender identity to the social world outside oneself. This is communicated in both conscious and unconscious ways. It involves many microdecisions every day, from clothing, to hair, to makeup, to manner of speaking. However, an individual’s gender expression may not always be an exact representation of one’s identity because of the social expectations and pressures that individuals feel to conform to the gender that is deemed congruent with their physical markers. In addition, gender role and expression are not causally related to gender identity (i.e., one can present as very gender nonconforming in one’s role but still identify as the gender assigned at birth). The relationship between socialization, culture, and gender is discussed below. Internal/Sensate/Identity

Gender identity refers to a person’s own view of oneself as a gendered being. It can be described as both a sensory and a psychological experience and includes one’s internal sense of oneself as masculine and/or feminine. Like other identities, gender is neither binary (i.e., one fits into the category of

either a man or a woman) nor a spectrum wherein men and women are on opposite poles. Rather, gender identity can be considered a “multiverse” wherein there are infinite ways by which one can identify. Importantly, gender identity is a matter of self-determination. It is not determined by genotypes or phenotypes and cannot be confirmed or disconfirmed by another person, but rather, it is dependent on an individual’s internal self. Two terms most commonly used to refer to gender identity include transgender and cisgender. Cisgender refers to individuals whose birth-assigned sex is congruent with their gender identity. Most broadly, the word transgender is used by people who identify differently than the sex they were assigned at birth, or by those for whom the gender assigned at birth is an incorrect or incomplete description of themselves. Generally, an individual who was assigned the male gender at birth, but identifies as a woman or in a more feminine-­ oriented way, might self-identify as a trans woman, transgender woman, or woman. An individual who was assigned the female gender at birth, but identifies as a man or in a more masculine-oriented way, might self-identify as a trans man, transgender man, or as a man.

Gender Identity and Sexual Orientation Gender identity and gender expression are often thought to be associated with sexual orientation. Sexual orientation typically refers to the gender or genders to whom one feels an attraction. It describes a pattern of emotional, romantic, or sexual attraction to another person based on that person’s gender and is composed of feelings, behaviors, and identities. While an in-depth discussion of sexual orientation is beyond the scope of this entry, it is useful to clarify both its distinction from and connection to gender identity. Gender identity and sexual orientation intersect in two important ways: (1) in English as well as in many other languages, the words used to describe sexual orientation also imply a gender of the subject (e.g., the term lesbian is a descriptor of gender and ­orientation) and (2) sexual attraction is itself seen as a category in which one can conform to expectations of one’s proscribed gender role (by being heterosexual) or transgress the expectations of their gender (by being lesbian, gay, bisexual, or other

Gender Identity

nonheterosexual orientation). However, despite these intersections, it may be useful to conceptualize gender identity and sexual orientation as separate, insofar as everyone has both. For example, if someone identifies as transgender, this is not in itself a statement about the individual’s sexual orientation. Transgender people can identify as any sexual orientation that cisgender people can (e.g., lesbian, gay, straight, bisexual, asexual, queer).

Gender Identity, Socialization, and Culture Concepts of gender and gender identity—male and female or masculine and feminine—are culturally dependent constructs. Although there may be similarities between various cultures with regard to male and female roles, generally speaking, there is variance between cultures with regard to what constitutes masculine versus feminine behavior. In general, however, many countries share similar gender stereotypes such as men being viewed as strong, active, and high achieving and women being viewed as weak, nurturing, and deferent. In addition, some cultures provide greater or lesser flexibility with regard to gender expression outside what is considered normative behavior. For instance, cross-cultural research suggests that ­gender roles are frequently more differentiated and rigid in conservative countries with low levels of socioeconomic development. Gender socialization occurs throughout the life span, in varying contexts (e.g., parents, school, media) and is both covert and overt. It sends implicit and explicit messages to people about how to appropriately act, think, and feel, as a male or a female. In Western culture, gender socialization most often begins at birth. After the doctor assigns a newborn a sex based on their phenotypes, gender socialization often quickly commences. It may be seen in the way parents talk to or about their infants (e.g., emphasizing strength when talking about male babies), how children are dressed (e.g., girls in pink), and what kind of toys parents buy (e.g., trucks and guns for boys). While the relationship between gender reinforcing parenting and gender expression is unclear, children like to please; thus, many transgender people describe suppressing or expressing gender identity at a tremendous cost. Notably, no research evidence suggests that transgender people are raised in less

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gender-strict socializing environments. Gender socialization occurs in many other contexts as well. For instance, in school, girls continue to be discouraged from playing certain types of sports, and boys are less likely to be given dolls or encouraged to play cooking games. Gender stereotyping also occurs in both child and adult television shows, movies, and books.

Models of Gender Identity Development Models of gender identity development fall into three broad categories: (1) essentialist, (2) developmental, and (3) socialization. Essentialist theories of gender identity development argue that gender is directly tied to sex and typically purport that sex is composed of two categories (male and female). Such theories reason that there are innate differences between men and women. Men are viewed as inherently masculine and females as inherently feminine, and typically, other categories of sex or  gender (e.g., intersex, transgender) are not acknowledged. Developmental theories of gender identity development suggest that gender identity changes over time in expected stages. As children get older, it is believed that they internalize the gender expectations they have learned. Lawrence Kohlberg’s ­theory of gender identity development, for instance, posits that children develop a cognitive understanding of gender in three stages: (1) labeling of others as male and female, (2) understanding that gender identity is stable across time, and (3) understanding that gender identity remains constant despite apparent changes. This theory reflects a limited understanding of gender identity, as it is now known that gender identity is not static but rather is fluid and can change and develop over time. Kohlberg’s theory is also based on male-female dualism, which, as illustrated here, is a limited and oversimplified conception of gender. Despite this, research suggests that the belief that gender is constant (i.e., gender constancy) has developmental implications. For instance, when children attain gender constancy, their behavior becomes more gender stereotypical. Many also argue that gender constancy is necessary for children to experience a sense of self that aids in psychological well-being and self-esteem. However, such well-being may be largely attributable to the

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feelings of social competence evoked when one identifies with a particular gender and successfully expresses it, an argument set forth by socialization theories. Socialization theories suggest that gender identity development occurs through the influence of others. The socialization process transpires directly through verbal messages about appropriate behavior for boys and girls and indirectly through the modeling of gender roles by others (e.g., parents). Children are rewarded for engaging in gender appropriate behavior and punished for gender nonconforming expression. Such punishment may take the form of bullying by peers or reprimand or abusive behaviors by caregivers. Gender conforming expression can be socially rewarding, as it results in social acceptance by peers, which is considered a protective factor against depression and loneliness in childhood and adolescence. Research suggests that children’s gender expression in play is more pronounced (e.g., boys play with more masculine toys) in the presence of other peers, compared with solo play. However, children whose gender expression is incongruent with their gender identity, due to social pressures to conform, often have various internal difficulties (e.g., depression). While socialization theories speak to the interplay between gender identity and expression, it is important to note that gender socialization is often so salient that it may influence how one feels or identifies. As an individual develops, their sense of self may diverge or converge with social pressures, thus making gender identity a malleable construct subject to change with personal growth and social forces.

Stigma, Discrimination, and Other Psychosocial Stressors Related to Gender Identity As previously mentioned, gender nonconforming individuals face myriad challenges from society due to demands and expectations to identify as cisgender and express themselves accordingly. As a consequence of these demands, transgender and other gender nonconforming people face stigma, discrimination, and sometimes abuse. These acts are motivated by transphobia, or the hostile attitudes and feelings toward transgender people based on their internal gender identity. Like other

types of oppression (e.g., homophobia, racism), transphobia can be internalized, meaning that gender nonconforming people may embrace the transphobic messages they are exposed to. This can happen consciously or unconsciously and may take the form of self-hatred and/or deep shame for having a gender identity and/or gender presentation that is inconsistent with their assigned sex. Gender nonconforming people may have internalized messages from others that they are inferior or unlovable, which may lead to isolation and depression. Discrimination against gender nonconforming or transgender people may transpire through microaggressions, which can be defined as brief and commonplace verbal, behavioral, or environmental indignities that communicate hostile, derogatory, or negative slights and insults toward marginalized people (e.g., people of color, people with disabilities). These events can be intentional or unintentional, though enactors of microaggressions are often unaware that they are engaging in such communication when they interact with oppressed people. Some common microaggressions experienced by trans people include being referred to by the wrong pronoun; being prohibited (either explicitly or implicitly) from using public restrooms, locker rooms, or other public gendered spaces; being referred to by one’s legal or birth name, rather than chosen name; and being told that one’s gender identity is the result of a phase, a mental disorder, or a trauma. Transgender and gender nonconforming people are also at a higher risk of experiencing very serious types of oppression such as physical violence and sexual assault. Due to the significant discrimination they face, transgender people are also more likely to be homeless, have significant psychiatric problems (e.g., depression), and are at a higher risk for suicide attempt or completion. Trans people experience a disproportionate amount of poverty, unemployment, and family rejection and have difficulties accessing medical care, school, and social services. These disparities have resulted in impaired life chances for trans people and an overall dearth in appropriate services and treatment for this population. The interaction between discrimination and internalized transphobia can also lead to some transgender people believing that they deserve the abuse they experience. Many gender

Gender Identity

nonconforming people may also attempt to express themselves in a gender conforming manner to avoid the stigma and pain associated with gender identity–congruent expression. However, as aforementioned, attempts to suppress gender nonconforming behavior and expression have mental health implications as well. Transgender people also face a number of institutional limitations that deter or prevent them from accessing necessary documentation and/or health care that aid in gender transition. Transitioning is particularly important in light of the significant risks associated with being identified as gender nonconforming. While this entry cannot adequately review the myriad ways in which institutions limit gender transition, a few salient ­institutional barriers are noted here. First, many identity documents (e.g., driver’s licenses, passports, immigration documents) require a gender classification, and several agencies that govern such documentation have rules and practices about gender classification and reclassification (e.g., by requiring a particular surgery or a doctor’s letter confirming trans identity), and some agencies do not allow reclassification at all. Gender-segregated facilities (e.g., public bathrooms, drug treatment programs, hospitals, homeless shelters) are often locations of increased risk and vulnerability for trans people. Not only are many of these places violent already, but the rules that govern gender segregation (e.g., organizational policies that prohibit trans women from staying in domestic violence shelters) also result in increased risk for harm. Importantly, trans people may be in greater need of many of these services because they experience a disproportionate amount of job discrimination resulting in unemployment and social and family rejection resulting in substance abuse and/or mental health problems. Finally, health care access is often limited for trans people as many health care policies do not cover gender confirming health care for trans people. Notably, such treatments (e.g., hormone therapy, chest surgery) are frequently covered for cisgender people, even in circumstances when it is used solely for cosmetic purposes (e.g., for breast reduction in cis men who develop abnormal amounts of breast tissue). Such restrictions can have significant mental and physical consequences, as many trans people resort to street-based

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interventions outside health care settings that may put them at risk for HIV and hepatitis infection, nerve damage, inappropriate dosage, and other dangerous risks.

Cisgender Identity and Privilege Given the many difficulties faced by transgender people, it is important to recognize the privileges experienced by cisgender individuals, particularly in how their identity development may be viewed as normative. Privilege can be defined as the advantages one group faces relative to other groups. Thus, cisgender privilege is defined as unearned rights afforded to nontransgender people by virtue of the fact that they are not transgender. Some examples of cisgender privilege include access to gender-segregated spaces (e.g., restrooms, changing rooms, sports teams), the right to be called by one’s preferred gendered names or pronouns (e.g., sir, ma’am, he, she), significantly lower likelihood of exposure to gender-based hate ­violence, and access to gender specific health care without requiring psychiatric evaluation (e.g., oral contraceptives, family planning, testosterone replacement). Recognition of previously unnoticed cisgender privilege can afford one with the opportunity to examine one’s potential contribution to the ongoing oppression faced by gender nonconforming people. Acknowledging cisgender privilege also allows for an increased understanding of the steps that can be taken to dismantle it and related systems of oppression. Finally, recognition of ­ ­cisgender privilege may also create more space for cisgender people to explore their own gender identities, since all people, not only trans people, may feel limited by the expectations imposed on them via their birth gender assignment. Future research can examine how cisgender privilege may influence identity development, biases against transgender and gender nonconforming people, and other psychological processes and outcomes. Maggi Price and Avy Skolnik See also Cisgender; Cultural Gender Role Norms; Gender and Society: Overview; Gender Development, Theories of; Gender Fluidity; Transgender and Gender Nonconforming Identity Development; Transgender People; Two-Spirited People

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Further Readings Brinkman, B. G., Rabenstein, K. L., Rosén, L. A., & Zimmerman, T. S. (2014). Children’s gender identity development the dynamic negotiation process between conformity and authenticity. Youth & Society, 46(6), 835–852. Fausto-Sterling, A. (2000). The five sexes, revisited. Sciences, July–August, 18–23. Retrieved from http://www2.kobe-u.ac.jp/~alexroni/IPD%20 2015%20readings/IPD%202015_4/FAUSTO_ STERLING-2000-The_Sciences%205%20sexes%20 revisited.pdf Kimmel, M. (2000). The gendered society. New York, NY: Oxford University Press. Laqueur, T. (1990). Making sex: Body and gender from the Greeks to Freud. Cambridge, MA: Harvard University Press. Mikkola, M. (2008). Feminist perspectives on sex and gender. In Stanford encyclopedia of philosophy. Retrieved from https://plato.stanford.edu/entries/ feminism-gender/ Reisner, S. L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., & Mimiaga, M. J. (2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health, 56(3), 274–279. Spade, D. (2011). Normal life: Administrative violence, critical trans politics, and the limits of law. Brooklyn, NY: South End Press. Stotzer, R. L. (2008). Gender identity and hate crimes: Violence against transgender people in Los Angeles County. Sexuality Research & Social Policy, 5(1), 43–52. Warin, J. (2000). The attainment of self-consistency through gender in young children. Sex Roles, 42(3–4), 209–231. Williams, J., Satterwight, R., & Best, D. (1999). Pancultural gender stereotypes revisited: The five factor model. Sex Roles, 40, 513–525.

Gender Identity Adolescence

and

Gender identity and adolescence are long-studied constructs in the counseling and psychological ­literature. Early research in this area focused on developmental milestones, as well as biological

and psychological changes in adolescents’ experience. More recently, there have been calls for the literature base on gender identity and adolescence to evolve so that gender identity development in adolescence not only accounts for the experiences of cisgender youth but also includes the gender identity development of transgender and gender nonconforming (TGNC) adolescents. Cisgender ­ adolescents are those youth whose sex assigned at birth aligns with the gender identity they assert, while TGNC youth may not experience their sex assigned at birth as in alignment with their ­gender identity. Sex is assigned at birth, resulting in the binary male or female based on a biological designation, whereas gender identity is a separate construct indicating a person’s identified gender (e.g., woman, girl, man, boy, or something else). In 2009, Birgit Möller and colleagues estimated that 5% to 12% of female-assigned girls and 2.6% to 6% of male-assigned boys indicated gender nonconformity. In this entry, the stages of gender identity development and related physical and ­ psychological changes are reviewed. In addition, multicultural and social justice concerns that cisgender and TGNC adolescents face are described.

Gender Identity Development Stages In the 1960s, developmental psychologists Erik Erikson and James Marcia focused on adolescence as the time when identity formation occurs. ­Erickson’s model of identity development includes an eight-stage model across the life span whereby humans experience various psychosocial crises that help them acquire a better understanding of themselves. According to Erikson, during early childhood, toddlers develop a sense of independence and self-reliance, which leads to confident exploration of their environment and a sense of mastery over the developmental tasks extending to late childhood. This independence and confidence provide a healthy foundation for the formation of identity, which is a main task of the adolescent stage. As part of the process of identity development, gender learning typically begins early, around 2 years of age, as children begin to recognize and label their own gender as well as others’ gender. This recognition is mainly the result of expressed

Gender Identity and Adolescence

gender-typed preferences based on stereotypes— playing with certain toys, engaging in certain play behaviors, and an increase in their preference for playing with same-sex peers. Children typically express their preferences for gender specific play around the age of 3 or 4 years. TGNC children will usually demonstrate nontraditional gender expression around this time as well. During childhood, most children’s gender identity maintains a connection with their specific gender role behaviors, and children typically do not understand gender constancy until around the age of 6 or 7 years. Parental influence is a strong force during children’s initial understanding of gender roles, and research indicates that fathers typically demonstrate more rigid expectations regarding gender expression. Parents and teachers are more likely to reinforce feminine play and expression for girls and masculine play and expression for boys. As children become more independent and social, peer influences become an even stronger force during middle childhood and into adolescence. ­ Socially constructed expectations about appropriate gender expression influence children’s interactions and their sense of gendered identity. C ­ hildren interact with their peers at school and on the playground—receiving both subtle and explicit ­ messages about their gender expression. For TGNC, school and playground experiences can present many challenges throughout childhood as a result of bullying and discrimination from peer groups due to their nontraditional gender expression. This carries into adolescence and can become a substantial barrier to healthy development if the adolescent does not have a supportive family or peer group. While children generally begin the process of understanding their gender identity during the preschool years, a cohesive sense of gendered self usually begins to take shape during preadoles­ cence. Viewed as a multidimensional construct, gender identity involves various elements of a child’s psychosocial development. Specifically, Susan Egan and David Perry in 2001 suggested that children develop an understanding of socially constructed gender categories; they recognize their own membership in, attitude about, and compatibility with a gender category as well as coping with felt pressure for gender conformity. In 2009, Susan

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McHale and colleagues studied the influence of gendered social contexts on ­adolescent-gendered personality traits. In their research, they found that by the age of 13 years, gendered social contexts generally contribute to the development of more stereotypical gender behavior. Prompted by significant hormonal changes as a result of puberty, adolescence is characterized by many physical and emotional changes and can affect gender identity development, depending on timing and variations in the process. Early and late maturation influences adolescents’ sense of identity as well as their peer relations. For example, early-maturing males perceive themselves more positively and have more successful peer relations than their late-maturing male peers, and early maturation in females correlates with higher rates of behavioral and emotional problems. Puberty can present varying levels of stress for all adolescents; however, TGNC adolescents typically encounter significant and greater challenges compared with their cisgender peers. Parents, peer groups, and teachers typically provide the most social influence on a young person’s understanding of their gender identity. Throughout childhood and adolescence, individuals thrive in families where parents demonstrate support for their child’s gender identity. Healthy gender ­identity development occurs in the context of supportive families and peers. TGNC adolescents whose parents and families do not support their gender identity are more likely to encounter challenges that can result in issues related to mental health— including depression, anxiety, and suicidal ­ideation. The process of healthy gender identity formation requires that the children and adolescents have the freedom to express their genuine preferences in an environment where they feel safe and affirmed. For both cisgender and TGNC adolescents, authentic gender identity development occurs as a result of this type of environment.

Multicultural and Social Justice Concerns Cisgender and TGNC adolescents come from a diverse array of cultural backgrounds and have varying experiences of privilege and oppression. Therefore, multicultural and social justice concerns are important aspects of working with

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c­isgender and TGNC adolescents. Cisgender and TGNC adolescents may come from cultural backgrounds where their identified gender is paired with restrictive or traditional gender norms. For instance, patriarchy creates differing gender role expectations for adolescent girls and boys in areas that range from access to education, expected work, and interpersonal behavioral norms trajectories, among others. These differing gender role expectations can influence the ways in which ­cisgender and TGNC adolescents learn to move through early, middle, and late adolescence—and even define the length of adolescence culturally. In Western contexts, for example, adolescence is widely considered to end in the mid-20s, whereas in other cultural contexts, adolescence may have a much shorter duration. In addition to the length of adolescence, cultural norms shaping gender roles can influence timing of events such as marriage and raising children. Cultural frameworks and definitions of adolescence and gender also intersect with the multiple identities of religion/spiritual affiliation (if there is one), social class, disability, and other identities. In addition to multicultural concerns, social justice issues can influence adolescent identity development. For both cisgender and TGNC adolescents, adultism is a common oppression experience, whereby adults hold power in their lives and may use this privilege in a way that is disempowering, or even psychologically and physically ­abusive. Because social justice experiences of privilege and oppression map onto multicultural identities, adultism may be mitigated in the life of a cisgender or TGNC adolescent’s life by being able to access privilege, such as financial or educational resources. On the other hand, multiple identities that do not have privilege may lead to multiple experiences of oppression that are additive to adultism. For instance, a TGNC adolescent of color from a ­family that has access to financial resources and who experiences family acceptance may have ­multiple experiences of privilege, while a TGNC adolescent of color from a family with low access to financial resources and who experiences homelessness due to family rejection has multiple experiences of oppression. With both cisgender and TGNC adolescents having increased access to the Internet and social media, youth have increased venues to express

themselves, connect with other cisgender and TGNC adolescents, and create social justice movements. For example, the Put This on the Map project out of the northwest United States is a ­ youth-founded and -driven empowerment group that seeks to challenge traditional norms of gender identities, gender roles, and gender expressions. With online venues, cisgender and TGNC adolescents can also connect with other youth internationally, allowing them to learn and understand how adolescence and gender is experienced differently across the globe. Anneliese A. Singh and Rebecca Eaker See also Gender Identity

Further Readings Fingerson, L. (2006). Girls in power: Gender, body, and menstruation in adolescence. New York: State University of New York Press. Möller, B., Schreier, H., Li, A., & Romer, G. (2009). Gender identity disorder in children and adolescents. Current Problems in Pediatric and Adolescent Health Care, 39, 117–143. doi:10.1016/j.cppeds.2009.02.001 Singh, A. A. (2012). Transgender youth of color and resilience: Negotiating oppression, finding support. Sex Roles: A Journal of Research, 68, 690–702. doi:10.1007/s11199-012-0149-z Updegraff, K. A., McHale, S. M., Zeiders, K. H., UmanaTaylor, A. J., Perez-Brena, N. J., Wheeler, L. A., & Rodriguez De Jesus, S. A. (2014). Mexican-American adolescents’ gender role attitude development: The role of adolescents’ gender and nativity and parents’ gender role attitudes. Journal of Youth and Adolescence, 43(12), 2041–2053. doi:10.1007/ s10964-014-0128-5

Gender Identity

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Childhood

Gender identity development begins in early childhood and intersects with many facets of growth across the life span. Psychologists have sought to understand this aspect of development for decades, and it continues to be a salient area for researchers and practitioners alike. Although there are numerous theories to explain gender identity development, consensus is lacking regarding which one, or

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combination, offers the best explanation. The growing research on transgender and gender nonconforming (TGNC) children has added a new element to this conversation. This entry outlines the major theories and typical development of both cisgender and TGNC children, from birth to 11 years of age. Cisgender refers to a gender identity that aligns with an individual’s gender assigned at birth, which is often consistent with one’s biological sex, whereas TGNC refers to a gender identity that does not align with the gender assigned at birth.

Theories of Gender Identity Development Psychoanalytic theory, developed by Sigmund Freud, is one of the earliest theories of gender development. This theory proposes that children identify with their mothers at birth and develop sexual feelings toward the parent of the other gender. This creates competition with the same-­ gendered parent and feelings of jealousy. To resolve the conflict, children begin to identify with the same-gendered parent. In the mid-20th century, Lawrence Kohlberg formulated the cognitive developmental theory of gender development. This theory suggests that children’s gender identity is directly related to their cognitive understanding of gender as a stable and constant construct. According to this theory, children progress through stages to ultimately achieve gender constancy. As children move toward constancy, their adherence to rigid gendertyped behavior increases. This theory proposes three stages of gender constancy: (1) identity, (2) stability, and (3) consistency. Identity is characterized by individuals’ ability to label the gender of themselves and others. Stability is characterized by an understanding that gender remains constant over time (e.g., a boy will grow to be a man). Consistency is characterized by learning that gender will not change by altering dress, appearance, or behaviors. This theory has since been tested and questioned, including discounting Kohlberg’s idea that gender constancy is equated with more rigid adherence to stereotypically gendered behaviors. Researchers have shown that rigidity for gendered behavior is strongest in the stability phase and begins to lessen throughout the constancy phase.

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Albert Bandura proposed social learning theory in 1977, which suggests that gender is a social, rather than biological, construction. This theory posits that children’s gender identity is formed through interacting with the environment. Specifically, children learn acceptable gendered behaviors through observation, imitate the behaviors aligned with their assigned gender, and experience ­reinforcement of those behaviors through consequences in the environment. Children are discouraged, implicitly or explicitly, from engaging in behaviors that fall outside gender norms and reinforced for engaging in behaviors that align with gender norms. Studies have shown that differential parenting practices, based on a child’s gender, start as early as infancy, even when parents believe that they are not doing this. Schools also show different gendered teaching practices as early as preschool. In the early 1980s, Sandra Bem proposed schema theory, which suggests that children use their own cognitive processes of schemas to form ideas of gender. A schema is a cognitive framework that organizes information into complex categories or webs, helping people sort and access ­ information quickly. Schemas of femininity and masculinity are developed by children at a young age, and this is facilitated by the environment (e.g., society, family, school, and media). Children view themselves in a gender schema and behave according to that schema, which influences their outlook on the way they work and problem solve. This theory also integrates the idea of androgyny (a combination of masculine and feminine traits). As scientific capabilities have advanced, more research has shown biological bases of gender development as well. Evolutionary psychologists suggest that our ancestors’ actions guide today’s gendered behavior. For example, in the past, men needed to propagate with many desirable (fertile) females to advance genes, and women looked for stable men to care for them and their offspring. Evolutionary theories have been criticized for not explaining the change in gendered behaviors over the past century. Research has also looked for a hormonal basis for gender. Prenatal exposure to high levels of testosterone or estrogen has been shown to be related to certain gendered behaviors. Furthermore, some studies have shown differences in brain lateralization and spatial skills between genders, although there is some evidence to suggest

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that these differences are lessening. Finally, genetic factors have been explored. Heritability of gender has been shown to have a low to moderate influence on personality (masculinity and femininity) and could explain the similar patterns of gendered behavior found across many cultures. Some specific alleles on chromosomes have also been linked to certain gender expressions. There are some gaps and shortcomings in the current literature. Historically, gender identity development has been studied as a stable construct, with deviations seen as pathological. Many studies look at averages among groups of children, not how individual variations of gender and gender expression may occur throughout childhood. The increasing rate of children presenting with gender dysphoria and nonbinary gender identities suggests an interplay between genetic and environmental factors that likely contributes to gender identity development for both cisgender and TGNC children.

Typical Cisgender Identity Development Process A typical cisgendered child can begin to tell the difference between females and males at 3 to 4 months of age. By 10 months, babies can differentiate between male and female faces and gendertyped items but are unaware of the social ­meanings associated with these items. Between 17 and 21 months, most children use gender labels in play or conversation, and girls often develop this skill earlier than boys. Between 18 and 24 months, ­ ­children seek out information about gender roles and appropriate gender behavior. By the age of 2 years, most children can understand the label of binary genders (boy/girl) and can identify their own gender. By the age of 3 years, basic gender stereotypes begin to emerge (e.g., boys wear ties and girls wear dresses), and between the ages of 3 and 5 years, children begin to understand that gender is stable. During preschool, children may develop the idea that boys are more aggressive and girls are more passive. Children at this age also begin to show preference for same-gendered peers, and form basic gender stereotypes, which peaks between the ages of 5 and 6 years. At this age, children show negative responses to other children

who exhibit behaviors, play, and expression that are not consistent with gender norms. Around the age of 7 or 8 years, expressions of gender rigidity begin to decline. At this time, children begin to understand that gender is constant. This facilitates more flexibility in how a child expresses themselves and increases acceptance of behaviors not aligned with gender norms. As children reach the later elementary years (ages 9–11), they become aware of differences in power and privilege regarding gender, continue to become more flexible with behavior outside gender norms, and most exhibit gender constancy.

TGNC Identity Development Not all children follow a cisgender identity development in which their gender assigned at birth aligns with an inherent sense of self as male or as female. Although the label “transgender” is being used with increased frequency to describe younger children who are gender nonconforming, some developmental scholars point out that this label may be premature for children who are still forming their identities and should perhaps be postponed for use in adolescence or adulthood. Many other terms exist, including gender nonconforming and gender creative. Unlike their cisgender counterparts, TGNC children often do not follow the typical gender identity developmental trajectory described previously. Instead, their gender identity is typically less binary and more fluid. Children as young as 3 years of age may exhibit gendered behavior, preferences, and expressions that are incongruent with those expected of the gender to which they were assigned. For these children, the developing gender identity may fluctuate between stereotypical masculine and feminine interests, behaviors, and expression or it may fall strongly on one end of the continuum. Some children may identify as their assigned gender but prefer toys, activities, playmates, and/or clothing typical of a different gender. Other children may strongly and persistently identify as a different gender and reject all things associated with their assigned gender, including their male or female anatomy. These children often report gender dysphoria—the distress that occurs due to an ­ incongruence between one’s body and assigned gender. Psychological distress (e.g., depression,

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anxiety, behavioral problems) often accompanies gender dysphoria for these children due to their discomfort with their gender and body, along with the associated societal stigma, rejection, and bullying that they may experience. Children with supportive families and social environments are ­ more likely to be resilient and thrive. Although there is variability in how strongly TGNC children identify with a different gender and the degree of dysphoria they have toward bodies, even those who report the strongest rejection of their assigned gender and body may not go on to identify as transgender later in life. For some of these children, the gender nonconformity may be a phase, for others, it may be a precursor to questioning sexual orientation in adolescence, while yet others may persist in their identification as a different gender. Some of the children who persist may ultimately pursue social and physical transitions to align their gender expression and body with their affirmed gender. Because of the multitude of trajectories any one TGNC child may ­follow, parents are often encouraged to seek assistance from qualified mental health providers who can provide guidance and support around this issue. Specifically, helping families make decisions regarding the possible social transition of young children (i.e., making a change to name and pronouns and allowing the full gender expression that the child desires) is critical, as there are pros and cons to pursuing this. Although there is no way to definitively predict which TGNC children will persist in their transgender identity into adolescence and beyond, emerging research suggests that children with more severe gender dysphoria at a young age, and whose gender dysphoria continues throughout childhood and intensifies in early puberty, are more likely to persist in their transgender identity in adolescence. Novel research published in 2015 suggests that TGNC children who are living as their affirmed gender exhibit patterns of gender cognition in line with their expressed gender rather than their gender assigned at birth, similar to their cisgender counterparts. This emerging knowledge may help provide guidance for practitioners working with TGNC youth and their families when faced with decisions regarding possible social transitions in childhood and medical interventions in puberty.

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Future Directions Scholars have yet to identify a theory of gender identity development that adequately captures all variations of this complex developmental process. The increased prevalence of TGNC children presenting to health care provider offices beginning shortly after the turn of the 21st century has resulted in an upsurge of research energy focused on this topic. Sorting out the underlying factors affecting any one individual’s gender identity development continues to be a mystery in many respects. While familial and early-childhood influences (e.g., trauma, abuse) are no longer ­ considered a likely contributing factor for most individuals, other social factors are being questioned particularly for adolescents, such as social media–related peer influence. The impact of the increased media attention on transgender issues may also contribute to the growing number of families seeking services for their children. Teasing out which of the TGNC children will persist and ultimately desire social and physical transition continues to be a perplexing diagnostic question. The potential benefits and disadvantages of children and young adolescents making social and physical transitions needs to be further explored. Finally, the comorbidity of gender nonconforming presentation in childhood with ­ neuro-atypical developmental issues, such as attention-deficit/hyperactivity disorder and autism spectrum disorders, is compelling. Regardless of gender identity’s etiology, a societal shift toward acceptance of gender diversity, including nonbinary identifications, in children appears to be occurring. Laura Edwards-Leeper and Alyshia Smith See also Childhood and Gender: Overview; Cisgender; Gender Variant Role Expression in Childhood; Gendered Stereotyped Behaviors in Childhood; Sexual Orientation Identity Development; Transgender and Gender Nonconforming Identity Development; Transgender Children

Further Readings Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106(4), 676–713. doi:10.1037/0033-295X. 106.4.676

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Drescher, J., & Byne, W. (Eds.). (2013). Treating transgender children and adolescents: An interdisciplinary discussion. London, England: Routledge. Martin, C. L., & Ruble, D. N. (2009). Patterns of gender development. Annual Review of Psychology, 61(1), 353–381. doi:10.1146/annurev.psych.093008.100511 Olson, K. R., Key, A. C., & Eaton, N. R. (2015). Gender cognitions in transgender children. Association for Psychological Science, 26(4), 467–474. doi:10.1177/ 0956797614568156 Ruble, D. N., Taylor, L. J., Cyphers, L., Greulich, F. K., Lurye, L. E., & Shrout, P. E. (2007). The role of gender constancy in early gender development. Child Development, 78(4), 1121–1136. doi:10.1111/j.14678624.2007.01056.x Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. doi:10.1016/ j.jaac.2013.03.016 Zucker, K. J., & Bradley, S. J. (Eds.). (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York, NY: Guilford Press.

Gender Identity Disorder, History of The term gender identity disorder (GID) applies to those individuals who are in distress or are incapacitated because of their transgender presentation and behavior. Such people are in distress because they behave in a gender behavior category that is incongruent with the one they were assigned at birth. Because of their presentation and behavior, family, community, and culture may reject them. For this reason, such people encounter social situations that are stressful. Gender behavior category refers to the behaviors, norms, expectations, and rules defined by culture for that category. In most contemporary cultures, the assignment to gender behavior category is based on assignment of sex at birth. Sex pertains to the structure of body organs that are involved in reproduction. Gender refers to

behavior. According to cisgender cultural rules, those deemed to be male are automatically assigned to the masculine behavior category, and those determined to be female are assigned to the feminine category. Such cultures are termed binary because there are only two possible gender behavior categories. In contemporary binary, cisgender cultures, the assignment to gender behavior category is automatic and movement between categories is outlawed. This entry reviews the derivation of the term GID, the history of its use in diagnostic coding, and the current status of the term.

Derivation of the Term There are three component terms in GID. The first component term, disorder, was originally used as a synonym for disease states that had known disease causes (e.g., infections). It has gradually come to mean, particularly in the mental health arena, a disease of uncertain origin. The second component term, identity, was developed through the work of Sigmund Freud (1856–1939) and Erik Erikson (1902–1994). It has come to mean an expression of one’s self and/or how one fits into affiliated groups. The third component term, gender, as developed by John Money (1921–2006) in the late 1950s (as gender role), means behavior within the gender behavior categories. Money borrowed the word from language grammars to deliberately mean gender behavior as opposed to sex because he was dealing with patients with uncertain sex. Money believed that after surgical sex assignment by genital modification, a child could adapt to either gender. However, gender has become confounded in social science and in public discourse as a synonym and polite word for sex. Because most contemporary cultures are cisgender in nature, it is assumed by many that sex and gender mean the  same thing, but scientifically, they do not. Because of this confound, it is important to understand the precise meaning of gender to the speaker or the writer. Transgender was a term originated by John Oliven (1915–1975) in 1965 to refer to those who presented in an incongruent gender behavior category, which for him included part-time and full-time presentation as well as transsexuals. The word was subsequently co-opted by those who

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would use transgender as a term that did not assume that the behavior was motivated by ­sexual arousal. The term now refers to those who present in a gender behavior category to which they were not assigned at birth. Transgender people now include transsexuals. Being transgender does not mean that one has GID. GID occurs only when a transgender person becomes distressed or is incapacitated by their transgender behavior. Most transgender people are happy the way they are and never need the assistance of mental health professionals and never are diagnosed as GID. The final term to be defined with regard to GID is conversion therapy. For some, urging the retention of GID in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s International Classification of Diseases and Related Health Problems (ICD) is an attempt to legitimize conversion therapy for children. Conversion therapy is mainly practiced on transgender children with the ostensible goal of averting homosexuality and/or transsexuality in later life. However, responsible professional organizations such as the World Professional Association for Transgender Health condemn it. It is now illegal at the state and province level in many locations. Conversion “therapy” techniques for transgenderism currently use operant conditioning and “jawboning” to discourage transgender behavior. In operant conditioning, parents and the therapist reward behavior within a child’s assigned gender behavior category and withdraw rewards for behavior in the “wrong” gender behavior category. The idea of jawboning is to verbally coerce the child into saying the “correct” things about their “correct” gender. There is no scientific evidence that indicates that conversion therapy is effective.

History of Diagnostic Coding Within a few years after it was defined by Richard Green (1936– ) in 1974, GID was featured as a medical insurance code classification both for the DSM and the ICD. The DSM is the diagnostic manual used in the United States and elsewhere by mental health professionals to classify pathological states for reimbursement of treatments. The ICD is the manual developed by the World

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Health Organization for health management as well as for research and epidemiology. The ICD does not pertain just to mental health; it is used to classify the full range of diseases, health problems, and other health conditions (e.g., normal pregnancy). The codes in both manuals are supposed to be evidence based. In the United ­ States, computer billing for mental health treatments has not used the DSM codes. Instead, the DSM codes are converted to the ICD codes. Unknown to most practitioners, this type of conversion, known as harmonization, has been ­ ­performed since 2004. The evolution of the meaning of GID can be traced through the various DSM editions and ICD revisions. Although not included in the DSM-I or the DSM-II, GID persisted in the DSM for a relatively long time, from 1980 to 2014. The term was originally categorized as a psychosexual disorder, became a disorder of childhood, later became a sexual disorder, and finally morphed into gender dysphoria in its own section of the DSM. Green originated the term GID based on his studies of transgender children. However, his studies did not provide evidence as to the cause of being transgender. GID was adopted in the DSMIII in 1980. The DSM-III placed GID into the category of psychosexual disorders, referring to disorders that were psychological rather than physiological. The psychosexual disorders in the DSM-III included gender identity disorders, paraphilias (fetishism), psychosexual dysfunctions, and other psychosexual disorders. The inclusion of GID and fetishism in the same category led to the false assumption by many that GID was motivated by sexual arousal, just like paraphilias or sexual perversions, which include exhibitionism, pedophilia, and voyeurism. The gender identity subsection of the DSM-III included GID of childhood (transsexual type), GID adult/adolescent (nontranssexual), and atypical GID. GID was defined as incongruence between anatomical sex and gender identity. This was the first time that nontranssexual GID was included in the DSM. Previous editions pertained primarily to transsexualism. Predisposing factors listed included childhood femininity in males and masculinity in females, although there was very little evidence supporting the claim that such behavior was pathological.

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Consistent with the ideas of Green and others that GID should be treated in childhood, GID appeared in the DSM-III in a category of disorders pertaining to childhood. GID again appeared in the psychosexual disorder category, with the assumption of a psychological, rather than a physiological, causation. Specifically, it appeared in the section “Disorders Usually First Evident in Infancy, Childhood or Adolescence.” The GIDs included GID in childhood, transsexualism, adolescent or adulthood GID, and GID not otherwise specified. Even though there was no ­evidence to support them, predisposing factors listed in the DSM-III-R for male-to-female transsexualism include weak reinforcement of child role models, absence or unavailability of father, and closeness of mother with son. For female-to-male transsexualism, the predisposing factors listed were interest in rough and tumble play and absence of reinforcement of gender role. Research on such factors has subsequently failed to validate them. In the DSM-IV, published in 1994, GID was changed from a psychosexual disorder of childhood to a sexual disorder. Physiological causes are permitted in this category, opening the possibility that GID causation might involve physiological mechanisms. The term transsexual was subsumed by GID. There were two GID categories: (1) GID and (2) GID not specified. In the revision of the DSM-IV, GID remained in the category of sexual disorders. There were four GID subcategories: (1) GID in children, (2) GID in adults, (3) GID in adolescents, and (4) GID not otherwise specified. Under pressure from mental health providers and the transgender depathology movement, GID was deleted from the DSM-5, published in 2013, and replaced with gender dysphoria. Gender ­dysphoria was defined as being manifested in several ways including a strong desire to be treated as the other gender or to be rid of one’s sex characteristics or a strong conviction that one has feelings and reactions typical of the other gender. Gender dysphoria was placed in its own section, separated from psychosexual and sexual disorders. However, because gender dysphoria is still in the DSM, it is technically still a disorder. Although GID has disappeared from the DSM, it remains in the 10th revision of the ICD, and the ICD code is the code used for insurance billing. Just as GID in the DSM-IV was translated to the GID category in the ICD for billing purposes so

too has gender dysphoria been translated to GID in the ICD. Nevertheless, despite being removed from the DSM, GID is still used by mental health professionals in professional discourse, and the term gender identity is commonly used by both professionals and the public in conjunction with transgenderism.

Current Status By the time GID appeared in the DSM-III in 1980, there was already a strong depathology movement among transgender people and their allies, including some mental health professionals. This movement intensified during the period covered by the DSM-IV, and their efforts ultimately resulted in the deletion of GID from the DSM-5. The movement is now urging that GID be deleted from the next revision of the ICD (ICD-11). The transgender depathology movement argues that terms such as GID and now gender dysphoria create feelings of shame in transgender people and serve no useful purpose. Although GID was supposed to apply only to those in distress or with incapacity, the term is used in public discourse to claim or imply that transgender people are sick or diseased. Mental health practitioners who support depa­ thology efforts do so because they see the shame and distress in their patients created by these pathological terms. Some health providers are opposed to deletion of GID and gender dysphoria. They give several reasons. Some believe that GID causes such great distress that it qualifies as a legitimate disorder. Some argue that GID codes or gender dysphoria codes are needed to support medical treatment of transitioning transsexuals. Transsexual transition often involves hormone therapy and various surgeries that may require diagnostic coding. ­ ­Conversion therapy advocates urge that GID in childhood be retained because of the “danger” that transgender children might become transsexuals or homosexuals as adults, even though there is little evidence to support such claims. The assertion that transgenderism and transsexualism treatment requires a pathological code for insurance reimbursement is countered by two arguments. First, transgender treatment such as counseling has historically been coded in the DSM, not as GID but under other codes such as those for anxiety and depression. Many providers

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have hesitated to use GID codes to reduce shame and to protect patient privacy. In this interpretation, anxiety and depression are due to interpersonal issues created by cultural and social conflicts resulting from being transgender, not from being transgender per se. Second, the ICD contains a section for codes for various health conditions that are nonpathological, such as normal pregnancy. A nonpathological code for allowing the treatment of transgender and transsexual people could be created in the next ICD revision; therefore, all DSM and ICD GID and gender dysphoria codes could be eliminated. Because there are growing legal protections against conversion therapy for GID children, the codes supporting ­ conversion therapy for childhood GID are inappropriate. Although GID as a term has technically been deleted from the DSM, it has not gone away. It is still in the ICD-10 but may be replaced in the ­ICD-11. GID continues to be used in medical and  public discourse, along with gender identity, but gender dysphoria is slowly catching on as a descriptive term. Thomas Bevan See also Gender Bias in the DSM; Gender Dysphoria; Gender Identity; Gender Nonconformity and Transgender Issues: Overview; Transgender and Gender Nonconforming Identity Development

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Green, R. (1974). Sexual identity conflict in children and adults. New York, NY: Basic Books. World Health Organization. (1992). The international statistical classification of diseases and related health problems (10th revision). Geneva, Switzerland: Author.

Gender Marginality in Adolescence Marginality, broadly defined, refers to the experience of being on the metaphorical edges of a society due to a particular set of characteristics that

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deviate from what is accepted by the mainstream. Therefore, gender marginality refers to the disparate social experiences of individuals based on gender identity (i.e., an individual’s personal sense of identification as male or as female, another ­gender, or somewhere in between) or one’s gender expression (i.e., an individual’s external display of gender through dress, demeanor, and social ­behavior). This entry discusses gender as a social construction and briefly introduces gender marginality research, with a focus on gender marginality during adolescence. Given that adolescence is a sensitive time of identity development and social belongingness, it is important to understand the unique impact of gender marginality during this stage. The entry concludes with a discussion of the ways in which gender is marginalized at the institutional level.

Social Construction of Gender and Marginality Although the terms gender and sex are often used interchangeably, they are distinct constructs. Sex refers to the biological and physiological characteristics assigned to an individual at birth (e.g., genitals). Gender, which is shaped by socialization and societal norms, refers to how people experience and present themselves to the world as male or as female. Gender is reflected in behaviors, activities, and roles and may or may not be congruent with sex. However, contemporary Western societies tend to accept, endorse, and perpetuate gender as a rigid binary concept—that is, one with only two options (i.e., male and female). These processes create the illusion that gender is a natural and essential binary, which results in socially constructed expectations of gender. Thus, individuals who do not conform to the gender binary are often marginalized and experience mockery, judgment, social isolation, and punishment on the basis of their gender identity.

Gender Marginality and Adolescence Individuals who deviate from typical gender stereotypes (i.e., gender nonconforming) or identify as a gender different from their assigned sex (i.e., transgender) face marginality across various domains throughout the life span. In particular, adolescence is recognized as an important period

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of gender development because of the physical and psychological transitions that occur during this developmental stage. Identity formation and selfconcept become salient, and the need for social belongingness is intensified as peers become more influential than families of origin. Thus, the ways in which adolescents experience gender is influenced by a combination of individual and external factors, which makes them a population susceptible to gender marginality. Research on gender marginality during adolescence suggests that transgender and gender nonconforming (TGNC) adolescents are more likely to experience pervasive bullying and harassment than their gender conforming peers. TGNC adolescents often feel unsafe in school settings and face more instances of harassment (e.g., verbal victimization, cyber bullying) and physical assault (e.g., punching, kicking, injury by weapon) related to gender. The literature also suggests that TGNC youth experience victimization more frequently than gender conforming peers who identify as lesbian, gay, and bisexual—who are also at heightened risk for harassment. In the school setting, adults often fail to respond sufficiently when TGNC adolescents report victimization, and school climate studies continue to show that teachers and other school officials are also perpetrators of gender marginality and harassment against TGNC adolescents. Apart from the academic setting, research suggests that TGNC adolescents also may experience gender marginalization at home. Parents, siblings, and other relatives might unintentionally invalidate adolescents’ gender or actively engage in efforts to change their presentation by forcing them to wear certain clothing and refrain from specific behaviors. In addition, studies have shown that families who reject an adolescent’s gender identity might limit access to resources, prohibit socializing with other TGNC individuals, and, in some circumstances, force a gender nonconforming adolescent out of the home. Because TGNC adolescents often lack adequate social and familial support, they are at high risk for clinically significant distress, including anxiety, depression, substance abuse, self-injury, and suicide. Approximately 50% of all TGNC individuals have attempted or will attempt suicide by the age of 20 (compared with approximately 20% of

l­esbian, gay, and bisexual individuals and approximately 5% of heterosexual individuals). Interestingly, research suggests that negative psychosocial outcomes for TGNC adolescents are associated with external experiences of marginality and rejection, rather than internal experiences of gender nonconformity.

Institutionalized Gender Pathology Given that adolescence is marked by increased interactions with broader social contexts, it is important to acknowledge that gender marginalization occurs at an institutional level. Despite the growing diversity around gender presentation and gender identity in contemporary society, an underlying assumption remains that TGNC individuals are sexually pathological, deviant, or abnormal. In the past, this assumption led the psychiatric and psychological communities to pathologize individuals whose sexuality and gender identity deviate from cultural expectations. The 2013 release of the Diagnostic and Statistical Manual of Mental ­Disorders, Fifth Edition (DSM-5), marked an important change in how society understands the experiences of TGNC adolescents and adults. Under the previous edition of the DSM (DSM-IV), transgender individuals could be diagnosed with gender identity disorder, which reinforced the view that gender nonconformity was a mental illness. The DSM-5 replaced gender identity disorder with gender dysphoria in an attempt to remove stigma and better characterize the experiences of affected individuals. To meet criteria for gender dysphoria, individuals must have clinically significant distress associated with the discrepancy between their experienced and assigned genders. Oftentimes, this distress is directly related to gender marginalization. Although debate remains about the utility of gender dysphoria, this diagnostic shift represents an important step in depathologizing TGNC adolescents and adults, while preserving access to care for those whose gender identity places them on the fringe of society. Elizabeth Weber Ollen, M. K. Oakley, and Christopher Overtree See also Bullying in Adolescence; Emotions in Adolescence and Gender; Gender Norms and Adolescence; Gender Role Conflict; Gender Socialization in Adolescence

Gender Microinequities

Further Readings Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. London, England: Routledge. Capodilupo, C. M., Nadal, K. L., Corman, L., Hamit, S., Lyons, O. B., & Weinberg, A. (2010). The manifestation of gender microaggressions. In D. W. Sue (Ed.), Microaggressions and marginality: Manifestation, dynamics, and impact (pp. 193–216). Hoboken, NJ: Wiley. Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association. Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressions: Psychological impacts on transgender individuals and communities. Journal of LGBT Issues in Counseling, 6, 55–82.

Gender Microinequities Despite laws, regulations, and policies promoting gender equity, and some progress in education and employment settings, gender discrimination continues. Much gender bias is subtle, covert, and u ­ sually not legally actionable, despite being very common. This entry examines seemingly small, unfair, demeaning, and discriminatory behaviors and events—microinequities and microaggressions— and their impact on women and men.

What Are Microinequities? Microinequities, by definition, are unfair to those whom they affect. Mary Rowe has further described these as small events that may be ephemeral and hard to prove; that may be covert, often unintentional, and frequently unrecognized by the perpetrator; that occur wherever people are perceived to be different; and that can cause serious harm, especially in the aggregate. Microaggressions are hostile exchanges that send denigrating messages. Derald Wing Sue has further described these as commonplace, daily, verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial, gender, and sexual orientation and as religious slights and insults to a target person or group. Microinequities and microaggressions are thought to be most damaging in the aggregate and

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commonly refer to behavior relating to gender and gender identification, sexual orientation, race, color, nationality, religion, age, disability, appearance, or other social identity that is not easily changed. These small discriminatory acts are widely studied as manifestations of sexism and racism. The concept of discriminatory micromessages is not new. Ralph Ellison published Invisible Man in 1952, referring to Blacks in the United States. In 1965, Jean-Paul Sartre wrote about microdiscrimination against Jews as a cause of continued ­anti-Semitism. Chester Pierce wrote seminal articles in the 1970s and coined the terms microaggressions, referring to racist acts, and childism, hostile manifestations of adult superiority over children. In the 21st century, Sue and many other authors have greatly extended Pierce’s work on microaggressions. The term microinequities comes from research at the Massachusetts Institute of Technology. In 1973, the president and chancellor of the Massachusetts Institute of Technology recruited Rowe “to help make human beings more visible” at that institution. Rowe had a special charge to help women and began to track concerns about illegal sexism like salary inequities. She dealt with apparently conscious sexism, such as sexual harassment, exploitation, and poor service to women. She also heard hundreds of poignant concerns about the minutiae of sexism and racism—­ including what appeared to be prevalent unconscious bias and unintentional discrimination—and the “invisibility” of female and Black achievement and potential. Rowe then extended the scope of Pierce’s work on aggression and racism. She ­collected reports of seemingly small acts of bias—­ conscious or unconscious—on the basis of gender, sexual orientation, race, religion, color, nationality, rank and class, age, disability, and appearance. She collected examples occurring in health care, in the media, on the street, in schools, at home, in public life, and at work. She called the universe of these “small” events “microinequities.” Scholars have extended research on microinequities in many domains, including analysis of very large data sets, and in different cultures and countries. Common examples of gender microinequities include the following: •• Presuming without discussion that tasks will be assigned based on gender (e.g., females will do

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Gender Microinequities

kitchen, caretaking, and cleaning chores, and males will do maintenance work and fix computers) Overstepping acceptable physical and spatial boundaries in interactions with girls and women, in ways related to gender Making unfounded assumptions about a girl’s math skills or a woman’s competence and commitment to take a top job Making unfounded assumptions about men with respect to child custody or adoption Interrupting women and girls more than men and boys Evaluating the work of females as worth less than that of males, when the work and performance are the same Assigning superior offices, titles, or athletic facilities to men and boys in ways that reinforce male authority and superiority Overlooking women and girls when introductions are made, making remarks about their appearance, and using derogatory nicknames

Where Do Microinequities Come From? One trigger for a microinequity is a perception of difference. Men and women tend to spend their time differently both at home and at work. This has led researchers to ask, does sex segregation cause or contribute to microinequities? Or do microinequities contribute to the persistence of sex segregation? Or both? Current explanations include cultural and societal factors and discussions about unconscious bias. Cultural and Societal Influences

Historically paid and unpaid work were structured differently for men and women—with ­significant sex segregation at work, in schools, in public life, and in the home. The 1879 U.S. Census reported that women constituted only one in six of the paid workforce. The primary roles of women then were caregivers and homemakers, a largely unpaid labor force. The primary roles for men were in paid employment. Thereafter, the proportion of women in paid employment increased, partly due to the World Wars. More women stayed in school, took advanced degrees, and appeared in public life. One hundred and fifty years of feminism influenced

women’s expectations to participate as more equal partners in society. A counterpart “men’s movement” examined gender inequities that affected men. Men, on average, now participate more hours in homemaking and caretaking than in the past, and women contribute more to household income. However, sex segregation is still common in how males and females spend their time—socially and professionally—and by “rank” in each role and occupation. Research shows that women, on average, are compensated less and promoted less often than men doing similar work. Segregation reproduces itself in open and subtle ways. The term oldboys club—the informal networks of Caucasian men—still describes much decision making in organizations and institutions. Unfair assessments of the achievements and potential of females—many of which are unconscious microinequities—perpetuate stereotypical gender roles that, in turn, then perpetuate continued unfair assessment of the achievements of females. The same kind of process may perpetuate unfair, gender specific assessments of males in ­certain roles. Unconscious Bias

Psychology illuminates unconscious biases, the automatic ways in which all individuals use information in the unconscious mind. Unconscious biases influence beliefs and behavior—about objects, people, places, and actions—in everyone. Everyone has unconscious biases. Both women and men exhibit unconscious gender biases that affect both women and men—depending on circumstance. Subtle changes in job descriptions may change the proportions of women and men who apply for a given job. The female head of a department may be mistaken for an administrative assistant; ­tenured professors, senior executives, and distinguished scientists—all females—have been ­mistaken as cleaning or service staff. A physician, searching for the parent of an infant, might look for a female in the waiting room—and not notice a male. Some buildings have too few bathrooms for females and too few infant care facilities for males. Researchers at the nonprofit organization Project Implicit have investigated implicit associations.

Gender Microinequities

Their findings illuminate the complex—sometimes paradoxical—nature of unconscious bias. Although individuals may believe that they are not biased against a certain person or group, associations triggered by their unconscious biases may suggest the opposite.

Effects of Microinequities It is not easy to measure the effects of gender microinequities, because effects of unfair behavior may differ by context. Some inequities are not observed, such as those that occur behind closed doors, and each person may define inequities in a different way. Many people experience other microinequities in addition to gender inequities— for example, microinequities on the basis of race, ethnicity, color, nationality, religion, age, class, ­ appearance, sexual orientation, poverty, and disability. Each country is a composite of cultures with different manifestations of discriminatory behavior. Thus, discrimination cannot be attributed solely to microinequities; macroinequities— such as illegal discrimination—may also provide an explanation. However, some effects of microdiscrimination can be seen. Research on gender microinequities robustly reports undervaluing of both women and men on the basis of gender bias in various roles. For example, due to gender microinequities, the best candidates for various occupations may be overlooked because of their gender (either male or female, depending on the occupation). Responses from qualitative research include the following words when asking about women’s experiences of microinequities at work or in education: excluding, devaluing, ostracizing, undermining, demeaning, negating, exhausting, and invalidating. Men have used similar words when describing their experience in roles traditionally held by women. Microinequities, whether or not conscious or intended, may be experienced as humiliation—and social rejection. Research shows that the same regions of the brain may activate whether an individual feels social rejection or physical pain. For example, when being put down in sexist terms during a meeting, a person may experience a feeling similar to when stubbing a toe or having one’s breath knocked out—momentarily unable even to

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think. The issue is not just the experience of pain but also that the pain happens as a result of ­gender—even though gender is not relevant to the work at hand—and gender at that moment is something the person cannot change. Continuous experiences of invalidation, environmental sexualization, and exclusion may create an environment of high anxiety. In addition, microinequities can lead to depression, related health issues, consequent loss of creativity and engagement, and low productivity. In addition, studies indicate that workplace turnover costs and low morale associated with being treated unfairly on the basis of gender are significant.

What Can Be Done? Microinequities are everywhere. At some point everyone treats others unfairly, although often unintentionally. How can individuals block unconscious bias in themselves? Understanding microinequities and microaggressions is helpful for improving one’s own behavior and also for helping each person prevent harm by others. Initiatives to address the intent and effect of microinequities and microaggressions can raise awareness, help those who are affected, and improve institutional structures to prevent discrimination. Training and reading about unconscious bias and the effects of microinequities can raise awareness. To examine one’s own associations with gender and other social identities, and to challenge one’s own thinking, one can take the Implicit Association test, which, according to the Project Implicit website, “measures attitudes and beliefs that people may be unwilling or unable to report.” Many schools now teach skills—that once were assigned to one gender—to everyone. Males and females learn cooking, gardening, knitting, sewing, carpentry, computer programming, auto mechanics, and public speaking. Counseling and coaching can help validate and understand the feelings and emotions experienced by individuals affected by microinequities and microaggressions. One-on-one sessions provide confidentiality—and a chance to develop options to minimize and remedy damage, and to think about changing institutional structures that ­perpetuate inequities.

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Gender Nonconforming Behaviors

Bystander training can help people notice and react responsibly to microinequities and microaggressions. Bystanders can do many things—­ including involving other bystanders—to prevent, interrupt, and remedy inequities; to assist those affected; to bring attention to recurring harm; and to work for institutional change. Proactive interventions include the concepts of microaffirmations, microadvantages, and behaviors that are widely perceived to be respectful. Microaffirmations are small acts and events that convey respect, recognition, support, validation, and encouragement. Microadvantages, as described by Stephen Young, are micromessages that motivate and inspire. These brief positive acts may be conscious or unconscious and are seen to be most helpful in the aggregate. Microaffirmations, if practiced consistently, may block and even change one’s unconscious bias, may ameliorate or remediate the effects of unconscious bias, and may model behavior that others will follow.

Future Directions Microinequities and microaggressions occur in many different forms, as men and women possess many social identities (self-appointed or perceived by others). Everyone portrays multiple characteristics at work, at school, and in communities and can experience microinequities through any of their identities. More research is needed on specific microinequities and microaggressions triggered by race, ethnicity, sexual orientation, gender and gender identification, economic status, disability, age, and other identities. These in turn provide a basis for yet more research on the effects of multi-­ identity microdiscrimination. More research is also needed regarding the ­effectiveness of microaffirmations to prevent and mitigate unconscious bias, to block or interrupt the impulse toward harm—before discriminatory actions take place—and to provide remedies afterward. Mary P. Rowe and Anna Giraldo-Kerr See also Bystanders; Gender Bias in Education; Gender Bias in Hiring Practices; Gender Segregation; Gender Stereotypes; Hostile Sexism; Institutional Sexism; Male Privilege; Microaggressions; Race and Gender; Sexism; Subtle Sexism; Women’s Issues: Overview; Workplace Sexual Harassment

Further Readings Project Implicit. (n.d.). Education. Retrieved from https:// implicit.harvard.edu/implicit/education.html Rowe, M. P. (2008). Micro-affirmations and microinequities. Journal of the International Ombudsman Association, 1(1), 1–9. Sue, D. W. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. Hoboken, NJ: Wiley. Thrope-Moscon, J., & Pollack, A. (2014). Feeling different: Being the “other” in US workplaces. New York, NY: Catalyst. Young, S. (2007). Micro messaging: Why great leadership is beyond words. New York, NY: McGraw-Hill.

Gender Nonconforming Behaviors Behaviors are gender nonconforming if they are inconsistent with the social and cultural expectations for one’s assigned birth sex. These behaviors include feminine behaviors exhibited by boys and men and masculine behaviors exhibited by girls and women. Examples of behaviors that may be gender nonconforming are aspects of one’s physical appearance (e.g., color or style of clothing, hairstyle, jewelry, presence or absence of makeup), mannerisms and body language (e.g., gestures, posture), speech patterns, social interactions (e.g., friendship preferences and patterns of interaction), behavioral components of gender-typed personality traits (e.g., behaviors that exhibit caring, nurturing, aggression, competitiveness, or other ­gender-typed traits), and choice of gender stereotyped career (e.g., nurse, hairdresser, lawyer, politician), activities (e.g., dance, football), and interests (e.g., sewing, hunting, sports). This review provides a list of related terminology, discusses how gender nonconforming behaviors vary with  time and cross-culturally, and summarizes ­differences in societal acceptance of gender nonconforming behaviors in women and men. Furthermore, this review describes the relationship between expressing gender nonconforming behaviors and identifying as lesbian, gay, bisexual, ­transgender, or queer (LGBTQ), while providing implications of gender nonconforming behaviors

Gender Nonconforming Behaviors

for interpersonal relationships, mental health, and career attainment. Gendered behaviors are behaviors that express the extent to which one is masculine or feminine. A gender nonconforming behavior is any behavior that expresses a gender different from one’s biological sex. For example, biological males who exhibit gender nonconforming behaviors might wear their hair long or wear makeup; might wear female or feminine clothing (e.g., skirts or dresses); might exhibit feminine mannerisms, body language, and speech patterns; might be more caring and nurturing and less assertive; might prefer friendships with biological females; and might prefer activities and interests (e.g., sewing) and pursue occupations (e.g., dance, fashion design, or nursing) that are typically associated with femininity or being female. For biological females, gender nonconforming behaviors might include, but are not limited to, adopting masculine hairstyles; adopting a masculine form of dress or wearing men’s clothing (e.g., ties); exhibiting masculine mannerisms, body language, and speech patterns; being more assertive and aggressive; preferring friendships with biological males; and preferring the activities and interests (e.g., contact sports) and pursuing occupations (e.g., law enforcement) that are typically associated with males or masculinity.

Related Terminology In the early 2000s, multiple terms arose in Western cultural discourse to describe people exhibiting gender nonconforming behaviors, including the following: differently gendered, gender variant, gender fluid, gender creative, gender atypical, gender expansive, and gender diverse. Among children, girls who exhibit gender nonconforming behaviors are often labeled “tomboys,” and boys might be labeled “sissies,” “princess boys,” or “pink boys.” Gender nonconformity is a related, but different, concept from being transgender, and the terms are not interchangeable. By definition, transgender refers to having a gender identity that differs from biological sex. However, someone can exhibit gender nonconforming behaviors regardless of whether their gender identity aligns or differs from their biological sex. Therefore, while people who are transgender may also be considered gender nonconforming, gender nonconforming behaviors are

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broader and are exhibited independent of holding a transgender identity. The link between exhibiting gender nonconforming behaviors and identifying as transgender is discussed in more detail later in this entry.

Gender Nonconforming Behaviors Across Time and Culture Because expectations for the behavior of men and women are socially and culturally constructed, what constitutes gender nonconforming behaviors changes over time and varies across cultures. For instance, the United States has seen significant changes in what constitutes normative gendered behavior for men and women in the past 150 years. Prior to the 1900s, both male and female children wore dresses and had long hair up until the age of 6 or 7 years; doing so did not violate the gendered expectations for behavior of the time. As another example, in the early 1900s, parents of young children were encouraged to dress their boys in pink and their girls in light blue. It was not until the 1940s that it became social convention to dress boys in blue and girls in pink. As yet another example, until the 1960s, women were typically discouraged from or not permitted to wear slacks. It was also rare for women to work outside the home. These are just some of many examples that illustrate that as social norms regarding “appropriate” behavior for men and women have changed over time, so have society’s labels of what behaviors are considered gender nonconforming. Cross-cultural differences in the exhibition and acceptance of gender nonconforming behaviors exist, too. The idea that a person can be gender nonconforming relies on a belief in a binary model of gender, which postulates that there are only two biological sexes (male or female) and two corresponding genders (masculine or feminine). Given this binary assumption, someone is considered to exhibit gender nonconforming behaviors when their gendered behaviors do not align with their biological sex (i.e., a male exhibiting feminine behaviors or a female exhibiting masculine behaviors). While this binary understanding of gender is popular in Western cultures (including in the United States), some cultures allow for either a nonbinary view of gender or a wider range of normative gendered behavior. For instance, Native

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American two-spirited people and Hindu hijras are people who display gender nonconforming behaviors and are highly valued by their respective ­cultures. Furthermore, Myanmar acaults are gender nonconforming males who are respected as shamans and seers. These are just some examples demonstrating that what behaviors are considered gender nonconforming vary from culture to ­culture, with some cultures allowing for multiple interpretations and expressions of gender, including many behaviors that Western culture would classify as gender nonconforming.

Differences in Societal Acceptance of Gender Nonconforming Behaviors in Men and Women There are marked differences in the extent to which Western society encourages and accepts ­gender nonconforming behaviors in men and in women. The permitted gendered behaviors and behavioral expectations of biological males are generally narrower and more constrained than the permitted behaviors and behavioral expectations of biological females. As such, males who exhibit gender nonconforming behaviors are generally less socially accepted than females who exhibit gender nonconforming behaviors. Men who exhibit g­ ender nonconforming behaviors are particularly likely to be stigmatized and experience high rates of microaggressions (subtle forms of bias), overt prejudice, and discrimination. Stigmatization of and prejudice toward males who are gender n ­ onconforming occurs among both heterosexual and gay populations. Research suggests that both heterosexual and gay people who are gender nonconforming in terms of appearance, mannerisms, and/or preferred activities or interests experience particularly high rates of social exclusion and peer rejection in comparison with their gender conforming counterparts. These ­findings imply that engagement in gender nonconforming behaviors explains (at least, in part) the microaggressions, prejudices, and discrimination experienced by gay men. Research on biological boys who engage in ­gender nonconforming behaviors finds that they are more likely to be encouraged to adopt gender conforming mannerisms, and are more likely to be referred for clinical treatment for gender

dysphoria, than are females who engage in gender nonconforming behaviors. In contrast, women and girls are often encouraged and rewarded for displaying gender nonconforming behaviors. For instance, women’s fashion trends have at times throughout modern history incorporated “menswear” styles. No similar movement has occurred in men’s fashion. Women’s adoption of masculine behaviors in workplace ­ settings in an attempt to advance their careers is generally supported and sometimes encouraged. Research with girls who exhibit gender nonconforming behaviors finds that they are perceived as holding numerous positive personality traits (e.g., leadership, cooperative, supportive of others) and are generally considered popular. Women are given greater flexibility in their gender role, and as such, a wider range of gender nonconforming behaviors are socially accepted among women and girls. Differences in societal acceptance of gender nonconforming behaviors exhibited by males and females are believed to be the direct result of living in a patriarchal society that values men and masculinity more than females and femininity. Biological women who exhibit gender noncon­ forming behaviors are generally rewarded for their behavior because they are seen as engaging in behaviors that improve their social status. Parents are typically proud of daughters who exhibit some masculine behaviors, and women’s social status typically increases by the adoption and display of masculine behaviors. Because feminine traits are less valued than masculinity, gender nonconforming males are viewed as engaging in behaviors that reduce their social status; thus, gender nonconforming males are subject to greater prejudice and stigma. It is because of these and other gender differences that some researchers have suggested that different theories on gender nonconformity and sexuality are needed for men and women.

Link Between Gender Nonconforming Behaviors and Being LGBTQ People who exhibit gender nonconforming behaviors are more likely to be stereotyped as gay in comparison with people whose behavior is gender

Gender Nonconforming Behaviors

conforming. Although some contradictory findings exist, there is research to suggest that LGBT people are more likely to exhibit gender nonconforming behaviors, both in adulthood and in childhood. Both LGBTQ and heterosexual, cisgender (nontransgender) people can and do display behaviors that are gender nonconforming. However, research with adult populations finds that LGBTQ people are more likely to express gender nonconforming behaviors than their heterosexual, cisgender counterparts. There is ample research evidence to ­suggest a very strong link between gender nonconforming behaviors in childhood and identifying as LGBTQ in adulthood, particularly among boys. First, research finds that many LGBTQ adults selfreport exhibiting at least some gender nonconformity in childhood. Second, in comparison with mothers of heterosexual, cisgender men, mothers of LGBTQ males were more likely to recall high rates of gender nonconforming behaviors in childhood, including reduced athleticism. This finding was not explained by biases in memory. Furthermore, retrospective content coding of childhood videos of both LGBTQ and heterosexual, cisgender adults has found that LGBTQ adults demonstrated greater gender nonconforming behaviors in childhood. The association between childhood gender nonconforming behaviors and LGBTQ identity in adulthood is stronger for biological boys, with some research indicating that the majority of boys exhibiting gender nonconforming behaviors will later identify as LGBTQ in adulthood, and for those children whose gender nonconforming behaviors are highly persistent and consistent across time. However, the existing literature attempting to link gender nonconforming behaviors in childhood with adult LGBTQ outcomes has been criticized for an overreliance on samples of predominately male children referred to clinics for gender dysphoria, which might not reflect the general population, and conflicting research exists. For instance, a recent public health study found that gender nonconforming behaviors in the general child population were not related to LGBTQ identification on adulthood and that most exhibiting gender nonconforming behaviors grew up to become cisgender, heterosexual adults. More research is needed in this area to determine the relationship between gender nonconformity in childhood and adult outcomes.

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Implications of Gender Nonconformity Engaging in gender nonconforming behaviors has significant social, emotional, and behavioral implications. People who do not conform to gender roles are likely to experience subtle and overt prejudice and discrimination. Again, due to the gendered differences discussed earlier, this is particularly true for boys and men. Interpersonal Relationships

Exhibiting gender nonconforming behaviors puts people, particularly children, at very high risk for victimization, abuse, and harassment from peers, strangers, and family. Boys and men in particular are more likely than girls and women to experience bullying, harassment, and physical and relational abuse for exhibiting gender nonconforming behaviors. As previously mentioned, this is presumed to be due to differences in social norms that give less leeway for deviations from gendered behavioral norms to males. Parents respond differently to gender nonconforming behaviors exhibited by daughters and sons. Many parents are generally encouraging and supportive of gender nonconforming behaviors in their daughters. However, research finds that ­similar gender nonconforming behaviors in boys are typically met with strong, swift, and severe parental pressure to act in line with one’s biological sex. As a result, boys who exhibit more gender nonconforming behaviors are more likely to experience rejection from family members than their gender conforming peers, are more likely to be abused, and experience poorer parental attachment. As these children age, these experiences translate into poorer attachment in adulthood and greater anxiety, particularly for men who were gender nonconforming in childhood. Children heavily “police” their peers’ gender expression, and as a result, children who exhibit gender nonconforming behaviors experience greater rates of marginalization, social exclusion, and harassment, including sexual harassment, by their peers. Research indicates that exposure to harassment and bullying might result in a reduction of gender nonconforming behaviors in children over time. However, other studies have found that social exclusion and isolation of gender nonconforming children by their peers is associated

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with heightened engagement in gender nonconforming behaviors over time. More research is needed to determine how the expression of gender nonconforming behaviors in children changes over time and changes in response to pressure to ­conform by peers and family, how such changes influence or are influenced by children’s developing identity, and the effect of these changes on ­children’s mental health and well-being. Mental Health Outcomes

In part due to the interpersonal difficulties people who exhibit gender nonconforming behaviors face, people who display gender nonconforming behaviors are more likely to experience poorer mental health outcomes. This is particularly true for men and is true for both LGBTQ and heterosexual, cisgender populations. For instance, research finds that both gay and heterosexual men with a childhood history of gender nonconformity have lower levels of adult body satisfaction and greater rates of depression, suicidal ideation, and posttraumatic stress disorder. Gay men who display gender nonconforming behaviors also rate higher in measures of psychological distress. The research on lesbian women who display gender nonconforming behaviors has provided conflicting results, perhaps due to the aforementioned differences in societal acceptance and support for gender nonconforming behaviors in women. More research is needed in this area with heterosexual and lesbian populations. However, at least for males who are gender nonconforming, their poorer mental health outcomes are explained by the increased exposure to homophobia, microaggressions, prejudice, discrimination, and violence or threats of violence that males who exhibit feminine behaviors experience. One study found that it was gender nonconformity per se, not sexual orientation, that accounted for the decreased mental health outcomes among gay and lesbian adolescents. As with adults, there is a clear association between childhood gender nonconforming behaviors and poorer mental health outcomes. However, again, research finds that this relationship is partly to fully explained by the increased rates of alienation, exclusion, familial and peer rejection, and abuse that children whose behavior is gender

nonconforming experience in comparison with their gender conforming counterparts. Recreational and Occupational Outcomes

Research has also suggested that exhibiting gender nonconforming behaviors is associated ­ with an increased likelihood of choosing gender nonconforming recreational and occupational choices. Gender differences exist here, too, with women being more likely than men to pursue gender nonconforming occupations. Choosing gender nonconforming occupations has significant implications. Women in gender nonconforming ­ occupations (e.g., females who pursue careers as politicians, scientists, or engineers) are subject to high rates of workplace-based prejudice, harassment, and discrimination and experience significant gender-biased barriers to career success. Men pursuing gender nonconforming occupations (e.g., male nurses and preschool teachers), however, experience a greater mix of benefits and drawbacks. While men in gender nonconforming ­occupations are typically paid higher salaries in comparison to their female counterparts, they ­ experience increased threats to their manhood and sexuality and are particularly prone to negative stereotyping. Michele M. Schlehofer See also Cross-Cultural Models or Approaches to Gender; Cultural Gender Role Norms; Gender and Society: Overview; Gender Conformity; Gender Nonconforming People; Gendered Behavior; Two-Spirited People

Further Readings Bem, D. (1996). Exotic becomes erotic: A developmental theory of sexual orientation. Psychological Review, 103, 320–335. Gordon, A. R., & Meyer, I. H. (2008). Gender nonconformity as a target of prejudice, discrimination, and violence against LBG individuals. Journal of LGBTQ Health Research, 3, 55–71. doi:10.1080/ 15574090802093562 Kane, E. W. (2006). “No way my boys are going to be like that!” Parents’ responses to children’s gender nonconformity. Gender & Society, 20, 149–176. doi:10.1177/0891243205284276

Gender Nonconforming People Mitchell, K. J., Ybarra, M. L., & Korchmaros, J. D. (2013). Sexual harassment among adolescents of different sexual orientations and gender identities. Child Abuse & Neglect, 38, 280–295. doi:10.1016/ j.chiabu.2013.09.008 Rieger, G., Linsenmeier, J. A., Gygax, L., & Bailey, J. M. (2008). Sexual orientation and childhood gender nonconformity: Evidence from home videos. Developmental Psychology, 44, 46–58. doi:10.1037/ 0012-1649.44.1.46 Rieger, G., & Savin-Williams, R. C. (2010). Gender nonconformity, sexual orientation, and psychological well-being. Archives of Sexual Behavior, 41, 611–621. doi:10.1007/s10508-011-9738-0 Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2010). Gender nonconforming lesbian, gay, bisexual and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46, 1580–1589. doi:10.1037/a0020705

Gender Nonconforming People Gender nonconforming people include individuals whose identities and/or expressions of gender do not consistently correspond to societal expectations of being male or female. In the 2011 National Transgender Discrimination Survey, 32% of respondents selected “gender nonconforming” as one of their gender identities. But some people who are gender nonconforming do not identify as transgender and therefore would be outside the target population for that survey. As of 2016, the prevalence of gender nonconforming people in the general population has yet to be documented. Some gender nonconforming people identify as either male or female, who are termed as binary gender identities. Other gender nonconforming people have nonbinary gender identities, which means that they may identify as both male and female, neither male nor female, or may have another term or concept they use to describe themselves. This overview provides information on gender nonconformity in childhood, adolescence, and adulthood, as well as further ­ information about people with nonbinary gender identities. Recommendations for research and ­ practice are also included.

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Dimensions of Gender Nonconformity Gender relates to several different dimensions of an individual’s psychology, including gender identity, gender presentation, and gender roles. Gender nonconformity can occur along these different dimensions. The ways in which individuals experience gender are also shaped by their contexts, such as through gender assignment. Gender Assignment

When a child is born, it is common practice for parents or doctors to announce “It’s a boy!” or “It’s a girl” based on the infant’s external genitalia. This announcement is referred to as the gender assigned at birth. The gender assigned at birth shapes the gender role expectations children experience from parents, family, friends, and social institutions. In some cases, parents raise their ­children without a gender assignment. This may occur for children born with an intersex condition, in which their genitals do not clearly indicate either male or female assignment. Children who are not assigned a gender at birth are often assigned a gender during the first few years of life, and it may or may not be gender nonconforming after that point. Gender Identity

Gender identity is how individuals experience themselves as male or female, or how they describe or label their experience as being a boy/man or being a girl/woman. People who are gender nonconforming may identify as both a man and a woman, neither, or like a man or woman in some ways and in others not at all. They also may experience their genders separately from the categories of boy/man and girl/woman. The term transgender is sometimes used as an umbrella term to refer to all people whose gender identity is different from the gender assigned at birth, including people who identify as gender nonconforming. However, some people who are gender nonconforming feel that the term transgender is specific to people who identify with binary genders (e.g., trans women and trans men). And some people who are gender nonconforming identify with the same gender they were assigned at birth, and thus are cisgender instead of transgender.

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Gender Nonconforming People

Gender Expression

Gender expression includes visual gender presentation and gender role behavior. Some people who are gender nonconforming have a binary gender identity, as in they are a man or a woman, but they do not conform to the expectations associated with that identity in their presentation and behavior. People’s intended gender presentations may differ from how others perceive them; many people who engage in gender nonconforming presentations (e.g., with their clothing or hairstyles) are erroneously perceived within a binary gender by those around them. Some people with nonbinary gender identities may have times when their gender expressions are binary (e.g., conforming to masculine or feminine styles), which does not mean that their underlying nonbinary gender ­identities have changed. People who engage in cross-dressing behaviors or who, at specific times, present as drag queens or drag kings are engaging in nonconforming gender expression that does necessarily reflect an underlying nonconforming identity. Gender Nonconformity and Sexual Orientation

Considerations of gender nonconformity disrupt the common classifications for sexual orientation. When people do not identify themselves as men or women, it is not intuitive to classify them as homosexual or heterosexual. The same goes for people who are attracted to or partnered with gender nonconforming individuals. On an individual basis, gender nonconforming people and their partners may choose to describe themselves using common terms such as gay, lesbian, or straight, although what the term means to that person may differ from the commonly assumed meanings. Some people use the word bisexual to indicate attraction to people of one’s own genders and other genders, or pansexual to similarly indicate attraction to people across a spectrum of genders. Relatedly, people who are gender nonconforming may or may not consider themselves included in the concept of LGBT, or as members of lesbian, gay, bisexual, and transgender communities. Gender Fluidity

At times, people who are gender nonconforming may change their identity labels and their gender expressions, which does not necessarily mean that

their underlying gender conceptions have changed. Experience of self, meaning making of the categories of male and female, and preferred self-labels develop and change through a person’s experience of race, class, education, and other e­ lements of their sociocultural context. Different words may have different connotations within particular subgroups. Throughout the developmental process, gender conformity and nonconformity can be fluid, as in individuals’ gender ­identities, gender presentations and gender roles may shift in different ways through the dynamic relationships between their developing selves and their developing contexts.

Gender Nonconformity Across the Life Span As of 2016, there is no unifying theory of the development of gender identity and gender nonconformity. However, the existing models coincide in several important ways. The development of gender identity is a multidimensional, dynamic process that involves an individual’s biology, psychology, and culture. Gender development is rapid during the first years of life and then again in adolescence. However, gender development is a ­ culturally specific process. People who are gender nonconforming may struggle to find reflections of themselves within cultural contexts structured through binary conceptions of gender. Therefore, the recognition of an inner self as gender nonconforming, the selection of nonbinary identity labels, and the outward expression of gender nonconformity may take place for different people at ­different times. More research is needed on gender ­fluidity throughout the life span and on how gender nonconforming people make meaning of their own experiences, identities, and expressions. Childhood

At birth, individuals are assigned as either male or female, as discussed earlier. As children grow, they first learn to identify what gender is and then start to categorize objects based on gender. Gender identity develops rapidly in the early years of life, followed by stability and more modest development throughout the life span, influenced by genetics, hormones, the parental environment, other early social interactions, and the cultural context. By ages 2 to 3 years, children may begin to exhibit gender

Gender Nonconforming People

nonconforming self-expressions or presentation preferences. However, parents, teachers, and other authority figures may attempt to suppress gender nonconformity at this time, due to personal beliefs or fear of social repercussions. Gender nonconforming children may thus receive messages of shame or fear regarding their presentation and behavior. Early gender nonconformity does not necessarily indicate persistent gender nonconformity later in life. For example, in early childhood, a person assigned female at birth may exhibit many aspects of boyhood in presentation and behavior but in adolescence begin to identify as a girl and perhaps shift to feminine presentation. Because of social stigma associated with children assigned male at birth who take on female gender roles, these ­children may restrict their feminine behaviors to specific contexts (e.g., the home). Children assigned (and perceived as) female may be able to exhibit masculine behaviors in other settings as well. In middle childhood, children begin to understand individual gender as constant and unchanging. At this point, gender nonconforming children may present with dysphoria (distress and discomfort with aspects of an assigned gender role) and may feel that they already are another gender or may desire to be another gender. Gender dysphoric children themselves may not yet have negative feelings about their bodies, but they may begin to feel pressure to conform. This pressure to conform can then become a source of distress that manifests as depression, anxiety, and other mental health problems. As of 2016, theories of gender development have yet to adequately explain what causes gender nonconformity or gender dysphoria. In addition, such theories have yet to explain why gender ­dysphoria is treatable only by gender transition, when desired by the child, or by validation of and support for gender nonconformity, when a child does not desire to transition. Adolescence

Late childhood and early adolescence, approximately between the ages of 10 and 13, appear to be critical periods for gender nonconforming youth. The adolescent social context is characterized by gender intensification, which involves greater bifurcation of gender roles, increasing pressures toward gender conformity, and stronger social consequences for gender nonconformity.

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These increased social pressures, in combination with puberty and the development of sexuality, can be distressing. At this point, youth experiencing gender dysphoria are at increased risk for depression and self-harm. Medical treatments that delay puberty have been demonstrated to be safe and effective in improving mental health outcomes and are fully reversible to allow an adolescent more time to decide whether to pursue hormonal transition. In addition, youth who did not exhibit gender nonconformity as children may shift toward gender nonconformity as adolescents. At school, many gender nonconforming youth do not feel safe and may be bullied or harassed for their gender expression. LGBT-inclusive practices, such as promoting gay-straight alliances and integrating LGBT material into the curriculum, have been shown to increase perceived safety for gender nonconforming students. Schools can also take steps to reduce gender binary language and practices in official school policies, and in unofficial school culture, in order to create a more welcoming environment for gender nonconforming ­students and, specifically, for students with nonbinary gender identities. Adulthood

At least some gender nonconforming children grow up to become gender conforming adults, while others may initiate a behavioral or biomedical gender transition, and still others may continue their nonconformity into adulthood. In addition, individual and contextual changes during adulthood mean that some individuals may initiate gender nonconformity at this time. Some of these adults do not ever experience gender-related dysphoria; rather, they express themselves through gender nonconformity or nonbinary gender identities because it feels good and makes them happy. Terms such as gender euphoria have been used to describe these positive feelings related to gender nonconformity.

Nonbinary Identities It is best practice to avoid using a term to label an individual unless that individual has specifically selected that label. As of 2016, nonbinary gender identity labels include, but are not limited to, agender, androgynous, ambigender, bi-gender,

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gender fluid, genderless, genderqueer, intergender, neutral, mixed gender, multigender, and pangender. More research is needed to understand how the use of these terms is shaped by cultural and social context and specifically by race, class, and education. Individuals may have several words that they use to describe their identity and may identify themselves differently in different situations. More detailed and precise labels may be preferred when around other people with nonbinary identities or within spaces that have many gender nonconforming or transgender people. A more commonly understood identity label might be used around people who are cisgender, in professional settings, or in family contexts, as needed. Many nonbinary people take an inexact and fluid approach to labels in this way. Nonbinary Genders

Nonbinary genders are gender alternatives to male or female. People who are nonbinary may identify as some mix of male or female, both at the same time, neither, or something else entirely. They may present in ways that conform to binary expressions (masculine or feminine) in certain ways at certain times or as their primary or preferred gender presentation. Therefore, many p ­ eople who appear to be a man or a woman may not identify with that gender; they may be neither a man nor a woman. It cannot be assumed that people with nonbinary gender identities will also be gender nonconforming in their gender expression. Different conceptions of nonbinary genders can be found across cultures, such as hijra in South Asia, kathoey in Thailand, and fa’afafine in Samoa. North American indigenous groups also have a variety of ways of recognizing and naming nonbinary gender identities, generally referred to with the term two spirit. In addition, as of 2016, several governments outside the United States legally ­ recognize third genders within documents such as birth certificates and identification cards. Nonbinary Pronouns

Nonbinary individuals may find the current set of English pronouns to be inadequate to

express their identities and may be distressed if referred to as either he or she. Distress or discomfort with binary pronouns varies, and which pronouns a person uses and requests from other people may be based on a number of factors, such as securing physical safety, avoiding emotional distress, and affirming a nonbinary identity. The singular they is an increasingly common alternative to he or she, as are coined pronoun sets such as zie/hir/hirs or using a gender neutral noun like bun as a pronoun (e.g., bun/buns/­ bunself). For example, “Zie had lunch with hir friend today and ate a meal zie cooked hirself,” “They had lunch with their friend today and ate a meal they cooked themself,” or “Bun had lunch with buns friends today and ate a meal bun cooked bunself.” The coining of new pronouns is not exclusive to English; the gender neutral pronoun hen has become an official part of the Swedish language. Many nonbinary people will have different preferred pronoun sets for different situations, such as opting to use singular they or he or she in professional settings but preferring a coined set with friends.

Recommendations for Practice Psychologists and other practitioners working with gender nonconforming people can benefit from following three basic guidelines: (1) affirm individual experiences, (2) avoid assumptions, and (3) recognize the challenges and complexity of gender nonconformity given the pervasiveness of the gender binary. Affirming individual experiences involves supporting all the complex ways in which a person’s assigned gender, gender identity, gender presentation, and gender role may or may not align. It also includes affirming the existence and validity of nonbinary gender identities and nonconforming gender expressions. Avoiding assumptions means recognizing that being gender nonconforming does not necessarily mean that a person is transgender or is not heterosexual. It also means avoiding assumptions about what a person’s pronoun choices signify and recognizing that people may use different pronouns in different contexts. In addition, avoiding assumptions allows for fluidity in individuals’ processes of understanding, exploring, and expressing their genders.

Gender Nonconforming People

Addressing Social Stigma and Enhancing Mental Health As a result of cultural assumptions and biases regarding gender, people who are gender nonconforming are at increased risk for harassment and violence. In the 2011 National Transgender Discrimination Survey, more than 80% of gender nonconforming people reported discrimination at school, and more than 90% reported bias at work. Thirty-two percent of gender nonconforming ­people had been physically assaulted because of their gender, and 15% of gender nonconforming people had been sexually assaulted because of their gender. Health care providers can directly address the challenges and complexity of gender nonconformity given the context of a societally pervasive gender binary. When a person with a nonbinary gender seeks support in coping with gender-related challenges, it is important to contextualize in what ways the challenges may be a function of internalized or interpersonal prejudice and actual or feared discrimination. In addition, one function of ­systemic discrimination can be to treat people who are marginalized as if that specific experience of marginalization defines who they are. People who are gender nonconforming and people who have nonbinary gender identities also have many other identities, experiences, interests, concerns, and challenges to understand and address.

Recommendations for Research Most research on gender nonconforming people or on transgender people may mention people with nonbinary genders, but attempts to directly study them have been rare. Therefore, a research agenda to describe, explain, and optimize the psychological experiences of people with nonbinary genders is called for. Research that accurately describes the lived experience of people with nonbinary genders includes understanding phenomenological experiences and meaning making around gender—for example, in relation to the creation and application of nonbinary identity labels and pronouns. Such investigations must also account for the ways in which gendered meanings develop within ­particular historical and cultural contexts, in relation to both mainstream culture and specific

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subcultures. Explaining the psychological development of people with nonbinary genders therefore needs to be approached through understanding the ways in which gender development is influenced by history and culture, without distracting from or invalidating the very real experiences of a gendered self that are expressed by diverse individuals in disparate contexts. How individuals navigate and negotiate the gendered meanings they have access to and the gendered feelings they have within themselves are therefore also important research questions. Pursuing a research agenda that can inform policy and practice would include direct investigation of the marginalization of nonbinary individuals within the dominant gender binary social and cultural contexts (e.g., professional spaces, team sports, the media, religious institutions). Research is needed to illuminate the characteristics and consequences of overt discrimination, covert ­ microaggressions, and other negative life events experienced by people with nonbinary genders and the different ways in which these issues may manifest in individual lives. By addressing these research questions, strategies can be identified for supporting individuals in coping with discrimination and for optimizing the ways in which people with nonbinary genders can flourish throughout their lives. Miriam R. Arbeit and Melissa S. Dumont See also Androgyny; Bi-Gender; Gender Nonconforming Behaviors; Gender Pronouns; Genderqueer; Third Gender; Two-Spirited People

Further Readings American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. Retrieved from http://www.apa.org/practice/ guidelines/transgender.pdf De Vries, A. L. C., Kreukels, B. P. C., Steensma, T. D., & McGuire, J. K. (2014). Gender identity development: A biopsychosocial perspective. In B. P. C. Kreukels, T. D. Steensma, & A. L. C. De Vries (Eds.), Gender dysphoria and disorders of sex development (pp. 53–80). New York, NY: Springer. Ehrensaft, D. (2012). From gender identity disorder to gender identity creativity: True gender self child

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therapy. Journal of Homosexuality, 59(3), 337–356. doi:10.1080/00918369.2012.653303 Fausto-Sterling, A. (2012). The dynamic development of gender variability. Journal of Homosexuality, 59(3), 398–421. Grant, J. M., Mottet, L. A, Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Retrieved from http://transequality.org/ PDFs/NTDS_Report.pdf Harrison, J., Grant, J., & Herman, J. (2012). A gender not listed here: Genderqueers, gender rebels, and otherwise in the National Transgender Discrimination Survey. LGBTQ Public Policy Journal at the Harvard Kennedy School, 2, 11–24. Retrieved from http:// escholarship.org/uc/item/2zj46213.pdf Kuper, L. E., Nussbaum, R., & Mustanski, B. (2012). Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. Journal of Sex Research, 49(2–3), 244–254. Sherer, I., Maum, J., Ehrensaft, D., & Rosenthal, S. M. (2015). Affirming gender: Caring for gender-atypical children and adolescents. Contemporary Pediatrics. Retrieved from http://contemporarypediatrics. modernmedicine.com/contemporary-pediatrics/news/ affirming-gender-caring-gender-atypical-children-andadolescents

Gender Nonconformity and Transgender Issues: Overview Transgender and gender nonconforming people (TGNC; also known as gender diverse people) have existed throughout history and across cultures. This entry introduces basic concepts related to people with TGNC identities and describes current conceptualizations of TGNC identities, barriers that exist for TGNC people, and the ways in which resilience serves as a buffer to these barriers.

Basic Concepts Regarding Gender Identity Gender is a concept that is easily confused with sex. Gender is a socially constructed concept, and there are many expectations for a person and how

they perform their gender based on the sex they were assigned at birth. Women are expected to be well mannered, while men are expected to hold their feelings in. These gendered expectations can become quite challenging for people if they do not firmly adhere to the gender binary. The gender binary assumes that there are two choices for gender: male and female. This proscriptive concept of gender may work for most people. It does not, however, work for people whose identity is not consistent with the binary. Terminology

There are a variety of terms that have been used to describe people who do not, in some fashion, subscribe to the gender binary. An early term was transsexual. Today, this term is primarily used by people who make a medical transition (also known as physical transition). This may include accessing hormones and gender affirmation surgeries. TGNC people may or may not make a medical transition but are likely to have made a social transition. A social transition may include a name change, a change in the use of pronouns, and a change in how a person expresses their gender (e.g., manner of dress). This is not meant to be inclusive of the ways in which a person might express their gender. Transgender is a term that has been used in a collective and individual manner. Collectively, it refers to anyone whose gender identity is not consistent with the sex they were assigned at birth. The term sex assigned at birth is the preferred manner when referencing a person’s initial sex (as opposed to natal sex or biological sex). Included in this broad conceptualization of transgender are cross-dressers, transsexuals, genderqueer, and transgender people. As an individual term, transgender might refer to people who make only a social transition. It is important to keep in mind that use of terms such as transgender and genderqueer are self-determined by the TGNC person. This entry uses the term TGNC to be as broadly inclusive as possible, recognizing that there are many ways in which TGNC people identify themselves and thus that these terms may be offensive to some people. Cross-dressers are people who dress in clothing and accessories that are traditionally associated

Gender Nonconformity and Transgender Issues: Overview

with the “opposite” sex. Cross-dressers have a long history of being pathologized, in part because this is a diagnosable mental health condition (e.g., transvestic disorder). Most cross-dressers are heterosexual men. The reasons why cross dressing is often considered to be problematic relates to the strict gender norms and rules that make it unacceptable for men to wear clothing that is typically associated with women. These gender norms are harshly enforced with people who are assigned male at birth and not as harshly for those assigned female at birth. Genderqueer people are those people who do not subscribe to the gender binary and may be seen by others as being androgynous. It is important to keep in mind that, for genderqueer people, the use of pronouns that conform to the gender binary are considered to be offensive. A genderqueer person may use pronouns such as per, hir, ze, yo, they, them, their, ey, em, and eir. Although these terms are not commonly used by cisgender people, it is critical to use affirming language with genderqueer people. This may mean that a person will need to ask about the pronouns a genderqueer person uses. Cisgender is a relatively new term that refers to people who are not transgender. This term has been in use for less than 10 years and has become popular in the TGNC community as a way of referring to people whose sex assigned at birth and gender identity are congruent. Language is important in our society. It informs the ways in which people relate to one another and the meaning they make of their experiences. As such, it is important to remember that the terms transgender and transsexual are adjectives and not nouns, verbs, or adverbs. This means that a person is neither transgendered nor transgendering. Just as a person wants to be called by their name as a means of respect, it is important to use the terms transsexual and transgender in a grammatically correct manner: The author of this entry is a transgender person. Cultural Variations of TGNC People

Transgender and transsexual people have existed throughout history and across cultures. Table 1 lists some of the terms used to describe TGNC people from these cultures as well as the country or

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Table 1 Listing of Transgender and Gender Nonconforming Cultural Identities Region or Culture

Term

India, Pakistan

Hijra

Albania

Burneesha

Thailand

Katohey

Native American

Two spirit

Polynesia

Mahu

Samoa

Fa’afafine

region of the world. In some of these areas, colonization has significantly affected TGNC people’s lives. The erasure of TGNC people in these areas of the world has largely gone unnoticed. TGNC people of color experience challenges that TGNC White people are often not faced with. When people have intersecting marginalized identities, it is not uncommon for them to experience additional challenges as they navigate their day-today life. It is common for TGNC people of color to refer to themselves with self-determined identity labels that are not typically used by White people (e.g., masculine of center).

Current Conceptualization of Gender Identity As previously stated, TGNC people have existed throughout history. The TGNC movement can be thought of as having existed in four waves. These include (1) the indigenous wave, (2) the transsexual wave, (3) the transgender wave, and (4) the gender nonbinary wave. Indigenous Wave

The indigenous wave relates to gender diverse people who have existed throughout history. As shown in Table 1, TGNC people have lived in countries across the world. In most cases, their gender diversity was revered within their communities. It is especially easy for people in Western countries to ignore this part of the TGNC movement in the same ways that colonization has affected the existence of indigenous TGNC people. Across the world, TGNC people are fighting for

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safety as they are at risk due to unfavorable laws and regulations, proscriptive expectations that all people subscribe to the gender binary, and intolerance that can lead to violence against TGNC people. Transsexual Wave

The transsexual wave began in the late 1960s with the medicalization and pathologization of TGNC people. TGNC people were expected to conform with a very specific narrative if they wanted access to hormones and surgery. They were also expected to want all of the available medical treatment and to move forward in life as if they did not have a previous gender history. This last point often led to TGNC people leaving their marriages and jobs. As such, TGNC people often struggled to find a place in society since they may not have been able to access job references and needed to create a new social identity, often in a new geographical area. Many of the TGNC people who transitioned during this second wave lived in stealth mode. This means that they transitioned and did not share with people their gender history. Providers during this era were often surprised by the consistency of the stories they heard from TGNC people who were seeking a medical transition. These stories included expression of a desire to move from male to female identity or from female to male identity, the desire to identify as heterosexual posttransition, and the feeling that one was “born in the wrong body.” During this time (the 1960s through the early 1990s), TGNC people were diagnosed with a mental health disorder. The nomenclature for these mental health disorders included transsexualism and gender identity disorder. In the latter diagnosis, what was considered to be a clinical concern was the TGNC person’s identity. Transgender Wave

Over time, and as some TGNC people were denied access to a medical transition, a surge of people who strongly held a TGNC identity but for a variety of reasons had no interest in a full ­medical transition was seen. This began to take hold in the 1990s and sparked the beginning of the

transgender wave. Virginia Prince has been credited with coining the term transgender. She selfidentified as transgender, in part because she ­identified as female but had no desire to complete a medical transition. Reasons for not wanting to complete a medical transition can be complex and are often different for each person. These reasons include cost (financial and social), lack of access to affirmative providers, having dysphoria about gender that does not include dysphoria about primary sex characteristics, and medical contraindications for hormones and surgery. Some TGNC people during this era of transgender identity made a medical transition that might have included a low dose of hormones or surgery without hormones. What characterized this wave, apart from the use of the term transgender, is that TGNC people were no longer going stealth. They were living their lives in a manner that celebrated their gender diversity rather than hiding it from their loved ones, friends, and coworkers. Still, the enforcement of the gender binary was seen during this wave. Gender Nonbinary Wave

Similar to the shift from the transsexual to the transgender wave, there was also a shift in those people who were moving away from the gender binary. The gender nonconforming, or genderqueer, movement began in the mid-2000s. TGNC people began to move away from self-determined labels that reified the gender binary. Instead of referring to themselves as female-to-male or maleto-female and using masculine and feminine pronouns (e.g., he, she, him, or her), gender nonbinary people embraced identities and used pronouns that suggest that gender is on a spectrum. Instead of having two choices for a person’s gender (e.g., female or male), genderqueer people believe that there are infinite number of choices since gender is on a spectrum rather than being two fixed choices. This fourth wave is continuing to unfold. However, this idea is hard for some people, cisgender or TGNC, to understand and embrace. The gender binary is reinforced constantly in everyday life. From the departments in a clothing store to the ways in which children are asked to line up in school, to the choices of restrooms available in public settings, we are often forced to choose from

Gender Nonconformity and Transgender Issues: Overview

two options. For people who do not identify with the binary, or whose gender expression is not consistent with the gender binary, having to make these choices can lead to personal safety concerns. These personal safety concerns include addressing basic biological needs (e.g., using the toilet) and the potential to be at risk for violence because they are perceived to be in the “wrong” restroom. This latter concern can lead to life-threatening situations.

Barriers Faced by TGNC People There are a number of challenges that TGNC people face. These include violence, bullying, discrimination, health disparities, and mental health concerns. Because health disparities are addressed in the Transgender People and Health Disparities entry, this entry covers the other concerns. Violence

TGNC people, and especially TGNC women of color, are at much higher risk for violence than are cisgender people. In 2014, approximately 11 TGNC women of color were murdered in the United States. In 2015, 22 TGNC women of color were murdered in the United States. TGNC people are not just murdered; they are often murdered in a very brutal fashion. In most states, these murders are not considered to be hate crimes because there is no law that defines hate crimes to include cases in which TGNC people are the target of the crime. There is protection against hate crimes at the federal level; this is known as the Shepard-Byrd Act, and it was enacted in 2009. Although this protection exists at the federal level, TGNC people are still often the victims of violent crime. Violence includes domestic, or intimate partner, violence (IPV). IPV includes physical, sexual, and emotional violence. TGNC survivors of IPV are often discriminated against when they attempt to access shelters. This is due to a lack of training and outdated policies that require TGNC people to be housed according to the sex they were assigned at birth. Bullying

Bullying begins for many people during elementary or middle school. TGNC students are at elevated

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risk for bullying. This includes verbal and physical harassment. Recent reports have indicated that 37.8% of lesbian, gay, bisexual, and transgender students felt unsafe in the school environment because of their gender expression. One third of students avoided spaces that were gender segregated, and three quarters of students experienced verbal harassment. In recent years, there has been an increase in cyberbullying. TGNC students are also victims of this type of bullying. However, more than half of students never report this to school officials. Reasons for not reporting include the belief that reporting will just make the situation worse or that no action will be taken to stop the harassment. Children and adolescents are experiencing this mistreatment at an important developmental stage of their lives. These traumatic experiences can lead to further violence and can significantly affect a person’s self-esteem and personality development. Community Response to Violence Beginning in 1999, the TGNC community and its allies have held annual vigils to memorialize the TGNC people who have been murdered in the previous year. This vigil is known as the International Transgender Day of Remembrance. The event is held on November 20. Vigils are held in many cities across the world. Fatal violence against TGNC people happens throughout the world. This is one way in which TGNC people are claiming their space and fighting back. Discrimination

Discrimination experienced by TGNC people comes in many forms. This can happen in the workplace, in public accommodations (e.g., restrooms), and in access to health care. This section focuses on workplace discrimination. Several states have enacted legislation that outlaws workplace discrimination on the basis of a person’s gender identity or gender expression. This protection is far from universal. There have been a number of important changes with regard to workplace discrimination since 2011. In December 2011, the Eleventh Circuit Court of Appeals ruled that Vandy Beth Glenn had been discriminated against in the workplace. The court ruled that this discrimination was a form of sex discrimination that is

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Gender Nonconformity and Transgender Issues: Overview

covered under Title IX of the Education Amendments of 1972. This landmark decision changed the landscape for employment law. Similar decisions have been reached in subsequent court cases. Even though there have been such victories for TGNC people, there are still many ways in which they experience discrimination. In short, the work of allies is far from over as it relates to ensuring that all people are protected equally under the law. Mental Health Concerns

TGNC people, like their cisgender counterparts, are likely to experience mental health concerns. The same types of mental health concerns that cisgender people experience are common in TGNC people. However, there are some mental health concerns that are exacerbated by the discrimination and violence TGNC people face. This section addresses suicide and nonsuicidal self-injury (NSI) as these are important clinical concerns that may require a higher level of care. Nonsuicidal Self-Injury TGNC people have been shown to be at higher risk for NSI. By its very nature, NSI is nonlethal injurious behavior. Cisgender people have been shown to engage in self-injury at rates between 4% and 18%, depending on the population. More than 40% of TGNC people who responded to an Internet survey indicated a history of NSI. This type of behavior can be considered as a contraindication to a medical or social transition. However, in the same study, 50% of participants who reported having been prevented from transitioning reported a history of NSI, whereas 30% of those who were not prevented from transitioning had a history of NSI. In addition, most people who had a history of NSI stopped this behavior within 5  years of having begun their transition. The differences in what led some people to stop and some to continue to engage in NSI are not known. NSI is a serious mental health concern that needs to be addressed in an affirming manner. ­Clients need to learn emotion regulation skills that will allow them to work through the distress they are experiencing. This distress can be very personal (e.g., the presence of primary sex characteristics),

or it can be related to the violence and bullying TGNC people face. Suicide Similar to NSI, TGNC people have much higher rates of suicide than the general population. It is estimated that less than 2% of cisgender people attempt suicide in their lifetime. A study conducted in 2008 indicated that more than 40% of TGNC people reported having made at least one suicide attempt in their lifetime. It is possible that these attempts are related to challenges a person faces in accessing treatment for their gender dysphoria; however, it is also likely that these attempts are related to the onslaught of violence and discrimination. Violence and discrimination are experiences over which TGNC people have no control. More than one dozen TGNC adolescents completed suicide in 2015. These young people often reported that the challenges they faced within their families were but one reason for ending their lives.

Resilience Although there are many challenges faced by TGNC people, there are also ample indications of the ways in which TGNC people experience resilience. Resilience can be seen at the community and individual levels for TGNC people. Community resilience is exhibited in a number of ways. For example, in many cities, TGNC people lead support groups. These peer-led groups provide a great deal of support for people at all stages of their gender identity development process (e.g., contemplation to transition). One example of these groups is the ongoing group offered in Seattle, Washington, by the Ingersoll Gender Center. The general meeting offered by Ingersoll has met continuously for more than 30 years. In addition to face-to-face meetings, TGNC people can also access support through online resources. These resources include blogs, chat rooms, online groups (e.g., Yahoo! Groups), and provider websites. There are many such resources for a person to learn about TGNC people, the types of services that might be available, and providers who are known to be TGNC affirmative. These online resources are available to any TGNC person, provided they have access to the Internet.

Gender Norms and Adolescence

Individual resilience varies within a person and between people. It is also dependent on the types of discrimination and violence a person faces or the ways in which they receive social support from friends and family. There is strong evidence that TGNC people who have social support are better adjusted than those who do not. Fostering resilience in TGNC people can come from a variety of levels and is not solely the responsibility of the TGNC person. lore m. dickey See also Gender Identity; Gender Nonconforming People; Gender Pronouns; Transgender and Gender Nonconforming Identity Development; Transgender People; Transsexual; Transvestic Fetishism

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Retrieved from http://www .apa.org/practice/guidelines/transgender.pdf Benjamin, H. (1966). The transsexual phenomenon. New York, NY: Warner. Burnes, T. R., & Chen, M. M. (2012). The multiple identities of transgender individuals: Incorporating a framework of intersectionality to gender crossing. In R. Josselson & M. Harway (Eds.), Navigating multiple identities: Race, gender, culture, nationality, and roles (pp. 113–127). New York, NY: Oxford University Press. Centers for Disease Control and Prevention. (2015). National suicide statistics. Retrieved from http:// www.glaad.org/reference/transgender dickey, l. m., Reisner, S. L., & Juntunen, C. L. (2015). Non-suicidal self-injury in a large online sample of transgender adults. Professional Psychology: Research and Practice, 46(1), 3–11. doi:10.1037/a0038803 Ekins, R., & King, D. (2005). Virginia Prince: Pioneer of transgendering. International Journal of Transgenderism, 8(4), 5–15. doi:10.1300/J485v08n04_02 FORGE. (2015). Transgender sexual violence survivors: A self-help guide to healing and understanding. Retrieved from http://forge-forward.org/2015/06/ trans-sa-survivors-self-help-guide/ GLAAD. (2015). GLAAD media reference guide: Transgender issues. Retrieved from http://www.glaad .org/reference/transgender

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Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Kiesling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality & National Gay and Lesbian Task Force. Retrieved from http://endtransdiscrimination.org/PDFs/ NTDS_Report.pdf International Transgender Day of Remembrance. (2015). About TDOR. Retrieved from http://tdor.info/about-2/ Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian & Straight Education Network. Retrieved from http://www.glsen.org/sites/default/ files/2013%20National%20School%20Climate%20 Survey%20Full%20Report_0.pdf Lambda Legal. (2011). Eleventh Circuit upholds victory for transgender employee fired by the Georgia State Legislature. Retrieved from http://www.lambdalegal. org/news/ga_20111206_eleventh-circuit-upholds Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York, NY: Haworth Clinical Practice. Namaste, V. K. (2000). Invisible lives: The erasure of transsexual and transgendered people. Chicago, IL: University of Chicago. Nanda, S. (1999). Neither man nor woman, the Hijras of India (2nd ed.). Belmont, CA: Wadsworth Cengage Learning. Singh, A. A. (2012). Transgender youth of color and resilience: Negotiating oppression, finding support. Sex Roles: A Journal of Research, 68, 690–702. doi:10.1007/s11199-012-0149-z Singh, A. A., Hays, D. G., & Watson, L. (2011). Strategies in the face of adversity: Resilience strategies of transgender individuals. Journal of Counseling & Development, 89, 20–27. doi:10.1002/j.1556-6678. 2011.tb00057.x Singh, A. A., & McKleroy, V. S. (2011). “Just getting out of bed is a revolutionary act”: The resilience of transgender people of color who have survived traumatic life events. Traumatology, 20(10), 1–11. doi:10.1177/1534765610369261

Gender Norms

and

Adolescence

Gender norms refer to the collective set of social attitudes and beliefs that determine the appropriate

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values, motives, and behaviors for males and females within a given culture. Gender norms are influenced by biological, cognitive, and contextual factors. Because adolescence is an important period of personal identity formation, gender norms play an integral role in shaping adolescent gender identity. This entry examines contemporary gender norms in adolescence using a developmental and cross-cultural lens and discusses current research trends in gender nonconformity as well as the psychosocial consequences facing adolescents who break traditional gender norms.

The Intersection of Gender and Sex Gender and sex are distinct but related aspects of the human experience. Although these terms are often used interchangeably, sex typically refers to the classification of people as male or female based on assigned biological characteristics, such as chromosomes, hormones, internal reproductive organs, and genitalia. Gender and gender identity refer to individuals’ experience and self-presentation as male or female and may or may not be congruent with their sex. Although children develop gendertyped patterns of behavior and preferences as early as 15 to 36 months, some research has suggested that gender intensification occurs during adolescence, as boys and girls face more pressure to conform to culturally sanctioned gender roles. ­ However, the current empirical focus on gender identity development among adolescents has been expanded to include the role of context and the influence of gender norms. In fact, the literature indicates that changing patterns of socialization, individual factors, family context, and the amount of time an adolescent spends in a gendered environment may be better predictors of gender identity development than biological factors.

Influences on Gender Norms in Adolescence Gender identity development is a critical feature of adolescent development. The gender intensification hypothesis suggests that as adolescents reach puberty, social pressures to conform to gender roles increases, which causes greater gender differentiation between males and females. Yet there appear to be few differences in how adolescents

acquire their gender identity, and in addition to biology, gender norms are largely shaped by cognitive and contextual factors. Some research has suggested that gender differences are the product of differences in brain organization. For example, males may display greater lateralization of brain functioning, which is believed to account for a greater capacity for spatial manipulation among males. Female brains in contrast are thought to withstand injury to the brain more effectively, which may help explain greater cognitive f­ lexibility among females. In addition, according to L ­ awrence Kohlberg’s cognitive developmental theory of gender, children progress through increasingly ­ complicated stages of processing information. By adolescence, youth are believed to have achieved gender constancy and behave in gender consistent ways. An alternative view of gender schema theory suggests that adolescents play a more active role in their gender identity development by seeking out information consistent with their understanding of maleness and femaleness. This internalization of gender norms results in behaviors consistent with their schemas of gender. A major criticism of the cognitive theories of gender development is that they ignore external and contextual influences. Familial influence is thought to play a key role in gender socialization for children because of the ways in which parents model gender roles, organize the child’s environment, communicate gendered expectations, and interact with children. For example, from a young age, boys and girls are often dressed differently, provided different toys to play with, and enrolled in gender specific activities, which inevitably affect how children view and experience their gender. During adolescence, boys are typically granted more autonomy than girls. Interestingly, in families headed by heterosexual parents, the development of children’s gender roles is more strongly influenced by the father’s masculinity and reinforcement of traditionally feminine activities, particularly for male children. The absence of a dependable father figure has been associated with difficulties in gender typing for preadolescent boys and problems in relationships with opposite-sex peers among adolescent daughters. Although less is known about gender development in children raised with same-sex parents, some subtle differences have been noted. Namely,

Gender Norms and Adolescence

children with same-sex parents may feel less pressure to adhere to gender stereotypes, may express fewer gender stereotyped behaviors and attitudes, and may be less likely to believe that their own sex is superior compared with their counterparts with opposite sex parents. Research has also shown that adolescent psychosocial outcomes, romantic relationships, behaviors, and school adjustment do not differ as a function of family type (e.g., parent sexual orientation) or adolescent gender. In addition to familial influences, peer relationships are an important source of gender norms. During adolescence, the influence of peers becomes stronger than that of families of origin. Research suggests that there are gender differences in friendship patterns and attitudes toward sexuality d ­ uring adolescence. For example, boys tend to socialize in larger groups and are more likely to be involved in organized sports and extracurricular activities where competition and aggression are highly valued. In addition, interaction patterns among adolescent males tend to discourage self-disclosure; conversational themes are more likely to emphasize power and control. Conversely, adolescent females are more likely to engage in collaborative discourse with peers. Generally speaking, girls are more affiliative and report greater intimacy in their close friendships than boys. Additionally, whereas conflict between male adolescent peers is more likely to result in physical aggression, adolescent girls tend to use covert, relational aggression to damage peer reputations through social exclusion, gossip, and rumor spreading. Gender role standards also differ for adolescents with respect to heterosexual dating and sexual behavior. Whereas boys are more likely to cite female physical attractiveness as a core motive for dating, girls tend to emphasize more personal characteristics. Although dating customs today are less rigid than those of previous generations, social expectations for males to initiate dating and sexual touching continue to permeate the heterosexual ­dating scene. In general, adolescent girls receive conflicting messages about the morality and ­ appropriateness of sexual experiences, while male ­sexuality receives greater social approval and less stigmatization. Consequently, adolescent boys tend to engage in sexual behaviors earlier than their female counterparts and are more likely to describe

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their initial experience as exciting and satisfying. Same-sex behavior among adolescents is not as well studied, likely because of the stigmatization with which it is still viewed in certain segments of society. However, a 2013 national sample of nearly 8,000 adolescents reported that more than half of them identified as gay or lesbian and 10% identified as transgender, highlighting the need to better understand how traditional gender norms influence these adolescents. Establishing a positive gender identity is believed to be a core developmental task for all adolescents; yet the ways in which gender norms are created and perpetuated by the broader social context must also be considered. For example, mainstream media continues to portray male and female roles in gender stereotypic ways on television and in children’s books: Men tend to play characters that are powerful and competent in the workforce, whereas women are more likely to play supporting roles as caregivers and homemakers. The propagation of these segregated gender norms can lead adolescents to engage in gender conforming behaviors that have a long-lasting impact on their future academic and professional pursuits. Schools represent another context in which adolescents experience gender norms. It has been shown that teachers treat male and female students differently. Likely because the traditional school setting privileges traits considered to be stereotypically feminine—passivity, obedience, and ­reticence—females are reported to perform better than males in elementary school. In addition, research suggests that teachers hold gender stereotyped attributions of success and failure. They tend to pay more attention to boys, call on them more, and give them more cognitively stimulating problems, particularly in math. Thus, what has been identified as a gender gap in math achievement that emerges during early adolescence is likely also the product of gender bias and stereotypes. In fact, one study found that the gender gap in math scores for adolescents disappeared in countries with a more gender equal culture. Yet in the United States, perceived gender norms of achievement and abilities in math- and science-related fields continue to deter young girls from pursuing these careers, which can set the stage for the emergence of a gender wage gap later on.

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Culture and Gender Norms in Adolescence Although cultures differ in the nature and intensity of gender norms, there is a great deal of consistency in gender stereotypes around the world: Men are typically viewed as active, strong, and conscientious, whereas women tend to be viewed as passive, nurturing, and agreeable. In developing societies, where cultures prescribe different social and economic roles for men and women, adolescence represents a unique period in which the onset of puberty triggers divergent trajectories for boys and girls. In some societies, when girls reach childbearing age, they are married young with the expectation that they will fulfill traditional gender roles. Their adolescence is cut short, and they spend more time on domestic chores and engage in fewer leisure activities than male adolescents. In addition, although global rates of school attendance and workforce participation for adolescent girls have increased more rapidly than those for adolescent boys since the early 2000s, research has also shown that marriage and childbearing often signal the end of formal schooling for adolescent girls. Thus, contradictory expectations for adolescent girls to adhere to gendered expectations while also seeking to join the labor force result in a more difficult transition from student roles to adult work roles for these adolescent girls than for adolescent boys. In most regions of the developing world, the extent of this difficult transition is reflected by the high rates of school attendance for both adolescent boys and girls but much lower levels of workforce participation for girls than for boys. Thus, gender norms, in many ways, shape the adolescent experience and lay the groundwork for adulthood for youth in developing cultures.

Transgender and Gender Nonconformity Given the rapidly increasing diversity around gender in contemporary society, it is important to address the psychosocial outcomes for adolescents who do not abide the traditional gender binary. Transgender is an umbrella term used to describe individuals whose gender identity (internal sense of being male or female) differs from the sex they were assigned at birth. Gender nonconforming is

the term used to describe individuals whose expression of gender (based on behavior or appearance) differs from the expectations associated with their birth-assigned sex. Adolescents who experience an incongruity between their internal experience of gender and the sex they were assigned at birth can experience increased emotional distress, which, when clinically impairing, can result in a medical condition known as gender dysphoria. It is important to note that the treatment of gender dysphoria does not involve trying to change the individual’s gender identity but rather focuses on providing support and preserving access to cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired gender. Although little is known about the formation of transgender identities in adolescence, like sexual minority youth, transgender adolescents face increased stigmatization, which places them at greater risk for negative psychosocial outcomes including depression, substance abuse, suicide, violence, increased family conflict, homelessness, and physical health problems. In the 2013 National School Climate survey, 10% of approximately 8,000 adolescents identified as transgender. Transgender students were more likely than all other students to feel unsafe at school and to experience victimization on the basis of their gender or gender expression. These individuals had lower grade point averages, higher rates of depression, and lower self-esteem, and they were twice as likely to report that they were not going to pursue postsecondary education because of the victimization they experienced on the basis of their gender. Thus, it appears that gender identity development for adolescents who do not fit the gender binary represents a more complicated developmental task worthy of continued empirical investigation and a broader, more inclusive conceptualization of gender “norms” in adolescence. M. K. Oakley, Elizabeth Weber Ollen, and Christopher Overtree See also Bullying in Adolescence; Emotions in Adolescence and Gender; Gender Marginality in Adolescence; Gender Socialization in Adolescence; Gender Socialization in Men; Gender Socialization in Women

Gender Pronouns

Further Readings Buvinic, M., Guzman, J. C., & Lloyd, C. B. (2007). Gender shapes adolescence? Development Outreach, 9, 12–15. Galambos, N. L., Almeida, D. M., & Petersen, A. C. (1990). Masculinity, femininity, and sex role attitudes in early adolescence: Exploring gender intensification. Child Development, 61, 1905–1914. Guiso, L., Monte, F., Sapienza, P., & Zingales, L. (2008). Culture, gender, and math. Science, 320, 1164–1165. Hetherington, M. E., & Park, R. D. (Eds.). (2003). Gender roles and gender differences. In Child psychology: A contemporary viewpoint (5th ed.). Columbus, OH: McGraw-Hill. Retrieved from http:// highered.mheducation.com/sites/0072820144/student_ view0/chapter15/index.html Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: GLSEN. Morrow, D. (2004). Social work practice with gay, lesbian, bisexual, and transgender adolescents. Families in Society: The Journal of Contemporary Social Services, 85, 91–99. Sammons, A. (2009). Gender: Cognitive theory. Retrieved from http://www.psychlotron.org.uk/newResources/ developmental/AS_AQB_gender_CognitiveBasics.pdf

Gender Presentation and Childhood See Gender Variant Role Expression in Childhood

Gender Pronouns Pronouns are words that replace nouns when repetitive noun usage would become unwieldy. For example, if a sentence reads “Sam and the dog went to Paris” it would be unnecessarily repetitive for the following sentence to read “Sam and the dog enjoyed Paris.” Instead, pronouns simplify the sentence: “They enjoyed it.” Pronouns include two categories: gender specific and gender neutral.

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Gender specific pronouns typically take the place of a noun for which the gender is known. For example, if Sam is known to identify as female, the ­gender specific third-person pronoun of she could be used: “She enjoyed Paris.” Gender specific pronouns are sometimes inappropriate. For example, Sam’s gender may be unknown, and/or Sam may identify as neither male nor female. In both cases, the use of a gender ­neutral (or epicene) pronoun becomes appropriate. Some languages are gender neutral (e.g., Malay, Finnish, Armenian, Persian, Japanese, and ­Turkish), whereas others utilize gender specific third-person pronouns (she/her) but not first-person (I) or ­second-person (you) pronouns. English falls into the latter category along with German, Russian, French, and Spanish.

Gender Binary Pronouns Gender binary pronouns are pronouns that express and reinforce binary conceptualizations of gender. The binary gender system constrains gender to the categories of male or female—and perceives both as comprehensive and mutually exclusive. Binary pronouns are the most common form of gender pronoun, including the use of he/him/his to refer to a person known (or assumed) to identify as male and the use of she/her/hers for a person known or assumed to identify as female. In some situations, however, the use of default pronouns is neither appropriate nor sufficient.

Epicene Pronouns Gender neutral, or epicene, pronouns serve a number of functions in addition to usage when the subject’s gender identity is unknown. For example, individuals who identify as lesbian, gay, bisexual, or queer may utilize epicene pronouns in describing romantic partners to avoid disclosing their sexual orientation. In addition, not all individuals self-identify with binary (male/female) gender. Some identify as a unique blend of masculinity and femininity, while others may identify as neither male nor female. Different pronouns reflect different identities. Epicene pronouns can be traditional or invented. Traditional pronouns are borrowed from existing

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terms. For example, it does not inherently imply a specific gender but can replace most nouns. Similarly, one does not imply gender but can indicate a general human subject where the gender is unknown (e.g., “One may consider using an epicene pronoun when one is unsure of what pronoun to use”). The pronoun they describes a single subject or a group of subjects when the gender is unknown or when male/female categories do not apply (e.g., “They grabbed their shoes”), although, as discussed later, the use of singular they remains controversial. Invented pronouns do not appear elsewhere within a given language. Examples include ne/nem/ nirs, ve/ver/vis, ze/zie/hir/hirs, and xe/xem/xyrs. These pronouns do not exist elsewhere in the English language, but they uniquely add to existing categorizations of traditional pronouns. Invented pronouns continually emerge as individuals construct pronouns that suit their personal gender identity. For example, fey/feis/feyr may indicate a feminine-of-center identification that is not necessarily tied to binary conceptions of gender, and per/pers, derived from the word person, represents the inherently gender neutral identification of human.

Pronoun Controversies Although it is largely accepted to use he to describe an individual who identifies as male, invented pronouns face a great deal of controversy as mainstream society struggles to process changes to the traditional English lexicon. Such changes are sometimes perceived as cumbersome, given the lack of organization or general consensus on the use of invented pronouns. Grammatical concerns also arise regarding the appropriate conjugation and use of invented pronouns. While more tolerated than invented pronouns, traditional pronouns have not escaped controversy. Historically, he has been used as a default when the gender of a noun is unclear. This usage accumulated criticism due to its situation of the masculine pronoun as dominant when the feminine pronoun (she) or an epicene pronoun (they) is just as likely. The use of singular they has also received criticism despite grammatical correctness as some prefer its more common use as a plural term. Regardless, singular they is often used in

daily speech. For example, a common response to “The mailperson came today” might be “Did they bring my package?” Last, use of the gender neutral it has faced controversy via claims that it dehumanizes individuals. While this term has been used as a derogatory slur to describe individuals who are transgender or gender nonconforming, some individuals have reappropriated the term. For example, it as a selfidentified epicene pronoun may demonstrate a sense of communality and equality with all living life forms (human, animal, and inanimate).

Pronouns in Daily Life When confronted with the multiplicity of gender pronouns available and the diverse motivations driving their usage, common responses include a sense of being overwhelmed and even defensiveness. Often, two questions arise: (1) “Why does it matter which pronoun I use?” and (2) “How do I know which pronoun to use?” The former question often arises from individuals who identify as cisgender (whose gender identity matches their birth sex) and who are comfortable with traditional pronouns such as he or she. However, some experience a sense of self that does not align with the sex assigned at birth. For example, an infant designated as female may grow up with a sense of self that is unmistakably male. Using the feminine pronoun she, therefore, invalidates that experience and may cause psychological harm such as increased gender dysphoria or decreased selfesteem. Similar to names, pronouns identify individuals and thus merit recognition and respect parallel to that of names. Often, physical appearances form a basis for assumptions regarding gender identity and pronouns; however, given the multitude of possible pronouns and the similarly diverse motivations for their selection, convention and physicality provide insufficient and often inaccurate foundations for this decision. The simplest way to ensure appropriate pronoun usage is to ask with which pronouns someone identifies. One may also observe the pronouns used by others in close relationships with a person to discern appropriate pronouns. Alternatively, traditional epicene pronouns may be used. Given the grammatical hindrances of one and the stigma surrounding it, they is appropriate for use

Gender Reaffirming Surgeries

across a variety of settings. Understanding how an individual identifies is crucial in determining which pronouns to utilize. Chassitty N. Whitman See also Cissexism; Gender Dysphoria; Gender Identity; Gender Nonconforming People; Gender Self-Socialization

Further Readings Ansara, Y. G., & Hegarty, P. (2014). Methodologies of misgendering: Recommendations for reducing cisgenderism in psychological research. Feminism & Psychology, 24(2), 259–270. doi:10.1177/ 0959353514526217 Everett, C. (2011). Gender, pronouns and thought: The ligature between epicene pronouns and a more neutral gender perception. Gender and Language, 5(1), 133–152. doi:10.1558/genl.v5i1.133 McConnell-Ginet, S. (2014). Gender and its relation to sex: The myth of “natural” gender. In G. G. Corbett (Ed.), The expression of gender (6th ed., pp. 3–38). Berlin, Germany: De Gruyter Mouton. Meehan, K. S. (2013). Gender variant neologisms (Doctoral dissertation). Retrieved from http:// hdl.handle.net/10211.10/4199

Gender Reaffirming Surgeries Although episodes of gender variance have likely been with us from at least ancient history—as evidenced by biblical references, art history, literature, and mythology—medical and surgical treatment of transgender individuals is a relatively new phenomenon developed over the past century. Much of the early work in transgender medicine and surgery and the assumed birthplace of the modern transgender movement was pre–World War Berlin, Germany. While gender expression as a reflection of historical binary standards of gender (male or female) is increasingly challenged today, surgery, as one component of medical treatment for gender dysphoria (i.e., discomfort with one’s assigned birth gender), is addressed here. Gender confirmation surgery (GCS) and gender reaffirmation surgery (GRS) are equivalent designations supportive of the notion that gender identity is established biologically, often very

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early in life and not necessarily consistent with the presence of a penis or vulva as a marker for maleness or femaleness, respectively. For individuals whose assigned gender and genitalia do not match, gender dysphoria can be the result. GCS can then become as important to the individual as the correction of any birth defect. In essence, GCS confirms and reaffirms the gender identity that the individual has been feeling for many many years. However, it is important to note that not all persons with discordant gender/genitalia experience dysphoria (e.g., drag queens, cross-dressers) and thus do not choose to undergo surgery. O ­ thers, due to limitations of current surgical technique or expectations or fears regarding possible complications, may also not seek GCS. Increasingly, GCS has also expanded to include all surgical procedures related to or supportive of nonbiological gender physicality among trans persons. As an example, a transgender man (born female) may seek chest surgery (mastectomy) to allow him to pass as a man but enjoys his female genitalia and may opt for children in the future. As a result, his choices may include the mastectomy but not the creation of a penis (phalloplasty) or the removal of his reproductive organs (hysterectomy). Another example would be an MTF (maleto-female) who wishes to undergo an Adam’s apple reduction and nose job to allow her to be perceived as female in public but does not seek breast augmentation or vaginoplasty (creation of a vagina) because her wife is uncomfortable with her husband physically becoming a woman.

Standards of Care For a variety of ethical, historical, and arbitrary reasons, GCS differs from any other surgery available today by requiring individuals to follow Standards of Care (SOC). These SOC are established by the World Professional Association for Transgender Health, a worldwide group of medical, legal, psychological, and moral experts who assimilate data and legal and ethical considerations in establishing guidelines for gender change. Execution of the SOC, depending on which GCS is chosen, can require as much as psychological ­ evaluation, physician referral, 1 year of living in the desired gender role (i.e., nonbiological), 1 year

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of hormone therapy, and two letters of support from mental health professionals. Whereas some find these special requirements unique to GCS encumbering, discriminatory, and unfair, others see these as minimum prerequisites that assure an outcome that is less likely to be associated with regret. Despite studies showing regret after GCS to be extremely rare, concern remains unique to these surgeries due to their implications with regard to sexual and reproductive function. Accordingly, these standards are applied most stringently to surgeries of the genitalia. Cosmetic GCS surgeries such as facial feminization, liposuction, hair transplantation, and others have no requirements beyond a surgical consent. Other cosmetic procedures such as breast augmentation may require a single psychological letter of support. World ­Professional Association for Transgender Health, as a governing organization, continues to evolve, and this evolution will likely be reflected in future versions of the SOC for GCS.

Costs and Insurance Although the cost of GCS is covered as part of many national health plans worldwide, the cost of GCS in the United States, until recently, was borne primarily by the patient on a cash basis with only rare insurance coverage. This situation is changing rapidly, with employers and states increasingly insisting on GCS inclusion in health plan offerings. As of 2015, nine states have mandated employer coverage for transgender GCS. Medicare recently lifted its exclusion of GCS coverage. For Medicaid plans, there are exclusions except in individual contracted cases. Costs for GCS can vary depending on regional factors, surgeon competence, and competition.

Male-to-Female GCS Male birth-assigned persons who feel themselves to hold a female gender identity or who desire a more female gender expression may seek to undergo GCS. Possible GCS may include surgical ­procedures designed to soften typically male features. These procedures can include Adam’s apple reduction (tracheal shave or chondrolaryngoplasty), rhinoplasty (nose job), brow reduction, blepharoplasty (eyelid surgery), and hair transplantation.

Additional GCS procedures designed to enhance typically female features can include liposuction (and fat transfer), rib removal, cheek enhancement, brow lift, lip augmentation, and butt lift. Further MTF GCS include procedures that unmistakably designate femaleness. These include breast augmentation and vaginoplasty. It is important to note that not all surgical GCS is necessary or chosen by all individuals. Facial feminization includes a variety of à la carte cosmetic surgical procedures associated with the face and generally associated with MTF GCS. Many MTF individuals do not require facial feminization to satisfy their transition needs, particularly younger patients. For others, facial feminization can be lifesaving and medically necessary in allowing them to pass in public without fear of harassment or violence. Brow reduction is the single most commonly chosen facial feminization procedure. Breast augmentation is necessary in only half of MTF individuals due to the fact that breast augmentation is highly individual, and breasts do grow in biological males as a result of estrogen therapy. FTM (female to male) individuals normally do not undergo facial masculinization unless they opt for Adam’s apple implantation (augmentation chondroplasty). MTF vaginoplasty is perhaps the quintessential GCS procedure. Since the first documented neovagina was reported in Berlin 1933, techniques have evolved significantly. However, despite far greater assurance of functionality among various techniques today, there remain wide differences and preferences among surgeons. Regardless, the procedural aesthetic results remain highly dependent on technique and surgeon chosen. Colon vaginoplasty continues to be a useful but second-tier technique reserved for primary failures where depth has been lost and spontaneous lubrication is an overriding concern. The prototype vaginoplasty technique worldwide remains the penile inversion technique. Modifications in Thailand and elsewhere utilize the scrotal skin as a graft to line the deeper portions of the neovagina, retaining variable amounts of outside skin to create labia minora. The clitoris is derived from a portion of the glans penis, retaining the nerves and blood supply to allow erotic sensation. Orgasm is possible in a majority of MTF patients who undergo vaginoplasty with current

Gender Reaffirming Surgeries

techniques. Ejaculation is possible via contributions of the retained prostate and Cowper’s glands. Spontaneous vaginal lubrication is reported but is typically supplement dependent. Complications of MTF vaginoplasty are rare though potentially significant and are correlated with surgeon volume and experience (i.e., the more surgeries a surgeon performs and the greater the surgeon’s experience, the rarer the complications). Wound and aesthetic complications, as well as sensory loss, are most common. Rectovaginal fistula (i.e., an abnormal connection between the vagina and rectum) is the most feared complication, although should be experienced in less than 1 in 100 cases. Satisfaction with MTF GCS is high, but there is some variation based on the quality of the surgical result.

Female-to-Male GCS FTM GCS, while validating, is chosen less frequently than MTF GCS. Reasons for this reduced frequency include perceptions of increased procedural complexity, higher cost, greater incidence of complications, and greater acceptance of a nonphallic male persona. Chest surgery (simple mastectomy) is the GCS chosen most commonly by FTM individuals. Relatively minimal keyhole incisions to remove breast tissue are possible for those with less breast volume and areola size. In the majority of cases, a more traditional anchor-type incision is necessary. An important aspect of achieving a male chest appearance is reduction of the areola to a male size. This requires removal, reshaping, and free grafting of the nipple and areola. Complications, while rare, involve adequacy of the graft process and minimization of scarring and excess skin (socalled dog ears). Genital GCS is chosen less commonly by FTM individuals, with estimates of less than 30% ­opting for these procedures. Although it is true that “genitalia do not make the man,” many find that some sort of affirming genital procedure is necessary to reduce feelings of body dysphoria. These options can include metoidioplasty or phalloplasty. Testosterone works to enlarge the head and body of the clitoris into a small but clefted penis with attachments to the labia minora. A metoidioplasty (sometimes referred to as a “meta”) involves freeing

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the tissue from the labia and reshaping it into a tube, which creates a small but convincing penis. If a urethral tube is additionally created from the labial linings, standing urination is possible (ring metoidioplasty). Phalloplasty involves the use of flaps from various locations of the body that utilize the skin, nerves, and blood supply from those donor locations. These are usually staged procedures meaning multiple procedures are necessary to achieve a final result. Donor locations include the lower abdomen, the lateral thigh, the upper back, or the forearm. In some cases, a urethral tube can also be included. As with metoidioplasty, addition of the urethral tube not only aids functional realism but also adds to the likelihood of complications that can occur in as many as 30% of cases. This includes complications such as narrowing (stricture) or leaks (fistulae). Donor site scarring remains a significant downside to the phalloplasty, although the size of this version of FTM GCS more closely approximates the adult male penis size. Limitations in size tamper the appeal of the meta (3–8 centimeters). Ability to achieve orgasm is generally retained. ­ Erotic sensation is maintained in the metas and can be achieved in certain phallo techniques. Erection occurs as a result of blood supply in the case of the meta (as it does in the natal male), while phalloplasty requires sophisticated techniques including use of inflatable devices, stiffening rods, or even implantation of bone. Testicle implants and construction of a male scrotum from the labia majora (scrotoplasty) is possible. Many trans men also find that presence of a vagina or uterus causes dysphoria, making removal (vaginectomy or hysterectomy) a consideration. Hysterectomy may or may not be chosen by individuals undergoing GCS prior to or following GCS with reproductive options discussed separately. Again, the emphasis is that GCS procedures for the FTM are à la carte procedures that may or may not be selected individually, dependent on sexual preference and a wide range of factors. Satisfaction, regardless of procedure chosen, is high. Marci Lee Bowers See also Gender Nonconformity and Transgender Issues: Overview; Hormone Therapy for Transgender People; Transgender and Gender Nonconforming Adolescents;

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Transgender and Gender Nonconforming Identity Development; Transgender People; Transgender People and Health Disparities

Further Readings Ettner, R., Monstrey, S., & Eyler, A. E. (2007). Principles of transgender medicine and surgery. Binghamton, NY: Haworth Press. Gorton, R. N., Buth, J., & Spade, D. (2011). Medical therapy and health maintenance for transgender men: A guide for health care providers. San Francisco, CA: Lyon-Martin Women’s Health Services. Israel, G., & Taver, D. (2001). Transgender care: Recommended guidelines, practical information and personal accounts. Philadelphia, PA: Temple University Press. Trombetta, C., Ligouri, G., & Bertoletto, M. (2015). Management of gender dysphoria: A multidisciplinary approach. Milan, Italy: Springer.

Websites The UCSF Center of Excellence for Transgender Health: http://www.transhealth.ucsf.edu

Gender Role Behavior Gender role behavior is a construct expressive of one’s identification as a man or a woman. As individuals receive social cues from their environments on how to behave according to their gender, they enact those behaviors in accordance with the expectations of being male or female. Behaviors along the gender spectrum have traditionally been seen and appraised through a binary perspective, although more recent explorations of gender roles view gender-based attitudes and behaviors as a more fluid and less dichotomized construct. This entry is a review of gender-based behaviors; their inception, history, and maintenance in society; their political and psychological implications; and the limitations of binary gender role behavior expectations.

Gender Roles Gender roles refer to constructs that encompass a collection of characteristics, attitudes, and behaviors

associated with the male and female sex. Socially constructed notions of what it means to be a man or a woman are ascribed to individuals based on their biological sex, which then leads to implicit and explicit expressions of one’s assumed gender. The level of congruence between a person’s gender-based expression and societal expectations of their gender affects how much reinforcement is received for that gendered behavior. For example, certain characteristics and behaviors are considered socially to belong to women (e.g., tenderness, passivity, nurturance, submission) or men (e.g., independence, self-­ confidence, aggression, dominance). People receive reinforcement from others based on how much they can represent the cultural expectations of masculinity and femininity. These roles have led to the creation and maintenance of racially and culturally sanctioned gender stereotypes that overlap and vary (e.g., the model minority myth, the angry Black woman, the absentee father, the superwoman). When traditional gender roles are enacted and unchallenged, they have the potential to maintain culturally endorsed ascriptions of how one should act out their gender. Deviation from these stereotypes has been scrutinized for not fitting the binary ideas of what is socially accepted as male and female. In turn, constricted views of gender roles create conflict for individuals who do not identify within the binary gender role behavior.

Gender as Action Scholars today assert that gender itself is not biologically ascribed but rather performed. That is, current perspectives on gender suggest that one does gender, rather than is a gender. Gender-based behavior is constructed, rather than developed, and goes through ongoing evolutions as the person engages in social interactions. This perspective maintains that women assert their femininity by behaving in ways that are pronounced to be feminine and passive, and men assert their masculinity through masculine actions (e.g., active and independent). Likewise, by refraining from doing certain activities (e.g., manual labor for women and child rearing for men), individuals who identify as one gender also assert their gender preference. It is said that doing gender comprises both biological and social factors that work together to co-­ construct each person’s unique expression of

Gender Role Behavior

gender. Both biology and social forces contribute to the enactment of gender expression. Each of these factors work bidirectionally, so that an individual’s innate characteristics (biology) influence their social environment, and vice versa. According to social learning theory, people extract knowledge from their environments and use that information to exhibit gendered behavior. Gender role behavior is therefore the output of learning how to enact gender, matched with one’s innate inclination toward a specific gender type. Understanding gender requires an understanding of the complex dynamics at play when a person is negotiating how to express their gender.

Gender Role Schemas and Behavior Gender schema theory is based on the belief that a person assigns attributes and behaviors into categories related to sex. Although the individual possesses alternate information that challenges ­ categorization, one will continue to compartmentalize ideas regarding gender. Two types of genderrelated schemata exist: superordinate and own-sex schemas. The superordinate schemas help relegate characteristics into a binary and the basic categories of male or female, whereas the own sex schema is a categorization mechanism that is more personalized to the characteristics and behaviors that have been ascribed to that person’s assigned sex. As children, people create a cognitive organization of their world and the messages they are exposed to about gender, which frame the context for their gender development. Between the ages of 2 and 7 years, a child makes cognitive judgments about their own gender identity, which continues to take form as they grow into adulthood. This frames the way one behaves according to gender, which usually follows the schemas a person has formed about gender, according to the messages about how a person is to behave according to gender. The propensity to see oneself in terms of certain gender schemas may be connected to a ­ predisposition to viewing others through gender schemata. According to social cognitive theory, three processes called (1) modeling, (2) enactive experiences, and (3) tuition shape schemas about oneself and others. Modeling refers to simulation of someone else’s behavior. A person assimilates comparable

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behavior that supports the model of how they should act according to their gender. Enactive experiences are instances where people receive positive or negative reinforcement for their genderbased behavior, which is likely to influence the person’s decision, conscious or unconscious, to maintain that behavior. Positive reactions generally are associated with expected gender role behavior, and negative reactions are more affiliated with deviations from the expected behavior. Tuition refers to when one person overtly teaches another person the appropriate behaviors they should exhibit according to their sex. For example, girls and women are taught to be kind and selfless, whereas boys and men are taught not to cry. As people enact these behaviors, they help sustain the ideas that men and women should behave in certain ways, which reinforce a binary view of gender. This view of gender has sociopolitical implications for both men and women, as gender schema upholds the dominant beliefs society has about gender—a set of beliefs that continue to be reinforced and reintegrated into the socialization process despite negative psychological consequences.

Gender Role Socialization and Development The gender socialization process begins as early as in utero, prior to a child being born. In preparation for their arrival, the world around them is created to simulate the gendered preferences that they are then expected to embody. Boys and girls are bought blue and pink outfits, respectively, their toys exemplify the types of roles and jobs they are expected to assume later in life, and their rooms are adorned with “gender appropriate” decor. There is already a preset expectation of how they will express their gender and the behaviors they will exhibit. As they grow, so does their knowledge about the expectations affiliated with specific sexes. Cultural components of children’s environment, such as norms and values, tend to have great influence on children, especially if there is adherence to those norms and values from other influencing agents, such as parents, teachers, and the media. Interaction with these agents, particularly those of the same sex, help children develop their gender identity and accompanying behaviors in relation

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to those who are like them. They relay messages about what choice of games is appropriate, what type of clothes to wear, and even about the nature of sexuality and sexual relationships. Because traditional gender roles mainly subscribe to heteronormative ideas of how a person should interact in social and intimate relationships, they disavow the gendered expressions of individuals who do not identify within the binary constraints as a heterosexual. Despite often resulting in negative psychological effects, these restrictions are perpetuated by the systems and individuals who maintain the status quo on gender. Children are especially vulnerable to these effects, as their choices in matters related to gender are often constrained and dependent on their parents’ choices. If not handled sensitively, significant psychosocial costs may occur.

Gender Politics The dichotomy of attitudes and behaviors that exist within gender roles and expectations enforces a power-based differential between men and women. Men typically assume the more dominant roles in society and exhibit a set of gender-based characteristics that align with being powerful. On the other hand, women are assigned more passive and subordinate attributes, leaving them in a state of diminished power. During the civil rights movements for gender equality in the United States, typically those based on feminist ideologies, particularly during the second wave of feminism in the 1960s and 1970s, the power dynamics inherent in gender roles were overtly and collectively contested. People challenged power relations between men and women and exposed, at great length, the intertwined discrimination that emanated from these unequal gender affiliations. Recent scholars have had a similar agenda of denouncing such dichotomous perspectives, along with the ideas that gender is synonymous with sex and that gender-based behavior must align with one’s sex. Instead, gender has been framed as a self-asserted, multifaceted, evolutionary, and everevolving process that looks different for each individual. Some have looked at the variations of how people express gender across societies and how the intersections of other identities, namely, sexual orientation and race/ethnicity, may factor into one’s identification as a gendered being.

The Intersection of Race/Ethnicity Gender is one of several identities based on social group membership, which together combine to form unique and complex experiences. Other defining identities include race/ethnicity, class, sexual orientation, ability, age, and religion. Each of these characteristics intertwine with one another to influence a person’s interpretation and enactment of gender role behavior. In addition, a person’s gender-based experiences are directly tied to the intersection of these identities. Race/ethnicity and gender is one intersection of identities that predisposes a person to a specific set of experiences that are entangled in the sociopolitical makeup of the United States. For example, females and males of racial/ethnic groups of color experience genderbased stereotypes that are generally associated with the intersected identities of race and gender. Gendered racism is a phenomenon created to describe the occurrence and entanglement of both racist and sexist attitudes, beliefs, and discriminatory behaviors that a person may experience at the intersections of race and gender. An accurate conceptualization of a person’s gender role behavior must be multidimensional and reflect the sociopolitical context in which it exists. It is challenging to infer overall gender identity from observing one single domain of functioning, which is why it is imperative to conjoin gender with other identities, as “normative” gender role behavior looks different from culture to culture. To help illustrate cultural variance and the subsequent influence on gender role behavior, two specific race/ethnicity intersections are explored in relation to gender roles: (1) African American males and (2) Asian American females. African American Males

Research on gendered racism reveals how the dual status of being Black and being male can lead to psychological distress. This is due to the conflicting messages African American males receive about leadership, responsibility, privilege, and oppression from both the larger society and the Black community. Unlike White males, African American males do not partake in the privilege and power that is associated with being a man in the larger society. Being an African American male means having to contend with negative stereotypes

Gender Role Behavior

(e.g., absent fathers, criminals, lazy) and finding ways of evaluating and integrating multiple conflicting messages about what it means to be Black and what it means to be a man. When negative stereotypes become internalized for an African American man, they could have negative psychological consequences for both the individual and their community. The act of “becoming a man” can be seen as a central struggle in which one must overcome adversity to pursue one’s dreams. This process is further complicated by mixed messages from family, friends, religious communities, school, and the media about how an African ­American male “should” be and act as a man. Sorting through the messages can be an arduous task, requiring each individual to attach their own meaning and identification to their gendered expression. Early-life memories and experiences inform how each individual will engender behavior, even if sometimes this is contradictory to “traditional” and more mainstream gender role expectations. For instance, if an African American man experienced men in his racial/ethnic community exhibiting “vulnerable” qualities, and views this as a positive trait, then he too may embrace his vulnerability. Women in the Black community contribute significantly to the development of African ­American boys and men in relationship to their male gender. For example, mothers communicate appropriate gender behavior through assignment of particular “gendered chores,” which are assigned to either daughters or sons depending on how “suitable” each chore is thought to be for females and males. African American males may experience cognitive dissonance when their gendered expression contradicts their assigned gender role behavior, which can create pressure to conform to gender role expectations and thereby participate in negative stereotypes. They are therefore assigned with the task of actively deciding on how to respond to barriers of their innate gendered expression and navigate their statuses of both privilege and oppression in relation to the Black community and larger society. Asian American Females

The intersection of gender and race/ethnicity looks different across cultures and across gender.

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Women of color occupy multiple oppressive ­statuses—that of being a woman and that of being a person of color. Nonconforming and ­non-Western ways of “doing gender” are generally overlooked and undervalued in the United States, particularly for women of color. For these women, cultural expectations often conflict with Western ideals and values. Among Asian American women in particular, the cultural expectations of family and community to act as a “model woman” and uphold familial gender role expectations of subservience to males conflict with the gendered expectations and stereotypes of the dominant culture, in which they are expected to be the “model minority.” The compounding of these messages results in Asian American women reporting pressure to be academically accomplished, financially stable, achievement oriented, and family oriented, all without “rocking the boat.” Filial piety and the prioritization of one’s family are highly influential in the formation of Asian American female gender role expectations and behavior. “Proper” gendered behavior (e.g., messages of passivity) for Asian American females are conveyed via family members who relay messages of subservience within their immediate families. Asian American women are often expected to sacrifice themselves for their husbands and families in the name of preserving cultural tradition. For example, mothers offer a common directive to their daughters to suppress their voice and defer to males. A customary reaction to the demands on Asian American women is the adoption of a “superwoman ethos,” or the need to meet both U.S. and familial expectations by “doing it all,” which can result in feeling overextended. Asian American females are expected to exhibit passive voices within their family and culture, which reinforces expectations of Asians as compliant and deferential. In addition, they face the broad and interactive effects of oppression and inequality based on their identification with the female sex. For instance, strong pressure may exist to conform to Asian female beauty standards, which can then be compounded by American ­ideals of beauty and perfection. This pressure is further exacerbated and complicated by the sexualization and objectification of the Asian American female, as well as a lack of Asian American role models or public figures.

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Asian American females, like others with uniquely intersecting identities, often create their own set of bicultural values and find ways to integrate and select which gender roles they choose to embody. Therefore, gender roles can be thought of as being both precise and unique, created in relation to a constellation of other identities. Also, gender roles constantly evolve depending on the life stages and circumstances. Researchers in the field of psychology have offered an emergent multicultural gender roles model as a way to conceptualize gender roles for diverse racial/ethnic groups by including contextual factors related to both race/ ethnicity and gender. The model is based on analysis and interpretations inclusive of different racial/ ethnic group narratives, which elucidates the unique experiences and process of gender role identification and behavior for racial/ethnic minorities. Mariel Buque, Joanna C. Min Jee Rooney, and Marie L. Miville See also Biculturalism and Gender; Cultural Gender Role Norms; Femininity; Gender Identity; Masculinity Gender Norms

Further Readings Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88(4), 354–364. Martin, C. (2001). Gender development: Gender schema theories. In J. Worell (Ed.), Encyclopedia of women and gender: Sex similarities and differences and the impact of society on gender (pp. 507–521). San Diego, CA: Academic Press. Miville, M. L. (2013). Multicultural gender roles: Applications for mental health and education. Hoboken, NJ: Wiley. Miville, M. L., & Ferguson, A. D. (2014). Intersections of race-ethnicity and gender on identity development and social roles. In M. L. Miville & A. D. Ferguson (Eds.), Handbook of race-ethnicity and gender in psychology (pp. 45–63). New York, NY: Springer. Muehlenhard, C. L., & Peterson, Z. D. (2011). Distinguishing between sex and gender: History, current conceptualizations, and implications. Sex Roles, 64(11), 791–803. Nadal, K. L. (2010). Gender roles. In S. Goldstein & J. Naglieri (Eds.), Encyclopedia of child behavior and development (pp. 687–690). New York, NY: Springer.

Zemore, S. E., Fiske, S. T., & Kim, H. (2000). Gender stereotypes and the dynamics of social interaction. In T. Eckes & H. M. Trautner (Eds.), The developmental social psychology of gender (pp. 207–242). Mahwah, NJ: Psychology Press.

Gender Role Conflict Gender role conflict is a theory that is based on the assumption that men experience a form of psychological distress and strain as they attempt to be men and to be masculine. This strain creates a form of intrapersonal (internal to the person) and interpersonal (in relationships) conflict and dysfunction. This theory is important due to the shift away from a static identity to socialized gender roles. For psychologists and researchers, this shift meant that the way in which men exhibited various forms of masculinity and the way men spoke about themselves as men were based on a lifetime of experiences and expectations from significant family members, friends, and society at large. This entry discusses gender role conflict within this new psychology of men and masculinity, focusing on the expectations and strain men experience as well as on how this theory is used in psychological practice.

New Psychology of Men and Masculinity Gender role conflict represented one of the first ways to understand masculinity beyond the popular notion of gender as a fixed and genetic trait. Following along with early feminist critiques of gender roles in the 1960s and 1970s, the new psychology of men also focused on the analyses of problematic gender roles and expectations for men. Many scholars, therapists, and researchers wanted to better understand the unhappiness many men experienced, the conflict men had in their lives, and the expressions and ideologies of sexism, hegemonic masculinity, and homophobia. Through these feminist critiques, scholars found that many of the gender role expectations for men are not unitary, linear, or direct. Boys have to decipher these codes of conduct, and when they become men, violation of these expectations

Gender Role Conflict

often  led to internal psychological distress (i.e., conflict). The critiquing of gender roles was not meant to suggest in any holistic way that being a man was bad or inherently negative. Instead, psychologist, psychotherapists, and researchers wanted to understand why so many men happened to be unhappy and unhealthy, psychologically and physically. How did some men take an expectation of being “competent” or having an adequate ability to mean that they could never fail as a man? Or for some other men, how did being in power mean that they could never show weakness? Or that being able to express emotions was a sign of femininity and therefore needed to be completely avoided?

Masculine Expectations and Resulting Strain In the 1970s, a popular notion of masculine expectations or ideology focused on the messages men were given—that they are socialized to believe that they have to avoid anything that would taint them as feminine, or what they called “no sissy stuff.” Moreover, men should be respected and successful or be the “big wheel”—that men should not show weakness (“Be a sturdy oak”). And finally, men should be adventurous and aggressive or “give ’em hell.” In more recent scholarship, researchers suggested adding “being a playboy” to this list as a way to capture the pressure men face about always being sexual and sexually available. These dominant expectations for men seem clear, and yet psychological strain occurs as men attempt to fulfill these ideologies. Three forms of strain result as men attempt to fulfill these expectations. (1) Discrepancy strain is a consequence of attempting and failing to fulfill these expectations. Gender role conflict is an example of discrepancy strain. (2) Dysfunction strain results from men fulfilling these expectations because what is considered socially desirable for men may not be psychologically or physically healthy for men. James M. O’Neil reports research suggesting that men who fulfill dominant gender role expectations may experience far-reaching and wide-ranging problems from physical health problems (e.g., heart attacks, weight problems) to interpersonal disputes (e.g., violence, aggression).

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Finally, (3) trauma strain is the socialization boys and men experience as they learn the masculine codes and expectations. Various scholars have discussed the problems with the ways boys are socialized into masculinity. Many scholars have focused on the problems with masculine expectations for boys and the ways in which many people dismiss or minimize trauma strain as a regular part of a boy’s experience. Bullying, for instance, is sometimes explained as “Boys will be boys.” Yet this popular adage of “Boys will be boys” is far from normal or healthy because what is often seen as gender typical or expected is simply problematic or toxic socialization of boys into aggression, violence, and interpersonal disconnection—the opposite of what boys want and what will make them healthy. Examples of trauma strain may be being called gay or being bullied for not wearing explicitly boy clothes. Researchers know that the construction of gender is fluid and that, depending on the situation and context, gender roles differ. These differences occur across the dimension of one’s growth or development (i.e., life span), and even though researchers know that this occurs, the current research only hints at what these changes may be for boys. There are also differences related to race and ethnicity as well as socioeconomic status. Cross-sectional research or research on specific populations at a certain time (in contrast to longitudinal research, which tracks an individual or community over a long period of time) suggests that men’s gender role expectations are related to racial identity (i.e., how a man sees himself with respect to race and ethnicity) and experiences with microaggressions (i.e., negative stereotypical treatment by others because of the man’s visible racial and ethnic characteristics). Moreover, masculinity may change and vary as a result of socioeconomic situations. Men who grow up poor may have a sense of masculinity that differs from that of men who have grown up in affluence. In all of these ways of knowing masculinity, the new psychology of men and masculinity studies multiple masculinities and multiple ways of constructing and expressing masculine norms, expectations, and conflicts. Masculinities are important to remember since even among men who may grow up in the same context, their sense of what it is to be a man may differ.

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Use in Psychological Practice Gender role conflict is a psychological construct or theory and not only is part of a long-standing research program for many scholars but also has been used extensively in psychological practice and interventions. For many men, gender role conflict may occur in four areas of their lives: (1) cognitive, (2) emotional, (3) behavioral, and (4) unconscious. Cognitive conflicts are the thoughts and questions about gender roles. The emotional aspects refer to the ways in which men feel about gender roles. Behavioral aspects are those ways in which men act that create problems inside and out. Finally, the unconscious conflicts are thoughts and feelings that the man may not even be aware of but still create problems. Related to these four areas or domains are also contexts or situations in which these conflicts might occur for men. One context may be intrapersonal (within oneself) wherein the man has ­private emotions and thoughts about masculine conflicts. Another context is interpersonal (with others) in which the man may act in negative ways to force another man (or men) to adhere to masculine expectations. Finally, conflict may occur during a time of transition or when men are developing over time and their sense of masculinity changes. For decades, researchers have used the Gender Role Conflict Scale (GRCS) as a way to better understand gender role conflict as well as the problems associated with this conflict. The GRCS has four subscales. These subscales may be conceptualized as categories or types of gender role conflict within the larger scale. One of the subscales is titled Success/Power/Competition, and an example of an item is “I worry about failing and how it affects my doing well as a man.” This subscale focuses on a man’s need to feel powerful, always successful, and competitive within himself as well as with other men. Another subscale is Restrictive Emotionality, and a sample item is “I have difficulty expressing my tender feelings.” Restrictive Emotionality addresses the problems some men may have in allowing vulnerable feelings to surface. The subscale Restrictive Affectionate Behavior Between Men focuses on problems men might experience around being affectionate with other men. A sample item is “Affection with other men

makes me tense.” Finally, the subscale Conflict Between Work and Family Relations assesses for the tension created for men as they attempt to negotiate time and expectations of work and family. An item here is “My work or school often disrupts other parts of my life: home, health, or leisure.” Researchers have found that men who experience higher forms of conflict, as measured by the GRCS, also have problems seeking help from physicians and psychotherapists. They may be susceptible to or have problems dealing with depression or depressive symptoms such as sadness and hopelessness, or they may have problems with anxiety and stress in their lives. Other researchers have found that men who score high on the GRCS subscales may also struggle with feelings of shame and guilt, homophobia and homonegativity, selfdestructiveness and suicidality, substance use and abuse, and body image and body dysmorphia. These are just a few samples of the extensive research conducted using the GRCS on men. In psychotherapy, the role of the psychologist with the male client is to help reveal the gender role journey. In various prompts for the man, such as “Tell me what it was like growing up as a boy in your home,” the psychologist helps the man uncover the positive aspects and challenges of growing up as a boy. Part of the responsibility for the psychologist is to help the man realize that he was not alone in his experience and that some of the masculinity-based traumatic socialization is unfortunately normative for many boys. Another aspect for the psychologist is to help the man articulate his cognitions and affect and to help him negotiate a healthier way to be a man. For instance, in working with a man who needs to see himself as the “alpha” man in every situation, the psychologist may help him understand the stress and strain related to always having to be the alpha male. The man may be encouraged to see strength from collaboration and consultation versus chronic independence. The psychologist may also work with the man on articulating his affect and feelings in a better way to those around him. For some men as they have grown up, they have not been nurtured or encouraged to understand their feelings or how to articulate them to others. Scholars define this problem as alexithymia (or no words for feelings).

Gender Role Socialization

Simply, for many men, the only feelings that are readily accessible are anger and rage. These two feelings are considered by the dominant culture as masculine congruent. Consequently, other aspects of their emotional life are truncated, limited, if not completely restricted. This restriction creates limitations for the man but also interpersonally. That is, if the man has difficultly expressing his feelings, it is also very likely that he has problems understanding the feelings of others (problems “reading” other people’s feelings). Thus, the psychologist’s role with this man may be to help him link an affect, in a situation, with the appropriate words. The goal is not only to help the man articulate his feelings but also to have a better way of understanding other people’s emotions. William Ming Liu See also Cultural Gender Role Norms; Gender Role Socialization; Gender Role Strain Paradigm; Heteronormativity; Gender Roles: Overview; Men’s Friendships; Patriarchy

Further Readings David, D., & Brannon, R. (Eds.). (1976). The forty-nine percent majority: The male sex role. Reading, MA: Addison-Wesley. Kindlon, D., & Thompson, M. (2000). Raising Cain: Protecting the emotional life of boys. New York, NY: Ballantine Books. Levant, R. F. (1996). The new psychology of men. Professional Psychology: Research and Practice, 27, 259–265. O’Neil, J. M. (2015). Men’s gender role conflict: Psychological costs, consequences, and an agenda for change. Washington, DC: American Psychological Association. Pleck, J. H. (1981). The myth of masculinity. Cambridge, MA: MIT Press. Pollack, W. (1999). Real boys: Rescuing our sons from the myths of boyhood. New York, NY: Henry Hold.

Gender Role Socialization Gender is specific to humans and connotes all the complex attributes ascribed by societies to human females and males, respectively. Only among

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humans there are girls and boys, women and men (i.e., gendered social categories). Gender is constructed or learned from the particular conditions, experiences, and contingencies that a society systematically and differentially pairs with human femaleness or maleness (the sex ascription given at birth). The category of gender is used by societies to assign social status and to regulate social behavior. We learn to respond to others on the basis of gendered cues with particular expectations, evaluations, and actions. When a child is born, its sex is typically apparent, and of immediate and utmost concern to parents, relatives, and friends. Sexual identifica­ tion—“It’s a boy” or “It’s a girl”—appears to be universal across the globe and is certainly so in the United States. The chromosome for sex (XX for female, XY for male) will normally lead to predictable gonadal, hormonal, and morphological components. Harmony among these components is associated with a small number of biological ­ imperatives: for females, capacities for menstruation, gestation, and lactation; and for males, only impregnation. None of the secondary sex differences that are influenced by hormones released in puberty and in the adult years—such as development of breasts, voice pitch, and distribution of body hair—is absolute. There is a wide range of within-sex variations in the quality and intensity of  these differences, and individual differences within groups of females and males are as great as the average differences between them. In each society, being a girl and then a woman, or being a boy and then a man, is the result not of sex but of a continuous process of learning. Social environments, expectations, mandates, and consequences are carefully paired with sex to create and maintain distinctions that the society values. Recognition of an infant’s sexual category is followed by the continuing development of gender through socialization—the learning of prescriptions and proscriptions with respect to expected behavior and suitable experiences—which this entry further explores.

Socialization The careful pairing of sex with particular experiences, expectations, and demands is the process of socialization. This concept, sometimes referred to

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as enculturation, can be defined as the teaching (and learning) of those behaviors selected as appropriate and necessary for members of a particular group—in this case, females and males. This process begins well before birth with, for example, parental assumptions, baby names, the colors chosen for infant clothing, and parental plans and hopes. It continues through childhood, and throughout a person’s life, resulting in the transformation of sex into gender. Each human infant with a normal nervous system shares with others the capacity to learn and to acquire culture. A marvelously developed characteristic of the human species is enormous teachability, flexibility, and plasticity—our ability to learn. We try to emulate persons who are most like us and to model our behavior to theirs. We learn to repeat actions for which we are rewarded or praised and to avoid those for which we are criticized, punished, or ridiculed. Of great importance are the environments considered to be most suitable for us by cultural agents (e.g., parents, teachers, the media) and that are made most available to us. Consider, for example, the typical U.S. preschool play areas of trucks and blocks on one side of the room and dress-up materials and a play kitchen on the other. Where are we most likely to see girls? Where do we expect to see boys? Who in the United States has not gone into a store selling children’s clothing or toys and not been asked by the sales clerk if the purchase is for a girl or for a boy? The process of socialization includes both the acquisition and the maintenance of approved behavior—a powerful dual process. There are continuing and pervasive opportunities outside the family environment, and throughout life, to practice and be reinforced for gender appropriate behavior. It may well be that parents do far less direct sex-typing for their own children than do other socialization agents. Parents are likely to recognize, and respond to, the uniqueness of their child and to have high aspirations for the child’s future that may be gender neutral.

Gender We are not born girls or boys but become them as we learn the differential behaviors that are appropriate, expected, and rewarded in a given society

and in a given historical period. These behaviors constitute the roles that a society identifies with biological sex. We use the word gender to identify the definitions of girls/women and boys/men that are learned. While female and male refer to sexual distinctions across all animal species, woman and man are specific only to humans and denote gender learned attributions about characteristics ­ and behavior. Gender serves to organize social relations and interactions at the structural, institutional, and individual levels. At each level, there is reinforcement of the prescribed behavior learned at others. Gender is a primary socially constructed category of relationship among human beings that continues to be significant throughout our lives, during which socialization—the shaping of ­ gender—continues. Other social categories, especially ethnicity and social class, interact significantly with gender, but normative gender assumptions are widespread and remarkably consistent. In the 21st century, however, particularly within highly developed societies, there are considerable heterogeneity and variations in gender behavior, beliefs, values, aspirations, and achievements. An individual can make a private or public decision to assume a gender identity that is not in harmony with the sexual markers present at birth. Transgender issues are becoming increasingly more visible, despite the probability that transgender people have existed across all human groups throughout history. Today, some can undergo hormonal and surgical modifications to bring their biological sex into alignment with their experienced gender. Gender differences in behavior can disappear when social forces influence both genders similarly. Yet for the most part, gender remains a powerful marker for expectations and for a heightened probability for certain behaviors and outcomes. Gender can reliably predict behavior in large numbers of particular situations, depending on previous opportunities for practice and reward, and on the context in which the behavior is evoked. It is important to recognize that a society sometimes expects similar behavior from its women and men. A contemporary example is that of Israel, where both men and women are drafted for military service. Another example is the Philippines, where both men and women are expected to attain higher

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education and are equally encouraged in fields like medicine, law, and politics.

Major Correlates of Gender Differences in Power

There are significant national and international social, economic, and political correlates of gender that reflect differences in status and resources. Importantly implicated in the ways women and men (and girls and boys) relate to one another is their relative power (i.e., access to resources). The specific features of the interaction will be influenced by time, place, context, and other identities of those involved in the interaction, but the lesser status of girls/women is a ubiquitous feature of U.S. society (and across much of the globe). Almost universally, beliefs about gender and the realities of everyday life reinforce men’s privilege. Historical and contemporary data support the conclusion of women’s lesser social status. Societies have encouraged the treatment of women by men as property and as sexual objects, and societies have erected barriers to women’s full societal participation and receipt of equitable rewards. While there have been extraordinary and great changes within the past few decades, women’s disadvantaged position in the economy with respect to hiring, wages, and benefits is amply documented across all job categories. It is still the case that women and men are often excluded from what is considered to be the domain of the other. For women, this translates into more limited access to positions of high status and, in general, to narrower opportunities for personal growth and development. For example, in the United States, at the end of the first decade of the 21st century, women constituted 16% of the House of Representatives, about 22% of all state legislators, 15% of corporate officers, and 25% of physicians, and were just three of nine members of the Supreme Court. Among those living in poverty in today’s world, 70% are women and children. In the United States, women employed full time earn 77 cents for every dollar earned by men. As women and men grow older, the difference in their earnings increases. Matching the near universality of gender inequality in the economic sphere is the sharp lack of equity in the realm of politics and government. In

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the world at large, women occupy only 17% of seats in national parliaments. In 2000, there were five countries in which parliamentary representation of women was greater than 30%; these were all Scandinavian nations. Parental Roles

Some scholars attribute the persistence of gender inequality to the universal division of household labor, particularly with respect to the care of children. With few variations, societies assume and prescribe that mothers (or other women) bear the greater responsibility for the welfare and development of children. Thus, women’s time and energy are devoted to a greater extent than men’s to child-related tasks and behaviors. The circularity of inequality is maintained as the public gender divisions are reinforced by, and contribute to, those within the family. In high-income countries, despite women’s greater opportunities for education and training and greater participation in public spheres, motherhood inevitably brings a set of expectations that are different from, and more complex and demanding than, those of fatherhood. It is instructive that the role of fathers and male partners is typically absent from media discussions in the United States of work/career conflicts or problems. Differential parental roles based on gender do not suddenly appear in adulthood. Girls and boys are prepared for these roles from early childhood by parents, schools, language, media, toys, games, and social institutions. Children of heterosexual parents also learn a great deal about expected behavior for women and men from the interactions they observe between their mothers and their fathers.

Gender as Culture A commonly agreed-on definition of culture is that it represents shared beliefs, values, and practices— shared distinctive norms of behavior that are transmitted to new members of the group. These norms provide interpretive perspectives that assist in the perception and cognition of events. Culture prepares us to attend to some events and not to others, to ascribe particular meanings to what we experience, observe, and learn about from others.

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Culture provides prescriptions, proscriptions, and expectations that may not be easily verbalized— since culture is lived and is only sometimes scrutinized by those within it. Girls/women and boys/men are members of cultures of gender that can be distinguished by what each group learns to do, believe, and value, and by significant common experiences in everyday life. These experiences take place in families as ­daughters or sons, mothers or fathers, sisters or brothers. They take place in schools, romantic relationships, and occupational and skill preparation, as consumers, workers, and community participants. As we grow older, and experience changed circumstances in our lives, the earlier lessons may be negated and contradicted or reinforced and affirmed. Variations in what we learn and what we do are tied to time, place, and background—to historical, economic, and social conditions. Despite great changes in the past several decades, expectations for women and men are still not the same, and significant consequences to the individual follow from both conformity and deviation. Gender continues to organize much of social life and thus much of individual experience. Particular life conditions remain systematically related to being born female or male, although there are variations in these conditions during different periods of our lives and across groups differing in ethnicity, social class, and geographical area. Behavior is affected by environmental events— their consequences, how others respond, observation of models, and gender labeling of persons, objects, attributes, and actions. In the United States, the gender culture typically includes how people dress, what they are expected to like and dislike and be good at, vocations considered most suitable for them (or obtainable), and appropriate behavior. Girls are still expected to be more interested in babies and more skilled in handling them and to be more disciplined and less physically aggressive than boys. It is still not the norm for a man to sew a missing button on a shirt, to iron it, or to be seen crying in the presence of others. It is also not the norm for a woman to be asked for advice about how to fix a malfunctioning auto engine or to spend a lot of time conversing with other women about big league sports. Most nurses are still women, and most firefighters are still men; Americans are intrigued by the exceptions.

A boy must learn to be “a man.” Such learning includes rules about emotional expression and expected family responsibilities, and privileges such as not having to choose between work/career and family and being able to eat heartily and openly admit to a big appetite. Men are supposed to be reluctant to seek help; to be willing to engage in risky behaviors; to be dominant, independent, competitive, physically strong, and focused on success; and to solve problems rationally. Women are still expected to assume primary responsibility for the care and rearing, health and welfare of children—particularly when they are young. The media still report on the problematic nature of work/careers for mothers, omitting for the most part the role of parenting for men. Also typically ignored in such discussions are the variations in practice related to ethnicity and social class. But overall, it is women who are expected to care for and tend to the needs of other family members, parents, spouses/partners, and the sick. There is a tendency to not focus on the places and times when some women are just as combative and aggressive as men and when some men are just as nurturing and harmony seeking as the model for women. While the life experiences of girls/women and boys/men are far more convergent now than has been the case in previous generations, there is as yet no simply “human” culture devoid of gender distinctions. In most contemporary societies, there are clear differences between the genders in the resources available and accessible to them, in their projected life course, and in their day-to-day experiences. The media—magazines, television, popular music, fashion—reinforce divergent gender cultures. There are typically different connotations to the presentation of women’s and men’s bodies and different expectations with respect to size and shape. Hair can be cut in a barbershop or a salon, but it is almost always in the latter that it is dyed or permed and fingernails are painted.

The Salience of Gender The importance and influence of gender on social behavior will vary with person and situation, time and place, experience, context, and pressures. ­Gender rarely stands alone as an identity or group membership. Other cultural identities provide

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intersecting influences on behavior, depending on the issue or event. Because gender socialization is continuously affected by social class, sexual identity, ethnicity, and other important social categories and by idiosyncratic personal and family ­variables, gender can be an unreliable predictor of behavior. It has been found to explain no more than 5% of the variance in a variety of social behaviors including aggression and sensitivity. Gender prophecies based on stereotyped expectations often fail, particularly in situations where other social attributes are more salient or relevant. Nonetheless, gender remains an extremely powerful cue for the expectations and behavior of others. Research and p ­ersonal experience continue to document the systematic exclusion of women from significant segments of experience and access to resources. Where access to social resources is consistently greater for one gender than for another, associating each with differently valued skills, attributes, interests, and behaviors would seem to be necessary. In the 21st century, in societies undergoing important social changes in family, economic, and political life, related progress in gender equality (i.e., in widening access to all areas of social life) can be anticipated. So too, greater recognition of gender variability can be anticipated. Understanding of gender is bound to change. A future in which gender does not restrict opportunities or prescribe the directions of one’s life is one that holds promise for promoting individual competencies and supporting prosocial behavior. Bernice Lott See also Cross-Cultural Differences in Gender; Cultural Gender Role Norms; Gender Role Conflict; Gender Role Strain Paradigm; Gender Roles: Overview

Further Readings Beall, A. E., & Sternberg, R. J. (Eds.). (1993). The psychology of gender. New York, NY: Guilford Press. Denmark, F., Rabinowitz, V., & Sechizer, J. (Eds.). (2000). Engendering psychology. Needham Heights, MA: Allyn & Bacon. Lev, A. I. (2007). Transgender communities: Developing identity through connection. In K. J. Gieschke, R. M. Perez, & A. K. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay,

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bisexual and transgender clients (pp. 147–175). Washington, DC: American Psychological Association. Lott, B. (1994). Women’s lives: Themes and variations in gender learning (2nd ed.). Pacific Grove, CA: Brooks/ Cole. Lott, B. (2012). Gender inequality. In C. J. Christie (Ed.), The encyclopedia of peace psychology. Malden, MA: Wiley-Blackwell. Lott, B., & Maluso, D. (1993). The social learning of gender. In A. E. Beall & R. J. Sternberg (Eds.), The psychology of gender (pp. 99–123). New York, NY: Guilford Press. Stewart, A. J., & McDermott, C. (2004). Gender in psychology. Annual Review of Psychology, 55, 519–544.

Gender Role Strain Paradigm The gender role strain paradigm (GRSP) proposed by Joseph Pleck in 1981 in his seminal book The Myth of Masculinity remains the dominant perspective on the psychology of men and masculinity. Stemming from feminist and social learning theories, the GRSP has generated an impressive body of empirical and applied work with broad implications for men and boys, the girls and women in their lives, and society at large. The GRSP was proposed as an alternative to what Pleck termed the gender role identity paradigm (GRIP), which dominated research on masculinity for 50 years (1930–1980). The GRIP posited that healthy personality development relied on the adoption of a traditional gender role and the stereotypical traits associated with one’s biological sex. The GRIP asserted that men who failed to do so would have poor psychological outcomes. In contrast, the GRSP highlights the ways in which pressure to conform to the traditional male role leads to poor psychological outcomes. This entry examines the past, present, and future of the GRSP.

GRIP and Essentialism The field of psychology’s endorsement of GRIP is evident in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, third edition, in which clinicians were encouraged to promote traditional behavior in gender nonconforming

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children (e.g., gender identity disorder in children). The GRIP is consistent with traditional psychodynamic perspectives, which emphasize the need for boys to separate or “de-identify” from their mothers in order to establish a masculine self. This early separation of boys from their mothers is posited to be a traumatic loss of the maternal holding environment. This loss is rarely acknowledged and is thought to leave men vulnerable to developing destructive entitlement—the unconscious belief that people in adulthood are required to make up for childhood losses. In addition, the GRIP is consistent with an essentialist approach to sex and gender. Gender essentialism was (and is) the widely held belief that masculinity and femininity are biologically based and do not vary across time or individuals. An essentialist belief is evident in pop culture (e.g., the book Men Are From Mars, Women Are From Venus) and persists in both conventional discourse and contemporary research. Essentialism is evident in a recent meta-analysis that found that scientists are more likely to attribute significant gender differences to evolution than to socialization.

Feminist Roots In the 1960s, feminist scholars challenged the idea that sex differences are biologically determined. Feminist scholars proposed that stereotypical feminine traits such as warmth, dependence, and nurturance, rather than being innate to women, are culturally sanctioned characteristics for women. This approach to gender is linked to social learning perspectives that approach gender as a social rather than as a biological construct. Social learning approaches highlight the ways in which “­masculinity” and “femininity” are performed by individuals rather than being innate within individuals. Similarly, social learning approaches demonstrate how gender roles are developed and shaped through reinforcement, punishment, and modeling. This feminist approach to gender roles challenged the essentialist assumption that all ­ women share similar behaviors, characteristics, and experiences. It is not an exaggeration to state that the GRSP and the modern study of masculinity would not exist without feminist scholarship. Leading GRSP scholars noted their indebtedness to feminism and

affirmed that social learning theory is central to the GRSP. Recent work on the GRSP explicitly described how boys adopt socially sanctioned masculine behaviors through reinforcement, punishment, and observational learning. Therefore, the GRSP views the male gender role not as biologically determined but rather as a social construct that stems from political and cultural institutions. There is substantial empirical support that gender roles are social constructs that vary significantly across time, ­context, and culture. A recent synthesis of meta-­ analytic studies of gender differences provides strong evidence for a social construct understanding of gender. Ethan Zell and colleagues examined more than 20,000 findings from 12 ­million participants comparing men and women on topics ranging from risk-taking to body image. The authors found that the majority of effects were very small to small, indicating far more similarities than differences between genders (d = 0 to .35).

Theoretical Tenets Pleck’s original description of the GRSP consisted of 10 propositions: 1. Contemporary gender roles are operationalized as stereotypes and norms about appropriate behavior for men and women. 2. Gender roles are contradictory and inconsistent. 3. The proportion of persons who violate gender roles is high. 4. Violation of gender roles leads to social condemnation. 5. Violation of gender roles leads to negative psychological consequences. 6. Actual or imagined violation of gender roles leads people to overconform to the gender role. 7. Violating gender roles has more severe consequences for men than for women. 8. Certain gender role traits (e.g., male aggression) are dysfunctional. 9. Each sex experiences gender role strain in paid work and family roles.    10. Historical changes cause gender role strain.

Gender Role Strain Paradigm

A clarification from Pleck identified traditional masculinity ideology and discrepancy, dysfunction, and trauma strain as important theoretical tenets of GRSP that guide investigation. Discrepancy strain results when men fail to live up to their internalized ideals of manhood. For example, a man who believes that self-reliance is central to masculinity will experience distress if he is unable to change a tire by himself. Although discrepancy strain is fundamental to the GRSP, it has generated the least empirical investigation. Pleck hypothesized that discrepancy strain leads to lower self-esteem and other negative psychological consequences. However, attempts to assess discrepancy strain and its correlates have been limited and largely futile. However, Richard Eisler and Jay Skidmore’s conceptualization of masculine gender role stress represents a successful attempt to assess the strain that results when a man perceives that he is not living up to his internalized gender role ideals. Among men, masculine gender role stress has been associated with adverse health habits, anger, violence, and cardiovascular reactivity. While discrepancy strain highlights how not fulfilling the traditional masculine role results in distress, dysfunction strain results from fulfilling the requirements of traditional masculinity. Many of the prescribed behaviors of traditional masculinity (e.g., aggression) have a negative impact on men and those close to them. There is considerable empirical support for dysfunction strain that stems from investigations of negative outcomes associated with the endorsement of traditional masculinity ideology and the concept of gender role conflict. Traditionally, trauma strain has been applied to certain groups of men whose experiences with gender role socialization and gender role strain are particularly damaging. For example, trauma strain includes the distress experienced by boys who are physically or emotionally abused for violating traditional male role norms. Groups that may experience harsh male socialization include men of color, professional athletes, veterans, survivors of child abuse, and gay and bisexual men. However, another perspective conceptualizes socialization in traditional masculinity as inherently traumatic for all boys and men who experience it. One consequence of traumatic socialization is normative male alexythymia, or the inability of men raised to conform to the traditional masculine norm of restrictive

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emotionality to identify and communicate their emotional state.

Theoretical, Empirical, and Clinical Contributions Theoretical paradigms are critical due to the foundation they provide for research and clinical practice. This is especially true in gender studies, in which stereotypes and “common knowledge” compete in conventional discourse with empirical investigation. There are few limits to how thoroughly a question or problem can be probed within a single, well-designed, theoretical paradigm. Accordingly, the GRSP has been a useful framework in the investigation of a diverse range of empirical questions, some of which include men’s health outcomes and help seeking, substance use, men’s loneliness, men’s behavior in femaledominated occupations, gay men’s experience as fathers, men’s violence, boys’ behavioral problems, and men’s sexual/romantic scripts. The GRSP has generated the largest body of research on the psychology of men and masculinity. According to a recent content analysis by Y. Joel Wong and colleagues, slightly more than half (53%) of the articles published in the Psychology of Men and Masculinity since its inception in 2000 were grounded in the GRSP or associated theories (e.g., gender role conflict). A search of Academic Search Complete in 2015 found 79 articles with “Gender Role Strain Paradigm” in the text. According to Google Scholar, as of 2015, Pleck’s original work The Myth of Masculinity had been cited 1,198 times, while the more recent “Gender Role Strain Paradigm: An Update” had been cited 614 times. The GRSP is the theoretical framework for the three most widely used measures of socially constructed masculinity: (1) the Male Role Norms Inventory, which assesses the endorsement of traditional and nontraditional masculinity ideologies; (2) the Conformity to Masculine Norms Inventory, which assesses the degree to which men conform to traditional masculine norms; and (3) the Gender Role Conflict Scale, which assesses the degree to which conformity to traditional masculinity leads to the restriction, devaluation, or violation of the self or others. Furthermore, the GRSP has contributed substantially to the clinical treatment of men. It is

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critical for counselors to view male clients and their problems with gender awareness. GRSP has major implications for men’s mental health as it predicts that their efforts to contend with traditional masculinity ideology will put them at risk for a wide range of psychological and physical health problems (e.g., neglect of personal needs, alcohol abuse). Specifically, the GRSP has been used to examine how men experience and express depression differently than women. The GRSP has been applied to the design of group therapy for adolescent boys, narrative therapy with men, and therapeutic men’s groups to supplement couple’s therapy. In addition, a manualized treatment for normative male alexythmia provides clinicians with guidance on how to help men who have been traumatized and incapacitated by harsh emotional socialization.

Future Directions There are several critiques of the GRSP that may guide future directions for GRSP scholars. Investigators have noted that the majority of existing research examines correlations between individual differences in various masculinity constructs and psychosocial problems. For a more contextual understanding of gender role strain, future GRSP scholars should focus on identifying the psychological mechanisms that mediate or moderate these relationships. Other criticisms include an evaluation of traditional (i.e., hegemonic) masculinity as being ambiguously or inconsistently defined. The perception that traditional masculinity is ill defined may be a misunderstanding of the GRSP, which emphasizes that masculinity is neither universal nor stagnant. Michael E. Addis and colleagues make a compelling argument that the study of masculinity has huge potential to promote gender equality, yet in everyday language the term is used to reinforce essentialism. Considering its roots in feminist and social learning theories, it is critical to differentiate the GRSP from essentialist or trait theories of gender. To highlight the contingent and contextual nature of the GRSP, future scholarship should highlight the experience of men with nondominant experiences of masculinities, especially marginalized groups of men. It is critical that future theoretical and empirical work emphasize the potential diversity of masculinities rather than

the reproduction and institutionalization of the traditional male role. Ronald F. Levant and Kathleen M. Alto See also Masculinities; Masculinity Gender Norms; Masculinity Ideology and Norms; Men’s Issues: Overview

Further Readings Addis, M. E., & Cohane, G. H. (2005). Social scientific paradigms of masculinity and their implications for research and practice in men’s mental health. Journal of Clinical Psychology, 61, 633–647. Addis, M. E., Mansfield, A. K., & Syzdek, M. R. (2010). Is masculinity a problem? Framing the effects of gendered social learning in men. Psychology of Men & Masculinity, 11, 77–90. Bohan, J. S. (1997). Regarding gender: Essentialism, constructionism, and feminist psychology. In M. M. Gergen & S. N. Davis (Eds.), Toward a new psychology of gender (pp. 31–47). New York, NY: Routledge. Levant, R. F. (2011). Research in the psychology of men and masculinity using the gender role strain paradigm as a framework. American Psychologist, 66, 762–776. Pleck, J. H. (1981). The myth of masculinity. Cambridge, MA: MIT Press. Pleck, J. H. (1995). The gender role strain paradigm: An update. In R. F. Levant & W. S. Pollack (Eds.), A new psychology of men (pp. 11–32). New York, NY: Basic Books.

Gender Role Stress Gender role stress is an umbrella term generally used to describe the perceived physical distress associated with violating male and female gender role stereotypes. The concept is most often studied in samples of men (i.e., masculine gender role stress) and grew from the original work of Richard Eisler and Jay Skidmore in 1987 examining men’s experiences of stress. Subsequent research has indicated that higher levels of masculine gender role stress have been associated with mental and physical health problems, as well as men’s violence toward women and gay men. This entry provides a brief overview of the original masculine gender

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role stress theory and key findings related to the construct. The entry concludes with an overview of extensions of the theory, including feminine gender role stress and subjective masculinity stress, and a synopsis of the debate in the literature regarding whether gender role stress is distinct from general stress.

Masculine Gender Role Stress Eisler and Skidmore first conceptualized masculine gender role stress in 1987. They defined it as stress generated from cognitively appraising a situation as demanding behavior that is contrary to masculine gender role expectations. This appraisal has two forms. In the first, the man perceives himself as being unable to behave in the manner expected for his gender. In the second form, he perceives the situation as requiring behavior that is regarded as feminine or unmanly. A key assumption of the theory is that men only experience gender role stress if they rigidly believe that men should not look, act, think, or feel in any way that could be considered unmanly or feminine. Otherwise, men would be able to violate such stereotypical male gender roles without experiencing stress. As such, researchers often use masculine gender role stress to identify men who are rigid and inflexible in their beliefs about what men are supposed to be and do. Masculine Gender Role Stress Scale

Masculine gender role stress is the most studied form of gender role stress and is measured using the Masculine Gender Role Stress Scale. Developed by Eisler and Skidmore in 1987, the questionnaire instructs men to indicate how stressful a certain event would be for them on a scale of 1 (not stressful) to 5 (very stressful), and thus, higher scores indicate more masculine gender role stress. The 40-item measure assesses masculine gender role stress in five different domains: (1) physical inadequacy, (2) emotional inexpressiveness, (3) subordination to women, (4) intellectual inferiority, and (5) performance failure. The first domain, physical inadequacy, is an inability to meet masculine physical standards such as strength or sexual prowess. For example, a man with high levels of masculine gender role

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stress in this domain would indicate that not being able to perform sexually would be a very stressful experience for him. The second domain, emotional inexpressiveness, relates to situations where men feel that they are required to express “feminine” emotions such as fear, love, or sadness. A man who scores high on emotional inexpressiveness may find it extremely stressful to express feelings of vulnerability. These men may also be more likely to channel their depression, which requires vulnerable emotional expression, into substance abuse, anger, and other externalizing behaviors. The third domain, subordination to women, reflects situations in which men feel they have less power than women. Men who score high in this domain find situations in which they cannot dominate women to be stressful. The fourth domain, intellectual inferiority, is when a man is in a situation in which his rational and decision-making capabilities could be questioned. A man who scores high in intellectual inferiority would find circumstances such as when someone calls him indecisive or he has to ask for directions to be extremely stressful. Finally, the fifth domain, performance failure, assesses stress from situations in which a man feels that he has failed either at work or sexually. Key Research Findings

Although the masculine gender role stress scale assesses five dimensions, most researchers combine all five into a total score indicating a general tendency to appraise situations that require violation of stereotypical masculine roles as stressful. Using this approach, investigators have found connections between greater levels of masculine gender role stress and a variety of interpersonal and intrapersonal problems. Mental Health Problems

Several studies have found that higher levels of masculine gender role stress are related to mental health problems such as depression and anxiety as well as greater use of problematic coping strategies, which can negatively affect mental health. Men who score high in masculine gender role stress also tend to report lower levels of perceived social support and less satisfaction with life. Masculine gender role stress theory suggests that these

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problematic mental health consequences are a result of men rigidly adhering to beliefs dictating male behavior that restrict their ability to effectively cope with life stressors. Physical Health Problems

Because masculine gender role stress is, in theory, a specific form of stress for men, several researchers have examined the possible health consequences of appraising situations that require one to violate male roles as stressful. Researchers have found that greater masculine gender role stress is associated with behaviors that can negatively affect physical health. In addition, men who score high in masculine gender role stress have demonstrated greater cardiovascular reactivity to tasks in which they have to prove their masculinity, compared with men who score low in masculine gender role stress. Masculine gender role stress theory explains these findings in two ways. First, similar to the argument for the negative mental health consequences of masculine gender role stress, researchers have argued that men who rigidly adhere to stereotypical beliefs about the male role have fewer options to be healthy because many positive health behaviors are considered unmanly (e.g., watching one’s weight). Second, investigators have explained men’s increased blood pressure during tasks that required them to prove their masculinity (e.g., holding one’s hand in a freezing bucket of water to demonstrate tolerance to pain) as a consequence of a fear of appearing unmanly. Hostile Attitudes Toward Women and Gay Men

Several studies have demonstrated connections between masculine gender role stress and hostile attitudes and behaviors toward women and gay men. For instance, laboratory studies of men’s reactions to women violating stereotypical feminine gender roles have found that men who score high in masculine gender role stress are more likely to act angrily and aggressively than men who score low in masculine gender role stress. Similar laboratory studies examining men’s reactions to gay men behaving sexually or expressing affection for each other have found that higher levels of masculine gender role stress are related to more angry and

hostile reactions. Masculine gender role stress theory suggests that men who rigidly adhere to stereotypical beliefs about what men are supposed to be and do are likely to become angry and feel the need to punish individuals who violate traditional gender roles. Intimate Partner Violence

One of the most researched areas within the masculine gender role stress framework is intimate partner violence (i.e., using or threatening to use physical, sexual, or psychological violence against one’s partner). Researchers have found connections between higher levels of masculine gender role stress and men’s acceptance of violence toward women. In addition, masculine ­gender role stress has been connected to different forms of intimate partner violence perpetration among samples of male batterers. According to masculine gender role stress theory’s explanation of these findings, men who rigidly adhere to stereotypical male roles funnel their vulnerable emotions in relationships into anger and violence. In addition, researchers have argued that men who score high on masculine gender role stress are hypersensitive to perceived cues of abandonment in relationships and may use violence and aggression to maintain a sense of power and control over their partners.

Extensions of Masculine Gender Role Stress Theory As a counterpart and extension to masculine gender role stress, Betty Gillespie and Eisler developed the Feminine Gender Role Stress Scale in 1992 to describe the reactions some women may have when faced with stressors that require them to violate stereotypical feminine gender roles. Like the masculine gender role stress scale, feminine gender role stress is measured through multiple domains: (a) fear of unemotional relationships, (b)  fear of physical unattractiveness, (c) fear of victimization, (d) fear of behaving assertively, and (e) fear of not being nurturing. Each of these domains assesses how stressful women would find hypothetical situations in which their fears of having to violate traditional feminine gender roles come to fruition.

Gender Role Stress

Feminine Gender Role Stress Domains

The first domain, fear of unemotional relationships, assesses stress from developing partnerships lacking in closeness or intimacy, including platonic, familial, and romantic relationships. The second domain, fear of physical unattractiveness, assesses the stress of developing or possessing unfeminine physicality, such as body hair or obesity. Also included in this domain is stress from failing to achieve feminine beauty standards. The third domain, fear of victimization, describes the stress of being a victim of harm or violence, particularly physical but also emotional or mental victimization. The fourth domain, fear of behaving assertively, describes the stress of engaging in situations that require interpersonal conflict. These situations may occur in a workplace environment, where a woman may be viewed as “bossy,” or in the context of a heterosexual marriage, where a woman opposes her husband. The last domain, fear of not being nurturing, describes the stress of failing to achieve traditional “mothering” or caregiver standards. These may include neglect of or not raising one’s own children, losing friendships, or deficits in one’s partner. Associated Findings

Feminine gender role stress often correlates with, or is even predictive of, mental illness. Research on the relationship between feminine gender role stress and mental illness has particularly focused on eating disorders. In one study, women with an eating disorder scored higher in feminine gender role stress, particularly in the domains of fear of nonemotional relationships and fear of physical unattractiveness. Investigators have also found that women with eating disorders have the highest levels of feminine gender role stress compared with women with other psychiatric disorders. Feminine gender role stress theory’s explanations for the associations with eating disorder pathology emphasize women’s self-conscious feelings and a tendency to shame themselves for not meeting the stereotypical standards of female beauty. Subjective Masculinity Stress

In 2013, Joel Wong and colleagues critically appraised masculine gender role stress theory and

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the Masculine Gender Role Stress Scale and noted that an important extension of the theory was warranted. Specifically, they created the construct of subjective masculinity stress, defined as stress associated with the subjective experience of being male. Unlike the Masculine Gender Role Stress Scale, which requires men to rank the stress they would experience in a variety of situations, the Subjective Masculinity Stress Scale requires men to write what it means to them to be a man and then indicate the degree to which those experiences are stressful. Thus, a key feature of subjective masculinity stress is that it taps men’s p­ersonal beliefs about what men should be and do and provides a window into how those beliefs create stress in a man’s life. Research using the Subjective Masculinity Stress Scale has found that subjective masculinity stress is uniquely related to psychological distress, even after statistically t­aking into account the contributions of masculine gender role stress and self-reports of general stressful experiences.

Gender Role Stress or General Stress: An Ongoing Debate One of the strongest criticisms of masculine gender role stress and feminine gender role stress is that the instruments used to measure these constructs may not be assessing stress resulting from gender role socialization. Instead, critics have suggested that each instrument may simply be assessing a tendency to experience stress in general. For example, critics have pointed out that the items measuring gender role stress for men stemming from losing one’s source of income may be biased because becoming unemployed would be stressful for anybody and is not necessarily a reflection of internalizing rigid male gender role expectations. In support of these criticisms, investigators have found that men do not always score higher than women on measures of masculine gender role stress. Researchers have also found that when women score high in masculine gender role stress (i.e., they report that various situations where one has to violate traditional masculine behaviors are stressful for them), they tend to have the same physical and mental health outcomes as men who  score high in masculine gender role stress. In  response to these criticisms, researchers have

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conducted a variety of investigations demonstrating that masculine gender role stress is related to men’s gender role socialization. For example, investigators conducted a multinational study and found that masculine gender role stress was significantly higher in countries with more patriarchal values compared with countries with more egalitarian attitudes. Ryon C. McDermott, Daniel McKelvey, and Matthew Kridel See also Gender Conformity; Gender Role Strain Paradigm; Masculinities; Masculinity Ideology and Norms; Violence and Gender: Overview

Further Readings Eisler, R. M. (1995). The relationship between masculine gender role stress and men’s health risk: The validation of a construct. In R. F. Levant & W. S. Pollack (Eds.), A new psychology of men (pp. 207–225). New York, NY: Basic Books. Eisler, R. M., & Blalock, J. A. (1991). Masculine gender role stress: Implications for the assessment of men. Clinical Psychology Review, 11(1), 45–60. doi:10.1016/ 0272-7358(91)90137-J Moore, T. M., & Stuart, G. L. (2005). A review of the literature on masculinity and partner violence. Psychology of Men & Masculinity, 6(1), 46–61. doi:10.1037/1524-9220.6.1.46 Wong, Y. J., Shea, M., Hickman, S. J., LaFollette, J. R., Cruz, N., & Boghokian, T. (2013). The Subjective Masculinity Stress Scale: Scale development and psychometric properties. Psychology of Men & Masculinity, 14(2), 148–155. doi:10.1037/ a0027521

Gender Roles: Overview A gender role is the set of functions and attributes that a society considers to be appropriate for a person of a particular gender to perform. A gender role may best be explained by using the metaphor of a stage play. People express their gender, whether the gender is freely chosen or imposed by society, in the particular part they play in their society. One’s gender role comprises a variety of components that are manifested through one’s

interpersonal relationships, dress, occupation, and behavior. However, gender roles in society are extremely complex and involve many interrelated expectations for personal and collective behavior in all areas of life and have wide-reaching effects on the individual and society. Gender roles are understood by some as largely socially constructed, without significant correlation to one’s biology. If this is the case, then it may be possible for gender roles to be modified. However, some would argue that the roles are at least to some extent biologically determined. For example, the traditional gender role expectation that men should work in industries in which heavy equipment needs to be lifted may be related to the greater physical strength that men in general have. Also, hormones that are different in males and females can affect an individual’s behavior. However, advances in technology in more modern societies can allow individuals more flexibility and fluidity in their gender roles. This entry discusses various theories of gender roles, with a focus on the historical context, the negative effects, early socialization, the media, school, work, parental roles, and the transgression of gender.

Historical Context Many researchers believe that gender roles originated with the societal division of labor, perhaps based on the necessities involved in women’s childbearing and nursing. With the Industrial Revolution in the West, these gender roles took the form of women’s taking on the household labors and men engaging in the more societally valued labors outside the household. This division of labor then tended to determine the gender roles assigned to men and women. Women would need to be more concerned with people (e.g., providing care for the children) and relationships, whereas men would need to be more concerned with taking action (e.g., competing in the work world). However, the contemporary world is fundamentally different from the world in which the traditional gender roles took shape. Although change in long-­standing social categories and expectations tends to lag far behind social reality, it is increasingly the case that people’s gender role conceptions have needed to adjust to current times.

Gender Roles: Overview

Negative Effects As individuals grow up in society, they may come to recognize that different gender roles afford different privileges, opportunities, and resources. In many ways, individuals’ chosen romantic relationships, career paths, and even physical and psychological well-being are affected by the gender roles they adopt or do not adopt. In some respects, one’s gender role may support one’s personal selfexpression and identity. Researchers Pamela Frome and Jacquelynne Eccles have shown how one’s self-esteem is higher to the degree to which one’s gender identity conforms to socially approved gender qualities. On the other hand, there may be negative effects of taking on gender roles. For example, women in general tend to have a greater incidence of depression and anxiety than men, although men have a higher incidence of suicide. Women are more concerned with weight-related body image issues, which can lead to serious problems such as eating disorders; however, men have been found to have much greater anxiety and depression related to muscularity-related body image issues, which can lead to steroid use. Even though gender roles can have negative effects on men as well as on women, many feminists believe that the gender roles prescribed by society are constrictive of women’s freedom and reproduce the domination of women by men (i.e., social patriarchy). Many people, if not all, hold stereotypes about others in their society as a way to simplify the task of understanding a group of people. However, when considering the variation in attributes and abilities between the traditional gender roles for men and women, it is important to keep in mind that the differences between individuals irrespective of gender are much greater than gender-based differences. In many instances, gender stereotypes influence gender role expectations in such a way as to have a negative impact on those who are stereotyped. Women in society may be stereotyped as dependent, submissive, weak, irrational, and overemotional. Social psychologist Geert Hofstede sums up this gender role difference with the terms male assertiveness and female nurturance. Carol Gilligan has argued that girls and women are concerned with maintaining and developing their relationships and their capacity for caring.

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Boys and men, in contrast, are more concerned with their independence from others and their personal success. Adolescent girls and women may thus tend to “self-silence” as a result of the dominating expressions of adolescent boys and men. Women also may be treated as sexual objects rather than taken seriously in terms of their intellectual and other competencies. These stereotypes influence others’ expectations of girls and women and of what thoughts, behaviors, and social and economic positions they are suited for. This traditional role in many ways provides inferior social and economic status opportunities when compared with the opportunities of the traditional masculine role. Women who defy this traditional gender role, and adopt a more masculine gender role, are likely to be perceived negatively, often by men as well as by traditionally gendered women. However, David Guttman has stated that after their children leave the household, the gender role expectations of women become less rigid; the mother may take on a more androgynous gender identity.

Early Socialization Parents who hold stereotypes about gender roles will raise their children to conform to these roles. In being raised to take on the traditional gender role, girls are taught to think about others’ wellbeing first and to nurture and care for them. Parents have been found to describe their day-old infants in terms of gender stereotypes such as “Boys are ‘strong,’ and girls are ‘delicate.’” This tendency translates into parents’ child-rearing practices. Parents dress their children differently based on gender; for example, pink clothing and dresses are encouraged for girls but not for boys. In this case, gender is literally color coded to make it easy for young children to perceive. The hairstyles that parents choose also are different based on gender. However, often adults’ gender role “casting” of children may be more subtle. For example, parents may have negative reactions to children playing with toys that are “inappropriate” to their gender role. In addition, girls are likely to be discouraged from playing rough games but encouraged to play with cooking toys. It is then not surprising that

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children as young as 3 years old have stereotypes about gender. According to cognitive development theory, by this age, the child has learned to selflabel as a girl or boy and has awareness of gender role expectations. The impact of differentiating functions based on gender leads to anticipation of gender differentiation of labor in the work world as parents assign children different chores based on gender. Researcher Sandra Bem’s gender schema theory holds that individuals process gender-related information about their society through what she calls gender schemata. Generally, a schema is a cognitive structure that groups together and organizes several entities on the basis of common features and the relationships among them. A schema allows for certain types of information to be assimilated. A child from a very early age begins to ­categorize on the basis of sex and gender. These perceived patterns develop over many situations into a more robust gender schemata. The child uses these cognitive structures to detect in the social environment those behaviors and characteristics that are gender appropriate to the child. In this way, gender becomes an integral part of the child’s self-concept. If the social milieu is strongly gender “typed” (e.g., traditional gender roles are taken on by males and females), the child is likely to come to see gender roles as rigid rather than fluid, and this will influence the formation of the child’s gendered self-concept. The child then uses this understanding to process further information and to make decisions about their comportment within society. Thus, the child is presented with gender role categories from an early age and has to make individual choices about their own gender identity and how these relate to the gender roles that are offered by society. The child attempts to further substantiate the societal meaning of the gender self-label by observing the behavior of others of the same gender, such as their mother, teacher, and same-sex peers. Nancy Chodorow argues that because woman have tended to provide the majority of care for their children, children are likely to develop conventional gender role characteristics. The mother may tend to identify with the daughter over the son. Some research has shown that mothers attend

more readily to their daughters’ expressions of emotion than to those of their sons. The mother then encourages the son to separate from her in terms of his psychological development. (A related finding is that fathers, who traditionally display independent attitudes and behaviors, devote more time engaging with their sons than with their daughters.) According to Chodorow, the boy develops a strong ego boundary and the girl develops a “fuzzy” ego boundary. Thus, women stereotypically would become emotionally invested in others, whereas men would become detached, and both would approach relationships and professions accordingly. Eleanor Maccoby believes that children today learn more about their genders from their peers than from adults. As children are grouped together by sex and engage in patterns of play that are distinct with respect to gender, they are learning about their society’s gender role expectations.

Media Media may include a wide range of communication channels including films, television shows (e.g., news shows, sitcoms), web content, popular music, newspapers, advertisements, magazines, and books. Many children’s movies, television shows, and books tend to show boys and men as aggressive, “take-charge” explorers, with girls and women as their helpers. Because children spend enormous amounts of time consuming various forms of electronic and print media, these depictions may have a significant influence on children’s attitudes. To take one example, Disney movies have long been criticized for portraying men and women in stereotyped gender roles. Since the 1980s, in movies such as Pocahontas and Tangled, Disney has attempted to address these feminist criticisms by portraying the female characters as strong, self-assertive, and independent rather than as weak and needing to be rescued by the heroic man. Gender socialization through media consumption can in no way be said to stop at childhood. As philosopher Simone de Beauvoir (and others since) have argued, gender is something that develops over time. Betty Friedan argued in the 1960s that magazine and advertising images help create the feminine ideal at various stages in a

Gender Roles: Overview

woman’s life (e.g., girl, teenager, mother, housewife). Until the 1990s, adult women were typically represented in television advertising in gender stereotypical roles—that is, as inactive mothers inside the home or as sexual objects, without knowledgeable opinions of their own and submissive to men. In many ways, such images can serve to legitimize the subordination of women by men in society. Due in large part to public criticism of these stereotypes, in the 1990s, women were portrayed in television advertising as more active and independent. Similar changes of depiction have occurred in an increasing number of television shows since the 1980s—for example, television drama series such as Cagney and Lacey, Prime Suspect, and The Good Wife. Such depictions have themselves been criticized for putting pressure on the woman to fulfill a new working woman role while still needing to play the traditional homemaker role. Advertising continues to depict women with ideal body types, which are nearly unattainable by most women. Such images can have negative effects on women consumers of the media. Nevertheless, changes such as that by Disney movies and television advertising and programming since the 1980s show that it is possible to put pressure on media producers to counter gender role stereotypes.

School In school, teachers tend to provide positive feedback to girls for their cooperation, cleanliness, and obedience. However, such positive experiences of girls may have a more negative influence on girls’ development than on boys’. Teachers do not tend to be as concerned with the academic and intellectual accomplishments of girls, whereas they tend to encourage boys in this regard. Often, girls are expected by teachers to be quiet and passive, whereas boys are encouraged to be active. Math teachers have been found to give boys the latitude to figure out alternative solutions to problems and expect girls to adhere instead to the rules more closely. Boys are far more likely during class time to be assertive and call out, and these boys’ questions are more likely to be answered by teachers, whereas girls who call out questions are more likely to be told to wait until they are called.

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Gender roles can influence one’s performance in certain activities and can thus determine one’s selfconcept and career path. Stereotype threat is the negative influence of a society’s stereotype of the group on the performance of a member of that group. Stereotype threat may have an influence on at least some children with respect to gender. Even young girls in elementary school have been found to hold the belief that mathematics is a subject that boys, and not girls, should be interested in. This gender stereotype may negatively influence girls’ school performance in mathematics. This low performance may then be perceived by the girl (and others) as evidence of the stereotype and may determine the girl’s later interests, activities, and career decisions. Jean Lipman-Bluman conducted a study that found that girls who grow up with traditional gender role expectations are more likely to refrain from seeking high levels of education than those raised in environments where men and woman are considered equal. As they approach adolescence, boys may experience various negative impacts of gender roles (e.g., being expected to fight with other boys in school). Boys of this age are increasingly expected to affirm their masculinity and to eschew any feminine attributes, behaviors, and activities. Boys may be taunted, ridiculed, or socially excluded by peers for behaving like a girl. In contrast, preadolescent girls may have more flexibility in terms of their gender expression. Adolescent boys tend to be focused on career goals, whereas girls may in addition be concerned with issues involved in having close relationships. In adolescence, there are early indications that girls who identify with society’s traditional gender role for young women are oriented toward finding a husband who can provide for children. Adolescent girls tend to be less oriented to personal self-­ development and more oriented toward their appearance so as to be attractive to males. In an attempt to fulfill their gender role, girls may not strive to excel or have a career in the stereotypically nonfeminine STEM fields (science, technology, engineering, and math). In middle school and high school, boys tend to take computer, science, and mathematics classes (often taught by men) more so than girls. If they go on to college, girls’ lack of background in these areas will influence their choice of their major.

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Work The traditional gender role of housewife or homemaker had for many generations kept women completely out of the work world. As women take on the role of working woman—often without ­giving up the role of homemaker—gender stereotypes and rigid gender role casting continue to have negative effects. There are any number of examples in which a person may have an immediate, almost reflexive response to an occupational gender role question such as “Is it more appropriate for a woman to be a nurse or a doctor?” or “Should a woman be the leader of a project or organization, or should she be the assistant to the leader?” These occupational stereotypes have a serious and significant psychological and economic impact on the worker. However, such stereotypes may increasingly come to be challenged by the changing socioeconomic reality of gender. For example, in the United States, as more women participate in the workforce, the stereotype that women are best suited to the role of unpaid housewife will come under more pressure to adapt to the reality. The breadwinner role is less reserved for men. One subtle deleterious effect of the changing gender roles in many contemporary societies is the need to play two roles: (1) caregiver at home and (2) successful woman in the workplace. A great deal of stress is put on the woman who “tries to do it all,” and often, one role must be sacrificed for the other. However, phenomena such as the glass ceiling effect, in which women are kept, without any acts of overt oppression, from achieving the positions of highest status in the work world, despite their qualifications, are still in effect. Such phenomena are largely a result of the stereotypes and expectations of those currently in positions of power. Leaders may be expected to have a stereotypically masculine leadership style, involving a tough-minded and aggressive speaking style and decision-making behavior. Women still often work in lower-status jobs more than men. There has long been a gender wage gap, in which women receive less pay for equal work, and in some places, such as the United Kingdom, this appears to be closing. However, since the mid-2000s, in the United States., the gap has remained the same, with women on average earning 78% of what a man makes. Moreover, many

women are victims of workplace mistreatment, including incivility and sexual harassment. In another example of disparity between genders, older men are perceived as capable of taking on leadership roles of increasing power much later in life than women, who are often viewed negatively in terms of their role in society as they age. Men may also face new difficulties as gender roles change. Even though stay-at-home fathers in the United States are on the rise, U.S. society still has an overwhelming preference for the mother to be the caregiver in the home. Furthermore, men are not likely to have paternity leave at their jobs.

Parental Roles In the family, the wife is most likely to arrange and coordinate social events and broader family communication and interaction. Married men and women may have difficulty communicating due to adhering to traditional gender roles. For example, a man may have been taught to believe that he should be a “sturdy oak” and not openly express his feelings. Men may not be comfortable expressing empathy, compassion, vulnerability, and s­ imilar emotions. Moreover, men tend not to be as attuned to nonverbal communication and behaviors as women. This traditionally masculine communication style would affect not just interactions with his spouse but also those with his children and with his wider circles of friends and family. Talcott Parsons held an interactionist theory in which people dynamically worked out between themselves the nature of their roles rather than simply adhering to given roles. In analyzing the U.S. nuclear family, he provided two extreme ­models of gender roles, across many areas of life in the United States (e.g., educational attainment and provision, career choices, family decisions and duties). At one extreme, the roles were totally separated between men and women. At the other, the roles were completely integrated, such that there was no difference in functions, opportunities, and goals for men and women. Contemporary views of gender roles within the family have shifted largely due to economic conditions and to the evolution of the “nuclear” family. For example, it is not feasible for many families to have one person in the workforce (traditionally the man) and one person at home to take care of the

Gender Roles: Overview

household and children (traditionally the woman). Furthermore, with an emphasis on education in the United States and around the world, more women are graduating college and going on to graduate school. Consequently, many wives are now earning more than their husbands, which can cause a shift in household responsibilities and subsequent gender roles. For example, there are more stay-at-home fathers now than ever before. Moreover, family composition has evolved to include single-parent families, blended families, and samesex couple families. Therefore, male and female gender roles within the family have become more fluid and sustainable.

Transgressing Gender The discussion herein of traditional gender roles and the strain they are under due to pressure from changes in social reality has emphasized the traditional Western view of gender dimorphism. This is the view that there are only two genders: man and woman. Nevertheless, this traditional gender ­normative view has been challenged by those who see the possibility of transgressing this dichotomy in some way. Bem stated that it is a mistake to consider anyone to be completely masculine or completely feminine in gender. Often people could have both sets of qualities or, conversely, could have few of these gender qualities, whether masculine or feminine, and be considered “undifferentiated.” Such androgynous or undifferentiated ­people may consider themselves (or be considered) transgender. This would be a nontraditional gender expression (in Western societies). The term transgender was coined by Virginia Prince in discussing changing one’s gender without necessarily changing one’s natal sex, yet the term has taken on a wider connotation. This perspective considers gender to be a continuum, with many areas along it that can be occupied by someone, and not necessarily in a fixed way. (Philosopher Judith Butler emphasizes this fluidity of gender, which she believes should not be viewed as a fixed characteristic of someone but, rather, as something that one performs.) Those with a transgender identity might self-identify as third gender, intergender, bi-gender, or genderqueer but could also be transsexual or intersex. In fact, the term gender role is credited to John Money, who used the term not in

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studying the traditional sexes of male and female but in observing the gender expressive behaviors of those with no traditional sex—that is, intersex people. Drag queens and drag kings are an example of transvestites (derived from the Latin for “across” and “clothing”) or cross-dressers, which would not involve being transsexual. Such transgender identities, values, beliefs, and behavior call into question many stereotypes about societal gender roles. As more people reject the rigidity of dimorphic roles, society’s gender expectations may need to become more flexible.

Conclusion Over the course of their lives, individuals find out about society’s gender roles from their families, school, the media, and work. An individual’s gender identity (whether intentionally chosen or not) may differ from the gender role society indicates is appropriate for the individual to play. Whether we adopt them, resist them, or reject them, these gender roles shape our perceived possibilities as gendered human beings within society and exercise a powerful influence in every domain of our lives. Gina C. Torino See also Bem Sex Role Inventory; Cultural Gender Role Norms; Gay Men and Gender Roles; Gender Nonconforming Behaviors; Gender Role Behavior; Gender Role Conflict; Gender Role Socialization; Gender Role Strain Paradigm; Gender Role Stress

Further Readings Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88(4), 354–364. Butler, J. (2006). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Kerr, B. A., & Multon, K. D. (2015). The development of gender identity, gender roles, and gender relations in gifted students. Journal of Counseling and Development, 93(2), 183–191. Valiente, C., & Rasmusson, X. (2015). Bucking the stereotypes: My Little Pony and challenges to traditional gender roles. Journal of Psychological Issues in Organizational Culture, 5(4), 88–97.

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Wood, J. (2010). Gendered lives: Communication, gender, and culture. Stamford, CT: Cengage Learning. Yip, P. S., Yousuf, S., Chan, C. H., Yung, T., & Wu, K. C. (2015). The roles of culture and gender in the relationship between divorce and suicide risk: A metaanalysis. Social Science & Medicine, 128, 87–94. doi:10.1016/j.socscimed.2014.12.034

Gender Segregation Gender segregation refers to the separation of girls and boys into same-gender groups. In childhood, boys and girls demonstrate a preference for samesex playmates, resulting in gender-segregated play in public contexts. Gender segregation is generally thought to be voluntary and initiated by both boys and girls starting in early childhood. Gender segregation is viewed as contributing to gender socialization. As a result of gender segregation, boys and girls have different experiences, and through gender-segregated play, girls and boys develop different communication patterns and interpersonal skills. Thus, gender segregation contributes to the construction of gendered behavior and potentially promotes gender power differences and gender inequalities. Gender segregation may contribute to gender adversity and gender antagonism. Possible causes of gender segregation are examined in this entry. Gender segregation has been observed in cultures around the world, but the ages of segregation and the rules and rituals related to segregation vary across cultures. In the United States, the style and competitiveness of play differ in gender-segregated playgroups. Gender segregation continues in some contexts into adulthood.

Gender Segregation Observed Preference for same-sex playmates has been observed starting in early childhood. Theorists have suggested that segregation is a naturally occurring pattern that results from a phase in children’s development. However, differences in the timing and rigidity of gender segregation in various sociohistorical contexts suggest that segregation is the result of more than biologically based phases in children’s development.

Gender segregation is at least partly the result of social and cultural factors. Spontaneous segregation was originally observed as occurring at the age of 5 years. However, in recent years, gender segregation is observed earlier, beginning at the age of 2 years. One explanation for this earlier emergence of gender segregation is children’s attendance at day care. Gender segregation is more likely to be observed in a day care or school setting than at home or in the neighborhood. In a school setting, there are large numbers of children, whereas in many neighborhoods, there are not enough potential playmates to allow gender segregation. Furthermore, at school, the child’s behavior is open to the observation and comment of other children and adults, and there may be more social pressure for segregation. A number of institutional and interpersonal cues present in school settings may contribute to children’s understanding of gender as an organizing principle, and the endorsement of gender segregation. For example, in school, children use gendered bathrooms, and boys and girls are often assigned different (colored) storage boxes or lockers, different spaces for nap time, and different (gendered) lines or times for lunch. At the minimum, teachers may call the students “boys and girls,” and in a more gendered context, teachers may make clear gendered pronouncements such as “Those cars are for boys to play with” or “The girls do a good job of cleaning up their work space.” In many schools, toys are separated into different corners of the room, implying gender segregation, and in some schools, boys and girls are assigned different play spaces. Some form of gender segregation has been observed in varied global contexts and across ­cultural and ethnic groups. However, there are differences in the age when segregation occurs, the rigidity or flexibility of the segregation, and the degree to which segregation is enforced by adults or peers. Generally, it appears that gender segregation is constructed and negotiated by a peer culture within a larger community. Observation is a method used to study gender segregation in children. Other methods include asking respondents about friends and friendship preferences; sometimes, time surveys are used to assess how much time is spent with same- and other-gender friends.

Gender Segregation

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Gender as Difference

School children often segregate in their play. In the mid-1980s, Barrie Thorne, a sociologist, reported on extensive observations of children on playgrounds and reported on the segregated play she observed. Boys and girls play differently in their segregated groups. Boys are more ­physical. Boys play in larger groups and typically play organized games of ball. Boys have networks of friends to call on for a game of ball. Boys are more competitive, confrontational, and risk taking. Girls’ play typically involves smaller groups, even dyads, and tends to be more sedentary. Girls often play games that involve turn taking and more democratic play. Girls are more self-disclosing and share opinions, experiences, and secrets. Gendered play affects friendship patterns and interactions. Girls’ friendships are organized around talking, disclosure, and sharing secrets. Girls learn interpersonal skills, which they prefer over physical aggression. Boys’ friendships are organized around sports; there are hierarchies within teams, and competition occurs both within the team and against other teams. Within boys’ networks, there may be teasing and name-calling. In childhood, gender segregation is practiced primarily in relation to play. The play styles of boys and girls are an important dimension of gender segregation. When playing alone, children have been observed to play similarly, whereas when children play in groups, the play styles of boys and girls diverge. Segregation is most likely to occur on the playground, at recess, in relation to recreation, and in after-school programs and sports. Girls who are active, physical, and interested in boy’s activities and sports have sometimes been observed to gain entry into boy’s playgroups; over time, they may produce their own gender-segregated groups of tomboys/girls. Some research suggests that both the physicality and the competitiveness of boys’ play are important factors in gender segregation. Young girls report separating themselves from the rambunctious play of boy peers. Others argue that segregation is motivated by sex differences in body size, physical activity, and competitiveness. According to this perspective, boys differentiate themselves from girls through physical and competitive play.

Gender segregation contributes to the construction of gender and results in boys and girls having different experiences in childhood. To some extent, the degree to which adult men and women are different, and have different interests, is the result of childhood sexual/gender segregation. Theory and research suggest that girls and boys develop different ways of relating and communicating with peers in their early segregated friendship groups. The differences in gender-segregated play have been cited as the basis for adult communication and relationship problems between men and women. Alternatively, the homosocial masculine world, in which boys and young men have limited contact with girls and women, has been seen as (re)producing stereotypes of girls and as contributing to male rejection of the feminine. Some have argued that gender-integrated teams and sports may help decrease socionegative outcomes and gender antagonism.

Gender Segregation and Male Dominance Some theorists suggest that boys learn dominance strategies in all-boy playgroups. Boys’ groups emphasize solidarity and the derogation of outsiders. Boys celebrate gender segregation by taunting boys who associate with girls and boys who do not like sports. They also tease girls and make jokes about romantic/sexual attraction. Boys police the boundaries between the gendered groups and encourage antagonism between the genders. Girls rarely tease tomboys or voice antagonism toward boys.

Gender Chauvinism and Antagonism According to cognitive developmental theory, gender segregation corresponds to and generates ­children’s construction of both gender roles and gender identity. As a child begins to label activities and objects as being for boys or for girls and develops an awareness of themselves as a boy or girl, values become attached to activities connected with one’s own gender, and one’s own gender is considered superior to the “other.” For example, boys have cooties, and girls rule. This aspect of

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gender segregation, gender competition, and g­ ender antagonism is exacerbated by the games sometimes initiated by teachers and other adults—­pitting girls against boys. Gender antagonism may continue into adulthood and may be the basis for gendered violence.

Gender Segregation in Adolescence In adolescence, there is a change in the time spent in gender-segregated groups as many boys and girls develop an interest in heterosexuality. However, gender segregation continues in many contexts, and most youth have more same-gender friends than other-gender friends. In adolescence, others (e.g., teachers, parents) may reinforce or insist on gender segregation. Some theorists argue that childhood gender segregation contributes in important ways to girls and boys developing differences and learning social roles, which lead to the enactment of male and female reproductive roles. Others have demonstrated an association between a preference for same-gender friends in adolescence and subscribing to sexist attitudes. As in childhood, there is variability among individuals in the experience of gender segregation.

Other Forms of Gender Segregation There are many ways in which adults continue to practice and experience gender segregation. Research confirms that many college majors and classrooms are highly gender segregated (e.g., science, technology, engineering, and mathematics) as students prepare for occupations that remain gender segregated. Gender segregation contributes to the gender pay gap and to the experience of stereotypes and sexual harassment in the workplace. Gender segregation in childhood is suggested as a factor in the maintenance of the gender-segregated workforce. Many people demonstrate adult preferences for  same-gender friends and belong to gender-­ segregated social circles and clubs (e.g., the Moose, a male bowling league). In some groups, couples may have couple friends, but social custom prohibits other-gender friendships. Even within genderintegrated contexts, individuals may separate into same-gender groups (e.g., Thanksgiving dinner in a large Italian family). Less research and theory have

been focused on the degree and the consequences of gender segregation in adulthood.

Gender Nonconformity Gender segregation is based on the gender binary and contributes to conformity to binary gender roles. Segregated play and friendships serve to inform boys and girls about gender appropriate behavior. Depending on the context and the community, cross-gender play and friendships may or may not be tolerated. Girls who are tomboys are generally accepted and even admired, and until adolescence, they frequently find acceptance with boys. Children are more likely to have ­cross-gender friendships in their home neighborhood than at school. School harassment is frequently gender based. Boys who do not enact masculine roles and engage in sports are frequently the target of gender harassment. Gender segregation presents a problem for transsexual and gender nonconforming i­ ndividuals. Bullying and harassment of all kinds disproportionately affect lesbian, gay, bisexual, and transsexual students, in particular gender ­nonconforming students in the younger grades and transgender students in the older grades. Transgender is an umbrella term used to describe people whose gender identity—one’s inner sense of being male or female—differs from the sex assigned to them at birth. Gender nonconforming people are people whose gender expression—the outward communication of gender through behavior or a­ ppearance— differs from expectations associated with the sex assigned to them at birth. Transgender girls are people who were assigned the sex of male at birth but identify as female. Transgender boys are people who were assigned the sex of female at birth but identify as male. Increasingly, research has indicated that reliance on gender segregation in our public spaces harms transgender and gender nonconforming people. Eliminating sex segregation of facilities can significantly decrease violence. Other suggestions include not overemphasizing the gender binary; for example, do not have students line up as boys and girls, and do not separate students by gender for certain activities. De-­ emphasizing the gender binary may not only accommodate gender nonconforming youth but also reduce gender antagonism and gender-based

Gender Self-Socialization

violence. Educators and sports and public officials are advised not to assign transgender youth to the girls’ or boys’ units strictly based on the sex assigned to them at birth; rather, they should make individualized, case-by-case decisions based on the physical and mental well-being of the youth, their level of comfort and safety, and the degree of privacy afforded. The origins and the advisability of gender segregation have been increasingly questioned, and increased acknowledgment of gender nonconforming individuals has contributed to challenges to the practices and policies of gender segregation. Maureen C. McHugh See also Bullying, Gender-Based; Child Play; Cognitive Approaches and Gender; Gender Role Socialization; Gendered Behavior; Masculinity in Adolescence; Men’s Friendships; Women’s Issues: Overview; Workplace Sexual Harassment

Further Readings Blackburn, R. M., Browne, J., Brooks, B., & Jarman, J. (2002). Explaining gender segregation. British Journal of Sociology, 53, 513–536. Leaper, C. (Ed.). (1994). Childhood gender segregation: Causes and consequences. San Francisco, CA: Jossey-Bass. Maccoby, E. E. (1998). The two sexes: Growing up apart, coming together. Cambridge, MA: Belknap Press. Mehta, C. M., & Strough, J. N. (2009). Sex segregation in friendship and normative contexts across the life span. Developmental Review, 29, 201–220. Mehta, C. M., & Strough, J. N. (2010). Gender segregation and sex typing in adolescence. Sex Roles, 63, 251–263. Thorne, B., & Luria, Z. (1986). Sexuality and gender in children’s daily worlds. Social Problem, 33, 176–190.

Gender Self-Socialization Beginning in early childhood, individuals become aware of their membership in a gender category; how this knowledge affects their personalities, selfconcepts, and social behavior is a question that is of interest to many developmental psychologists. An enduring view is that gender identity—thoughts

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and  feelings about one’s membership in a gender ­category—motivates children to incorporate gender stereotypes into their self-concept (gender stereotype emulation). Self-perceived gender-typed attributes are also believed to shape the development of gender identity in children (gender identity construction). Furthermore, gender identity is thought to influence the learning of gender norms and stereotypes (gender stereotype construction). The common feature across these three processes is that children’s gender cognitions are conceived as the driving force, rather than external socialization agents (e.g., parents, peers). Collectively, these processes are often referred to as gender self-socialization.

Gender Cognition Constructs Three constructs are key to understanding the gender self-socialization processes: (1) gender identity, (2) gender stereotypes, and (3) attribute self-­ perception. Gender identity refers to the association individuals make between the self and a ­gender category—for example, “I am a boy,” “I am like other boys,” or “I like being a boy.” Gender stereotypes refer to the association individuals make between a gender group and an attribute— for example, “Boys are aggressive” or “Boys are good at math.” Attribute self-perception refers to the association individuals make between the self and an attribute that they (or others) believe differentiates the genders—for example, “I am aggressive” or “I am good at math.” Gender Identity

Gender identity is a multidimensional construct and comprises the following components: (a) membership knowledge (i.e., knowing whether one is a boy or a girl), (b) gender contentedness (i.e., satisfaction with one’s gender), (c) felt pressure for gender conformity (i.e., internalized pressure to avoid gender-atypical behavior), (d) gender typicality (i.e., similarity to others of one’s gender), and (e) gender centrality (i.e., the importance one places on gender in one’s self-concept). These dimensions are fairly stable and presumably reflect aspects of personality. Membership knowledge varies in preschoolers, but by the age of 7 years, most children report that they have a stable sense of their identity as a boy or a girl. Gender contentedness and felt

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pressure for gender conformity begin to develop in the preschool years after intergroup cognitions (e.g., in-group favoritism and out-group denigration) are established. Many children feel strong gender contentedness into middle childhood and derive self-worth from it. Felt pressure for gender conformity declines with age and is consistently linked with internalizing problems, especially in girls. Gender typicality develops in middle childhood and is a source of comfort to children and adolescents (partly because it is rewarded with peer acceptance). Gender centrality is high in preschoolers and declines with age, although individual ­differences are seen even in middle childhood. Gender Stereotypes

Gender stereotypes are beliefs about how males and females differ (descriptive stereotypes) or should differ (prescriptive stereotypes). Usually, by the age of 3 years, children are aware of gender differences in toys, activities, and clothing, for example, and are beginning to internalize these stereotypes and thus tend to view these gender norms as moral imperatives that must be rigidly adhered to. Once children attain gender constancy and an understanding that their gender is permanent and will not change (usually around the age of 6 years), they become more flexible in their gender stereotypes (i.e., they understand that even if an activity is more commonly performed by members of one sex, that does not preclude members of the opposite sex from engaging in it). Traditionally individual differences in children’s gender stereotypes were assessed using lists of male/female-typed attributes (e.g., “Girls play with dolls”; “Boys don’t cry”). To assess their stereotype knowledge and flexibility, children were asked whether the stereotyped attribute is appropriate for both sexes or only for one sex. However, this approach is problematic as it only indicates the number of stereotypes that are known or endorsed by the child, while ignoring the child’s personal/ idiosyncratic stereotypes. For instance, two children might endorse the same number of stereotypes, but they may vary in the specific attributes that they personally endorse. Focusing on sets of specific attributes has helped overcome this problem as it enables researchers to assess both stereotypes as well as

self-perception with respect to a specific attribute. Using a set of attributes allows researchers to determine the importance of each attribute relative to the others, as well as better understand contextual qualifiers (e.g., “Girls do X more than boys in Situation A but not in Situation B”). Similarly, self-attribute associations can also depend on the context (“I do X in Situation A but not in Situation B”). Thus, context-specific stereotypes can translate to context-specific self-guides, thereby contributing to situational specificity in observed behaviors. Attribute Self-Perceptions

Attribute self-perception refers to the association individuals make between the self and an attribute that they (or others) believe differentiates the genders. At a basic level, it could characterize the self (e.g., “I am X”), but it could also assess self-perceptions along other dimensions including importance/salience (e.g., “Being X is important to me”), interest (e.g., “I enjoy X”), self-guides (e.g., “I should do X”), and behavioral intentions (e.g., “I am going to do X”). Just as gender stereotypes can be context dependent (e.g., “Boys should pay for dates”), similarly s­elf-perceptions can also be context dependent (e.g., “When I am with my boyfriend, he should pay”); thus one’s overt behaviors are often influenced by these self-perceptions. The gender self-socialization paradigm uses these three constructs (i.e., gender identity, gender stereotypes, and attribute self-perceptions) as building blocks and discusses how each of these constructs is also a product of the cognitive interplay between the other two variables—namely, gender stereotype emulation, gender stereotype construction, and gender identity construction.

Gender Stereotype Emulation The gender stereotype emulation perspective of the gender self-socialization model posits that gender identity and gender stereotypes collectively affect attribute self-perceptions. The more children identify with a gender collective (gender identity), the more likely they will be to perceive in themselves the attributes they view as more typical of, or desirable for, persons of that gender. Stereotype emulation may begin once children attain basic

Gender Self-Socialization

gender identity around the age of 3 years, an age when children’s self-concepts typically consist of gender normative ideas. As children grow older, however, two important developmental changes occur. The first is the emergence and stabilization of individual differences in the various aspects of gender identity as children begin to exhibit variations in their profiles for g­ender contentment, felt pressure, and gender typicality. The second change that occurs is the development of individual differences in descriptive as well as prescriptive ideologies and stereotypes. Eventually, these two sets of cognitions combine to shape  a cognitive system that guides children’s self-­perceptions of specific attributes. Although the motivation of children’s emulation of internalized stereotypes is the prime role of gender identity, due to the individual variations seen in children’s stereotypes, the specific attributes influenced by gender identity vary among children of each sex. For instance, gender contentedness might encourage one boy to adopt macho, assertive, risk-taking behaviors but lead another to pursue math or sports; felt pressure might cause one girl to avoid math and science and another to avoid assertive behavior, perhaps especially with boys or men. These ideas are consistent with research findings indicating that different children of the same sex may adopt different sex-typed behaviors.

Gender Stereotype Construction The gender stereotype construction perspective of the gender self-socialization model postulates that children project their own attributes onto a gender collective to the extent that they identify with the collective (e.g., “I am friendly and I am a typical boy, so boys are friendly”). This view focuses on the interactive influences of gender identity and self-perceptions of attributes on gender stereotypes. This perspective is consistent with research that indicates that people often project their own socially desirable as well as socially undesirable attributes onto the groups to which they belong. Similarly, research also suggests that children sometimes use their own behaviors and preferences to form stereotypes. For instance, when children are shown novel items and asked how much they like each item and how much other boys/girls

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would like them, research findings indicate that children often attribute their own preferences to same-sex others. This suggests that both descriptive as well as prescriptive stereotypes may trace their genesis to the self-perceptions of attributes. Furthermore, gender identity should influence the direction and strength of people’s tendencies to project their qualities onto gender groups. Although most people would be expected to project primarily onto their same-sex collective, individuals with a weak gender identity may not demonstrate this bias. Similarly, strongly cross-gender-identified individuals would be more inclined to project their attributes onto the other-gender collective. The perspective that children’s gender identity might combine with their self-perceived gender typing to foster gender stereotypes can help explain why children whose parents hold egalitarian attitudes about gender roles may sometimes develop gender ideologies that are widely divergent from the attitudes of their parents. Thus, the gender self-socialization model’s gender stereotype construction perspective specifies that strong same-gender identity encourages people to project an attribute perceived in the self onto the same-gender collective. However, when people perceive a negative quality in a group to which they belong, they tend to project that negative attribute onto another group.

Gender Identity Construction The gender self-socialization model’s gender identity construction perspective specifies that the more children’s self-perceived attributes match their stereotypes for a gender, the more likely they would be to identify with that gender. Thus, the gender self-socialization model considers how stereotypes and attribute self-perceptions come together to influence each of the gender identity components. For instance, the attainment of membership knowledge may be influenced by the perception of a match between one’s own attributes and samegender stereotypes. However, some research suggests that children’s ability to assign themselves to a gender category may precede, rather than follow, gender-typed preferences. Therefore, perhaps it is more likely that children’s attainment of the later stages of membership knowledge development (gender stability and gender conservation) is helped

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if children note that their sex remains unchanged even when they occasionally engage in cross-sex activities. Similarly, matching versus failing to match gender stereotypes might also affect felt pressure for gender conformity. For instance, children who believe that they are falling short of important and valued gender stereotypes might apply more pressure on themselves to conform. Furthermore, extant research indicates that people often base their perceptions of gender typicality, gender contentment, and gender centrality on the basis of self-evaluations across multiple attributes that are idiosyncratically weighted. Therefore, the more children view themselves as typifying salient and valued same-gender stereotypes, the more gender typical and content they would feel, and these children would also be more likely to consider gender as a vital component of their identity (i.e., gender centrality).

Conclusion Gender self-socialization refers to three interrelated processes that explain how children (1) emulate gender stereotypes and incorporate them into their self-concept, (2) build a stable gender identity by self-appraising themselves against gender standards that are personally and consensually determined, and (3) project their own attributes onto the samegender collective. The outcomes of each process are determined by the influences of the interactions between gender identity and gender stereotypes (stereotype emulation), gender stereotypes and attribute self-perceptions (identity construction), and gender identity and attribute self-perceptions (stereotype construction). Madhavi Menon and Meenakshi Menon See also Cognitive Theories of Gender Development; Gender Development, Theories of; Gender Identity; Gender Identity and Adolescence; Gender Identity and Childhood; Gender Self-Socialization Model; Gender Stereotypes

Further Readings Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37, 451–463.

Liben, L. S., & Bigler, R. S. (2002). The developmental course of gender differentiation: Conceptualizing, measuring, and evaluating constructs and pathways. Monographs of the Society for Research in Child Development, 67(2), i–viii, 1–147. doi:10.1111/15405834.t01-1-00187 Martin, C. L., Ruble, D. N., & Szkrybalo, J. (2002). Cognitive theories of early gender development. Psychological Bulletin, 128(6), 903–933. doi:10.1037/ 0033-2909.128.6.903 Perry, D. G., & Pauletti, R. E. (2011). Gender and adolescent development. Journal of Research on Adolescence, 21, 61–74. doi:10.1111/j.1532-7795 .2010.00715.x Ruble, D. N., Martin, C., & Berenbaum, S. (2006). Gender development. In N. Eisenberg (Ed.), Handbook of child psychology: Vol. 3. Personality and social development (6th ed.). New York, NY: Wiley. Tobin, D. D., Menon, M., Menon, M., Spatta, B. C., Hodges, E. E., & Perry, D. G. (2010). The intrapsychics of gender: A model of self-socialization. Psychological Review, 117(2), 601–622. doi:10.1037/ a0018936

Gender Self-Socialization Model Gender self-socialization typically refers to people’s adoption of the attributes (personal characteristics, behaviors, thoughts, and feelings) that they perceive to be appropriate for their gender. This process figures in most cognitive theories of children’s development of gender differentiated attributes, including the theories advanced by Sandra Bem, Lawrence Kohlberg, Eleanor Mac­ coby, Carol Martin, and Janet Spence. The process is believed to contribute not only to differences in diverse gendered attributes between the genders as groups but also to individual differences in such attributes within each gender (presumably, children of a given gender differ in the degree to which they identify with a gender and thus differ in their motivation to adopt the attributes associated with their gender). The gender self-socialization model (GSSM) is a comprehensive theory of the structure and dynamics of gender cognition, advanced by Desiree Tobin, David Perry, and colleagues. Like other cognitive theories, the GSSM includes the idea that children emulate the attributes they

Gender Self-Socialization Model

associate with their gender, but the model also includes additional ways in which children cognitively operate on gender-relevant information. This entry describes three cognitive constructs central to the model and summarizes three hypotheses advanced by the model.

Three Cognitive Constructs The GSSM distinguishes three types of cognitions: (1) gender identity, (2) gender stereotypes, and (3) self-perceptions of personal attributes. Considerable individual differences are assumed to characterize children of each gender on most measures of these cognitions. Gender identity refers to the connections ­children make between themselves and a gender category. Gender identity takes several forms, ­ including simple knowledge of one’s gender (e.g., “I am a girl”), felt gender typicality (e.g., “I am similar to other girls”), gender contentedness (e.g., “I like being a girl”), felt pressure for gender conformity (e.g., “I must behave like girls and unlike boys”), and gender centrality (e.g., “Being a girl is more important to me than being Black”). The GSSM stipulates that measures of gender identity require children to make judgments about themselves in relation to gender category labels (i.e., “girls” and “boys”). Gender stereotypes are children’s beliefs about the attributes that characterize (or should characterize) males and females as groups. Stereotypes are often contextually tagged (e.g., “On the playground, boys do X, and girls do Y”), and many specify how persons of one gender should behave toward persons of the other (e.g., “On a date, the boy pays for the girl”). Some stereotypes form the basis of gender ideologies (e.g., sexist beliefs that subordinate females to males). Some characterize only a subgroup of children of a particular gender (e.g., boys viewed as “geeks” or “jocks”). To measure stereotypes, children make judgments about gender ­collectives, not about themselves. Self-perceptions of personal attributes are children’s perceptions of their own attributes. Many attributes of interest to gender researchers are gender differentiated at the group level or are widely gender stereotyped, but the attributes need not be gendered in any general way to figure in research testing the GSSM. Measures of self-perceptions

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include self-efficacy, desired and actual selves, and possible future selves. The GSSM stresses that in research on gender cognition, it is important to treat the aforementioned three constructs as independent and to measure them separately. Researchers sometimes infer gender identity from self-perceptions of specific gender-typed attributes (e.g., they infer feminine and masculine identity from self-perceptions of expressive and instrumental personality traits, respectively). This practice violates the GSSM because gender identity is assessed without asking participants to judge themselves in relation to gender category labels and because self-perceptions of expressive and instrumental traits are considered a type of cognition distinct from gender identity and attribute self-perceptions.

Three Hypotheses The GSSM recognizes that the variables exemplifying each of the foregoing three cognitive constructs are influenced by numerous factors, many of which the GSSM does not address (e.g., culture, interactions with parents and peers, hormones, genes, temperament). However, the GSSM holds that each type of variable is also a product of a cognitive interplay between the other two types of variables. Thus, three hypotheses are proposed, each describing how one type of variable is affected by the interaction of the other two. The hypotheses were inspired by a theory of implicit attitudes developed by Anthony Greenwald and his ­colleagues, and all are based on the idea that people alter their cognitions to be consistent with other cognitions they hold. The three hypotheses are (1) the stereotype emulation hypothesis, (2) the stereotype construction hypothesis, and (3) the identity construction hypothesis. The stereotype emulation hypothesis specifies that gender identity and gender stereotypes interactively influence attribute self-perceptions. The prediction is that the more children identify with a particular gender, the more they will perceive in themselves the attributes they personally view as more typical of, or desirable for, persons of that gender. All forms of gender identity described earlier are expected to motivate children to emulate the stereotypes they have internalized, but owing to individual differences in children’s stereotypes,

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the specific attributes influenced by gender identity will vary among children of each gender. For example, gender contentedness might encourage one boy to adopt aggressive, macho, or risk-taking behaviors but lead another to pursue science, math, or sports. Cross-gender-identified children (e.g., children discontent with their gender) should adopt attributes they view as appropriate for the other gender. The stereotype construction hypothesis specifies that gender identity and attribute self-perceptions interactively influence gender stereotypes. The prediction is that children project their own attributes onto a gender collective to the extent that they identify with that gender (e.g., “I am kind and I am a typical boy, so boys are kind”). Cross-genderidentified children should project their attributes onto the other-gender collective. The identity construction hypothesis specifies that gender stereotypes and attribute self-­perceptions interactively influence (certain forms of) gender identity. The more children’s self-perceived attributes match their stereotypes for a gender, the more they should feel they are typical members of that gender. The more children perceive themselves to possess attributes they view as cross-gender appropriate, the lower their felt same-gender typicality and gender contentedness should be. The GSSM resolves prior ambiguities in gender terminology and proposes many testable hypotheses. Some hypotheses have been supported, but studies have been correlational; longitudinal and experimental tests are needed. David G. Perry, Rachel E. Pauletti, and Christopher D. Aults See also Gender Identity; Gender Stereotypes

Further Readings Ruble, D. N., Martin, C. L., & Berenbaum, S. A. (2006). Gender development. In N. Eisenberg, W. Damon, & R. M. Lerner (Eds.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (pp. 858–932). Hoboken, NJ: Wiley. Tobin, D. D., Menon, M., Menon, M., Spatta, B. C., Hodges, E. V. E., & Perry, D. G. (2010). The intrapsychics of gender: A model of self-socialization. Psychological Review, 117, 601–622.

Gender Socialization in Adolescence Gender socialization is how an individual learns what it means to be a male or a female in the society in which the individual lives. While gender socialization occurs in all parts of the world, the way males and females are socialized can differ drastically depending on the geographic region and culture. This entry focuses on the socialization process as it occurs most generally in the United States. Gender socialization begins in early childhood and continues through the teenage years. As young children, gender socialization teaches us the difference between boys and girls and that the genders dress, look, and can be treated differently. For the young child’s mind, this firm dichotomy is the only way by which the child can understand the topic of gender. As children mature, they start to comprehend that the concept of gender does not have to be so black and white. However, with the onset of puberty, gender socialization intensifies as both sexes navigate what it means to be male and female within their culture.

Gender Socialization and Appearance Parents, family members, and peers as well as the teen’s larger sociocultural surroundings shape the way adolescents view themselves as male or female within their society. The norms and beliefs about physical appearance differ greatly depending on whether one is male or female. While the norms for physical appearance shift with time, the gendered understanding of what an ideal female and an ideal male look like is a constant. No matter the decade or era, there have always been societal rules about what one should look like as a female and as a male. Teens who do not conform to this view of femininity and masculinity risk being rejected and becoming outcasts within their society. While the turn of the 21st century has seen an increase in open-mindedness when it comes to gender nonconformity and appearance, adolescent boys and girls are still socialized into the belief that there is a right and a wrong way to look depending on their sex.

Gender Socialization in Adolescence

Females

Females in the United States are socialized very early into believing that their physical appearance is of upmost importance. Being pretty is seen as being “good,” and pretty is defined in a very narrow way. Girls are socialized at a young age with DisneyTM princesses and BarbieTM dolls: small waist, long legs, large breasts, and soft hair. This is the ideal. This is what girls should look like when they grow up. Parents continue this socialization by buying the dolls and the clothes that reinforce this ideal. As girls enter puberty and their adult female bodies begin to develop, the focus on appearance begins to strengthen. Girls begin to feel the need to live up to these standards of beauty that have been taught to them. At this point, however, it is not just dolls and cartoons. Movie stars, pop stars, fashion models, and Internet celebrities now also become the physical role models. The women these girls are shown are praised for their physical appearance, not for their brains or moral character. Magazine articles aimed at females focus on the best hair removal practices, dieting strategies, and makeup tips. Young girls are constantly being told by society that their physical appearance is what is important about them. Because of this, girls in early adolescence tend to become overly focused on their physical appearance and on making themselves look as feminine as possible. They begin shaving their legs and armpits, plucking their eyebrows, applying makeup, straightening their hair, wearing padded bras, and sometimes practicing unhealthy dieting in an attempt to make their appearance as feminine as possible. However, few girls can meet the physical expectations that have been socialized into them. For some girls, this need to be physically perfect can lead to anxiety, depression, and/or eating disorders. Males

Males in the United States are socialized very early into believing “real” men have big muscles. Boys begin playing with toy soldiers outfitted with plastic biceps and superheroes with pecs that are busting out of their suits. Parents tell boys that they should consume healthy food to grow up “big and strong.” The role models in place for young boys tend to be professional athletes, tall and

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muscular. In adolescence, boys continue to be shown this “ideal” male body in movies, on television, online, in video games, and in print. The leading man, model, or even music star tends to be tall, with chiseled facial features and a highly muscled physique. This is the body that real men have. This is what masculinity looks like. Moreover, men who are short, scrawny, or overweight, or who overall do not fit the masculine mold are shown as losers, nerds, and victims. The tall guy with muscles is the one who saves the world, stops the bad guy, and gets the girl. Adolescent boys who feel that their physical appearance does not stack up to this ideal may turn to unhealthy exercise routines, use steroids, develop eating disorders, and/or become anxious or depressed.

Gender Socialization and Sexuality Adolescence is marked by the onset of puberty. Male and female bodies become sexually mature and capable of reproduction. Some cultures celebrate this change with rite-of-passage rituals, such as the Jewish bar/bat mitzvah, Jugendweihe in Germany, and quinceañera in many Latin American countries. These ceremonies let the young person know that he or she is seen as a mature and important member of society. However, few teens in the United States are socialized in this way. The adolescent years are seen as a time when hormones are going to take over and teens are going to “go wild,” although what this actually means, that the teenager is going to become interested in sexual activities, is usually not stated. American society tends to sidestep talking to teens about the natural phenomenon of becoming sexually aware and instead uses this time to enforce heteronormative messages about sexuality and reinforce sexual stereotypes. Females

An adolescent female’s body changes dramatically as she goes through puberty. The curves that come from the development of breasts and hips tell the world that she is no longer a little girl—she is becoming an adult and a sexual being. American teenage girls are told that their sexuality, especially their virginity, is the most important aspect of who

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they are. Purity equals femininity. Adolescent girls are not supposed to want sex or have sex. If they do, they are called whores, sluts, skanks, or worse. This is at odds with their brains and hormones telling them that it is time, biologically, to reproduce. Parents tend to ignore talking with their adolescent girls about sex or only talk about being abstinent. Most American parents make it clear to teen girls that virginity is what is expected of them. The U.S. school system also tends to focus sex education more toward abstinence-only material. Adolescent girls are constantly being told that they should not be having sex, sex is dirty, sex is wrong, and girls who have sex are not as good as girls who wait until marriage. However, teen girls are sexual beings. Puberty makes their brain ready for intimate relationships with other people. This can be especially hard for adolescent girls who identify as lesbian or bisexual. Society explicitly teaches that girls need to control their urges about boys but tends to ignore that some girls are having sexual feelings for other females. As a result, many lesbian and bisexual teen girls do not get proper sex education about nonheterosexual sex, while also potentially developing mental health issues like depression, anxiety, or low self-esteem. The media’s overwhelming use of sexual imagery also complicates the matter. American teen girls are inundated with images of the sexualized female body on television and in movies, video games, magazines, and the Internet. The message is clear: Your body is here for the sexual enjoyment of men. On the one hand, society is telling adolescent girls that they need to remain “pure,” and on the other, it is showing them that they should be sexy and available for men in a sexual way. The results of this confusing contradiction are that many teenage girls in the United States do become sexually active but do not have knowledge about how to be safe. Consequently, the United States has one of the highest rates of teen pregnancy and sexually transmitted infections in the industrialized world. Males

Adolescent males have a different kind of socialization when it comes to sexuality. For them, part of being a man means that they have had sex

with a female. Teen boys who are virgins are made fun of and seen as less masculine than the boys who have had sexual intercourse. Adolescent males do not have the same stigma on them as females if they are not “pure.” When a teen boy has had sex, he is extoled by the other males in his peer group. While parents may still tell their sons to remain abstinent, it is not with the same vigor as when they tell their daughters. Purity balls, in which a teen girl pledges her virginity to her father until marriage, which are becoming more common in the United States, are nonexistent for teen boys. Teen boys also see the same sexualized images of the female body that teen girls see. However, to them, this is how females are supposed to act. Girls should want to flaunt their bodies for the male’s enjoyment, and all girls want to have sex, even if they say otherwise. Teen boys should want to have intercourse with these girls and do whatever is necessary for that to happen. Such messages tend to fuel a rape culture. The emphasis on heterosexual sex also puts a stigma on gay or bisexual teen boys, or those boys who are struggling with their sexual orientations. The term fag is commonly used as a putdown, as society tells boys that there is nothing worse than being gay. Not conforming to heterosexual norms as a male can lead to bullying, physical violence, and even death from homicide or suicide. As a result, many gay or bisexual boys or young men hide their sexual orientations to “pass” as heterosexual, which may lead to other mental health issues such as depression, anxiety, or internalized heterosexism. Transgender Adolescents and Gender Socialization

While there is dearth of research in the field on transgender adolescents, future research can examine how transgender adolescents are affected by gender socialization. When families or peers do not support transgender people as they explore their gender identities, transgender people become susceptible to an array of disparities, including mental health issues (e.g., depression, suicidal ideation), homelessness, educational disparities (e.g., increase in high school dropout rates, less academic achievement), and poverty. As a result, it is important to understand that gender socialization can be

Gender Socialization in Aging

harmful in many ways to both cisgender boys and girls, but it may be especially problematic and ­detrimental to transgender adolescents. Tracy Meyer See also Adolescence and Gender: Overview; Body Image and Adolescence; Gender Identity and Adolescence; Gender Norms and Adolescence; Gendered Behaviors in Adolescence; Role Models and Gender

Further Readings Bradley, H. (2013). Gender (2nd ed.). Cambridge, England: Polity Press. De Gaston, J. F., Weed, S., & Jensen, L. (1996). Understanding gender differences in adolescent sexuality. Adolescence, 31, 217–231. Grusec, J. E., & Hastings, P. D. (Eds.). (2007). Handbook of socialization: Theory and research. New York, NY: Guilford Press. Lerner, R. M., & Steinberg, L. (Eds.). (2004). Handbook of adolescent psychology (2nd ed.). Hoboken, NJ: Wiley. Lindsey, L. L. (2011). Gender roles: A sociological perspective. New Delhi, India: PHI Learning. Moore, S., & Rosenthal, D. (2006). Sexuality in adolescence: Current trends. London, England: Routledge. Pascoe, C. J. (2012). Dude you’re a fag: Masculinity and sexuality in high school. Berkeley: University of California Press.

Gender Socialization

in

Aging

Beginning at birth, individuals are subjected to gender socialization, a process by which an individual’s gender is shaped by cultural norms as to what is considered appropriate (e.g., appearance, clothing, behavior, ways of thinking, opinions). The expectations for men and women are different for various ages and stages of life. Age can be compared to Candace West and Don Zimmerman’s “doing gender” theory in that one “does age,” meaning that age is performed along with gender expectations. Individuals across the life span who do not “perform” or fit nicely into gender stereotypes are often ostracized and ridiculed for being different, which has negative implications for

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self-esteem. This entry outlines the gender socialization process across the life span.

Gender, Self-Concept, and Historical Context Gender role attitudes learned in childhood and adolescence are integrated into one’s self-concept. Gender roles become a salient part of identity and are shaped by family environment and societal gender norms and are further contingent on cultural and historical factors. Gender socialization experiences vary based on generational status and birth era. For example, an individual born in the 1920s to 1930s was raised in a conservative time  period before World War II, when women were primarily housewives and men were responsible for financially supporting the family. ­However, since the mid-1980s, gender roles have shifted, with adolescent girls and young women adopting nontraditional, egalitarian attitudes toward women’s roles in the home and workforce. The literature suggests that age is positively associated with traditional and nonegalitarian attitudes, such that older people tend to endorse more traditional gender role attitudes versus those of younger generations. To further explain gender socialization, the following section explores some theories of how one learns to “perform” as one’s gender.

Theories of Gender Socialization This section discusses two common theories of gender socialization: (1) social learning theory and (2) gender schema theory. These differing theories of gender socialization are meant to complement each other as theoretical explanations, rather than contradict each other. Social learning theory focuses on observable behavior and is predicated on the notion that appropriate behaviors are rewarded, with the goal of increasing a particular behavior, whereas inappropriate behaviors are punished, with the goal of decreasing and extinguishing a behavior. Behaviors that are modeled, imitated, and subsequently reinforced develop into a habitual behavioral pattern. Boys are typically praised for playing rough and demonstrating battle-themed pretend scenarios, whereas girls are reinforced for playing with dolls and kitchen sets. Children are reinforced for playing

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and acting out socially acceptable gender roles. This continues into adulthood: Women are often ridiculed for being independent and assertive in communication in leadership roles, while men are ridiculed for being in employment positions per­ ceived as feminine, such as a nurse or a midwife. Gender schema theory posits that children play an active role in their socialization process by interacting with their environment. Schemas are patterns of cognitions used to understand, interpret, and process gender-related information, which is then used to accurately identify gender. Schemas underlie perceptions of what individuals can and cannot do based on gender labels, which affects behaviors and self-esteem. Sandra Bem, a prominent gender scholar, suggested that cultural definitions of gender become a center point around which other information is situated. For example, sense of self is associated with congruence between behaviors and gender schemas. In adulthood, gender schemas also translate into ways in which parents behave and treat their children to perpetuate socially acceptable notions of maleness/masculinity or femaleness/femininity. Throughout the gender socialization process, which begins in childhood, individuals develop attitudes and perceptions of acceptable expectations of ways to be treated and roles to embody. The divergence of the sexes results in a binary gender expectation, such that males represent masculine characteristics and females embody feminine characteristics. A binary conceptualization of gender excludes the experiences of individuals who challenge classifications solely as masculine or feminine or who fall between the extremes on the gender spectrum (e.g., individuals who identify as transgender, genderqueer, or gender fluid).

Important Factors to Consider in Gender Socialization There are several important factors to consider regarding gender socialization during the aging process. First, socialization is a process that is frequently in a state of flux. Several socializing agents are at work, with the primary institution being the context of the family, the environment in which individuals are introduced to the expectations of the world. Empirical studies suggest that the more a home incorporates gender egalitarian parenting,

the more likely the child will endorse gender ­egalitarian beliefs as an adult. Socialization also continues outside of the immediate family, including peers, teachers, the media, and other institutions (e.g., the education system). Second, numerous subcultures combine to create diverse, heterogeneous subcultures that are similar and different in various ways. Subcultures are differentiated by social categories such as gender, race, ethnicity, class, age, and other factors. These subcultures also perpetuate perceptions and stereotypes of social categories such as age. For example, research suggests that people equate being young with being healthy and additionally equate being visibly healthy with moral “goodness.” Furthermore, research suggests that people assume that those who are healthy have taken the time and effort to look that way and believe that older, unhealthy-looking people deserve to be excluded as they did not take advantage of the multiple scientific ways of “staying young.” Last, these social subcultural categories overlap in important ways to create a unique and complex intersectional experience. Subcultures based on age are strongly associated with gender role norms and emerge at critical time points. For example, a Canadian study found that older women are more likely to experience poverty and homelessness, suggesting a social inequality based on age and gender. The researchers hypothesized the following: (a) women have a higher life expectancy, and many older women are experiencing a lack of affordable, physically suitable places to live; (b) retirement and pension benefits were designed for men in the workforce and assume that women would be supported by wage-earning men; and (c) women receive lower wages throughout their career, affecting their retirement savings. To continue this discussion, it is important to look further into the idea of intersectionality.

Intersectionality Intersectionality, a term coined by Kimberlé Crenshaw, is the study of how biological, social, and cultural identities contribute to systematic and social inequality. Ageism, in combination with at least one or more forms of social oppression or devaluation, creates a unique form of discrimination. Ageism is exclusion or discrimination of

Gender Socialization in Aging

another based on age. For example, older women may experience discrimination based on gender and age, resulting in ageist and gendered stereotypes. In a study regarding gender stereotypes, young adults rated older women higher on qualities of nurturance and older men higher on intellectual competence and autonomy. Ageism ­combined with other forms of oppression can create many difficulties for those affected, in particular individuals of minority races. This is discussed in greater depth in the following section.

Intersectionality of Age, Gender, and Race Among African American Women Socialization and the intersecting of roles are concepts that apply to all social identities; however, socialization and intersectionality of identities among African Americans create additional complexities regarding what it means to be Black in the United States. Typically, Caucasian/White women are viewed solely with regard to their gender, whereas African American/Black women are seen with regard to both their gender and their race due to these identities being intricately interwoven with each other. The intersectionality of age, race, and gender is a concept that has a deep history within the African American population. In the era of slavery, due to African American men being stripped of their rights and responsibilities as fathers and husbands, African American women were tasked with being the authority figure in the household, thereby taking on gender roles that could be deemed by the general society as masculine in nature. Following this era, African American women also adopted additional traits, apart from being the caregiver and nurturer, to survive, including independence, strength, and assertiveness. Thus, gendered racial socialization among African Americans entails a process by which parents, typically the mother, teach their children what it means to be a Black male or female in the United States, what type of experiences to expect from interactions with others in society (especially their White counterparts), and how to cope with their experiences. Black women are attributed with being the matriarch of the family. Throughout history, the matriarch is the head of the family, the one through which history, including racial socialization, is

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passed down from generation to generation. Older African American women’s experience of racism will likely be different from their children’s experience and their grandchildren’s experiences; thus, it is critical to have such a history passed down, with lessons attached on how to survive in America. Beyond spreading knowledge between generations regarding race specifically, Black women are also tasked with teaching their girls not only what it means to be Black in America but also what it means to be an adult Black woman in America. It is important to note that through these teachings, African American mothers are teaching their children how to not only survive in America but also thrive. Growing up, Black women are expected to be strong and resilient, with researchers speaking of the strong Black woman archetype. Being a woman in America already comes with difficulties regarding how women are viewed and treated; therefore, being a woman of color, specifically, a Black woman, adds another level of difficulty and obstacles to overcome. As mentioned previously, older African American women are typically seen as the matriarchs in their families. Research has shown that when looking at aging as a variable to intersectionality, Caucasian individuals who are at retirement age are typically concerned with issues surrounding their retirement, widowhood, or transitioning from independent living to senior home living. Aging African American women (the matriarchs of the family), however, are concerned and to a certain level stressed with the discrimination, prejudice, and racism they have experienced during their lives. In addition, they are concerned with the wellbeing, safety, and future of Black youth. Typically, older African American women may retire from financial employment, but they do not retire from working within the community. They continue educating youth and attempting to effect change in the lives of African American youth. Therefore, aging African American women are not able to simply enjoy retirement due to the way their identities intersect. Research shows that due to the many stressors African American women experience, they tend to age faster biologically, specifically stating that Black women age 7.5 times faster than their Caucasian counterparts. Research on aging is a growing field as humans are both living and working longer. More research

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on gender socialization and aging and how this process is different across cultures is warranted. G. Nicole Rider, Curtesia Plunkett, and Emily White See also Aging and Gender: Overview; Gender Role Socialization; Gender Socialization in Men; Gender Socialization in Women; Identity Development and Aging; Stigma of Aging

Further Readings Baker, T. A., Buchanan, N. T., Mingo, C. A., Roker, R., & Brown, C. S. (2015). Reconceptualizing successful aging among Black women and the relevance of the strong Black woman archetype. The Gerontologist, 55(1), 51–57. doi:10.1093/geront/gnu105 Beal, F. (2008). Double jeopardy: To be Black and female. Meridians: Feminism, Race, Transnationalism, 8(2), 166–176. doi:10.1353/mer.0.0005 Berger, M.T., & Guidroz, K. (Eds.). (2009). The intersectional approach: Transforming the academy through race, class, and gender. Chapel Hill: University of North Carolina Press. Jordan-Zachery, J. (2007). Am I a Black woman or a woman who is Black? A few thoughts on the meaning of intersectionality. Politics Gender, 3(2), 254–263. doi:10.1017/S1743923X07000074 Lindsey, L. L. (2016). Gender roles: A sociological perspective (6th ed.). New York, NY: Routledge. Min, J., Silverstein, M., & Lendon, J. P. (2012). Intergenerational transmission of values over the family life course. Advanced in Life Course Research, 17, 112–120. doi:10.1016/j.alcr.2012.05.001 Twigg, J., & Martin, W. (Eds.). (2015). Routledge handbook of cultural gerontology. New York, NY: Routledge. West, C., & Zimmerman, D. (1987). Doing gender. Gender and Society, 1, 125–151. doi:10.1177/ 0891243287001002002

and by dressing the child in pink or blue clothing. Gender-based categorization and differential treatment become increasingly pervasive means for organizing children’s socialization. This entry reviews some of the major research findings on this topic during the childhood years (approximately from birth to 12 years of age). As with most psychology research, these studies have been ­ conducted primarily in Western industrialized ­ countries. First, the processes involved in gender socialization are summarized. Afterward, a few important targets of gender socialization and their  consequences on children’s development are highlighted.

Gender Socialization Processes Contemporary research on the socialization of gender in childhood is guided by various theories. Most approaches acknowledge the combined influences of social-structural, cognitive motivational, and physiological processes. However, the theories vary in how much they address or emphasize particular processes. Social-Structural Processes

Social-structural processes refer to the ways in which the larger social structure may affect the kinds of opportunities and role models that girls and boys have during development. These influences are emphasized in feminist-oriented approaches or cultural-ecological models. During childhood, social-structural influences include the gender role models that children encounter in their homes, their communities, and the media. They also encompass the range of opportunities for play and learning available to children based on their gender. Cognitive Motivational Processes

Gender Socialization in Childhood When a healthy child is born, the parents’ first question is typically about whether it is a girl or a boy. The child’s gender is commonly marked through the assignment of a gendered first name

Cognitive motivational processes refer to the mental representations and emotional associations that individuals form by linking the self and others to gender categories and particular attributes (traits, activities, roles). These include gender identities (self-identification with a gender group), gender stereotypes (linking gender groups and attributes), and attitudes (positive or negative emotion

Gender Socialization in Childhood

underlying the stereotypes). Children learn gender through observational learning (e.g., noticing that only girls wear dresses), differential treatment and opportunities (e.g., girls, but not boys, are given dolls), and experiencing positive or negative incentives for behaviors (e.g., a boy is teased for playing with a doll). However, there are variations both between and within cultures in the degree to which and the manner in which gender divisions are modeled and enforced. For example, adult gender roles are generally the most egalitarian in Scandinavian countries. Although family members and peers may generally pressure children to conform to certain gender role traditions, most children ultimately internalize gender conventions and incorporate them into their identities and behavioral repertoire. In this manner, a process of self-socialization ensues, whereby girls and boys often seek out things associated with their gender and avoid things they associate exclusively with the other gender. Given the higher status of boys and men in most societies, it is more common for girls than for boys to adopt some cross-gender-typed behaviors (e.g., many girls play sports or with trucks, but fewer boys take up ballet or play with dolls). Some children demonstrate very strong crossgender-typed preferences over gender-typed preferences from an early age—despite conformity ­pressures from family and peers. In some cases, these children may identify as transgender. Whereas cisgender children identify with their assigned gender at birth (based on their observable genitalia), transgender children do not identify with their assigned gender; that is, they may identify with a different gender category (e.g., a child with male genitals may identify as a girl) or seek to avoid gender binary categorization. The reasons for strong cross-gender-typed preferences and transgender identity remain unclear. In past years, many clinicians and parents have viewed these children as having a gender identity disorder. However, this perspective has begun to change among many psychologists and parents who allow for a broader range of expression in gender identities and gender roles. Same-gender peer groups are one of the most pervasive and powerful contexts for the socialization of gender. Starting around 3 years of age, children tend to prefer affiliating primarily with

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same-gender peers (known as gender segregation). As a consequence, most children form social identities based on their gender in-group. Group members tend to foster assimilation into gender-typed norms. Conversely, gender nonconforming children are commonly subjected to peer rejection and harassment. Also, children who identify and affiliate with their same-gender peer group tend to evaluate the individuals and characteristics associated with their gender in-group more positively than those associated with the gender out-group. Thus, the amount of time that children spend with same-gender peers is associated with increases in gender-typed behavior. Physiological Processes

Finally, relevant physiological processes during childhood include average gender differences in dispositions toward self-control (girls higher) and activity level (boys higher), which may be related to sex-related hormonal influences on the nervous system during prenatal development. Also, some children appear to have strong dispositional interests in certain cross-gender-typed behaviors despite encountering strong socialization pressures to conform. When children have strong dispositions toward particular behaviors, they may elicit reactions from others that reinforce their tendencies (e.g., an active child attracts other active children); also, children’s dispositions may lead them to seek environments that strengthen their tendencies (e.g., an active child regularly joins sports teams). In temperamental dispositions, there is a great deal of overlap between girls and boys (e.g., both girls and boys range in activity level).

Targets of Gender Socialization in Childhood Some of the most investigated and potentially consequential targets of gender socialization during childhood include play, emotion, language, aggression, and academic attitudes and achievement. When average gender differences in behavior are indicated, there are variations within each gender (i.e., not all members of the same gender are alike). Also, there are variations across behaviors in the magnitude of the average difference (i.e., the amount of overlap in the distributions of scores for

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girls and boys); for some behaviors, the average difference might be small, whereas for other behaviors, the average difference might be larger. Play

One of the largest average gender differences in behavior occurs in toy and play preferences. Boys are much more likely than girls to favor toy vehicles, construction toys, sports-related play, and action adventure fantasy play. In contrast, girls are much more likely than boys to prefer dolls, cooking sets, dress-up materials, and domestic fantasy play. Similar gender-typed preferences have been found among children from a variety of ethnic and cultural backgrounds. Indeed, gender-typed toy and play preferences are common in gender ­egalitarian cultures, such as Sweden. Nonetheless, within any culture, there is variability in the how and to what extent particular children may prefer gender-typed and cross-gender-typed play. Developmental psychologists generally recognize that play activities are important in children’s cognitive and social-emotional development. Play activities provide opportunities to practice ­particular behaviors. Repeated practice in an activity typically leads to increases in self-efficacy (confidence), skill, and interest. Hence, when children are systematically encouraged to participate in some play activities and discouraged from participating in other play activities based on their gender, gender inequities in development may result. Gender-typed play activities for girls, such as doll play and dress-up, exercise socio-emotional behaviors and concerns with physical appearance. Conversely, gender-typed activities encouraged in boys, such as construction play and sports, foster object-oriented mastery and managing interpersonal competition. In these ways, girls are traditionally prepared for intimate relationships, whereas boys are prepared for the competitive work world. Moreover, these patterns may help reinforce gender differences in status and power: Dominance and competition are emphasized more in boys’ play, whereas nurturance and compliance are reflected more in girls’ play. Although most infant toys are gender neutral, as the child gets older, parents are likely to purchase more gender-typed toys, such as dolls for girls and trucks for boys. Although older children may usually ask for gender-typed toys, many parents are

less likely to purchase cross-gender-typed toys than gender-typed toys when they are requested, especially for sons. Research indicates that the encouragement of gender-typed activities is one of the most likely ways in which parents treat girls and boys differently. Moreover, as children increasingly spend time with same-gender playmates, they will often experience reinforcement from peers for gender-typed play and negative sanctions for crossgender-typed play. Children’s interest in gendertyped toys and play activities is further reinforced in the media through advertising and role models in children’s programming. Temperamental and other dispositional factors can affect children’s play preferences. For example, children vary in temperamental activity level. Although higher average activity levels are seen among boys than among girls, girls who are high in activity level are more interested in sports activities than girls who are low in activity level. Also, there are some children who express a strong interest in cross-gender-typed play activities despite strong social pressures to do otherwise. In some instances, these children may not identify with their assigned gender (known as transgender). Although temperament and other dispositional factors may partly account for some girls’ and boys’ play preferences, longitudinal and experimental studies indicate that social-environmental factors have causal influences on play behavior for most children. Emotion

Researchers have compared girls and boys (mostly from Western cultures) in emotion expression, emotion talk, emotion regulation, and emotion understanding. First, across studies, significant but slight average gender differences were indicated in emotional expression. Girls are slightly more likely than boys to express fear and sympathy. Conversely, boys are slightly more likely than girls to express anger. No average gender differences during childhood are indicated in happiness, guilt, anxiety, embarrassment, or pride. Second, based on a limited number of studies, girls were observed to talk about emotion from a younger age than boys. Research studies are inconsistent regarding whether this pattern persists at older ages. Third, studies indicate that girls are moderately

Gender Socialization in Childhood

higher in self-control, including emotion regulation, than boys during childhood (although the magnitude of the difference may reduce at later ages). Finally, modest gender differences in studies indicated a slight average advantage among girls in empathy and in decoding others’ emotions during childhood. However, there are no differences in overall emotion understanding. Children may learn gendered cultural norms and practices about emotion through everyday interactions with parents and peers. A few patterns are apparent from studies conducted primarily in Western countries (but with samples of ethnic minority and immigrant families in the United States included). First, on average, mothers and fathers may differ in the ways in which they model emotional expression. Mothers use more emotion words and discuss emotional topics more often than fathers. Second, parents may treat girls and boys differently in emotional expression and talk. On average, mothers used more emotion words with daughters than with sons. Also, mothers and fathers discussed sadness more with daughters than with sons; conversely, parents talked about anger more with sons than with daughters. Finally, children may practice gender-typed patterns of emotion with their peers. Girls tend to be more likely than boys to use more emotion labels, emotion explanations, and mental state talk with peers. Also, children generally demonstrate awareness of gender stereotypes regarding emotional expression (e.g., “Boys don’t cry”). Language

According to literature reviews of studies (mostly conducted in Western cultures), language use is another area associated with some average gender differences. First, researchers have found that girls tend to acquire language at an earlier age than boys. Also, during early childhood, girls are slightly more talkative on average than boys (although this average difference was not indicated at older ages). Second, across the available studies, small to moderate average gender differences in verbal ­ communication strategies were observed. Boys were somewhat more likely than girls to use speech acts high in assertion and relatively low in affiliation (e.g., directives). In contrast, girls were somewhat more likely than boys to use collaborative

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speech acts that are both affiliative and assertive (e.g., statements building on the prior speaker’s remark). Average differences in the affiliative dimension of communication have been observed more reliably across different racial/ethnic and socioeconomic samples of children than differences in the assertive dimension. The research also indicates ways in which parents and peers may contribute to average gender differences in language use. First, mothers and fathers may tend to differ in language use and thereby provide differing role models. Across studies, there were small average differences indicating that mothers are more talkative, use more supportive speech, and use less directive speech than fathers. Second, based on several studies of motherchild interactions, mothers tend to use language differently with daughters than with sons. They are more talkative with daughters and use more supportive speech and more directive speech with daughters than with sons. It is unclear whether the mother or the child (both together) is responsible for the greater average talkativeness in motherdaughter than in mother-son pairs. The use of more supportive speech with daughters may foster an affiliative orientation in girls, whereas the use of less directive speech with sons may encourage greater autonomy in boys. Finally, gender-typed patterns of language use are reinforced in children’s same-gender peer interactions. These effects are partly a function of children’s selection of gender-typed play activities. For example, playing house is more likely to involve talking and supportive comments, whereas construction play is less likely to require a lot of talking and is more apt to involve directive speech. Aggression

Researchers distinguish between direct (overt) and indirect (covert) types of aggression as well as between physical and verbal forms of aggression. Starting around 3 years of age, average gender differences in aggression are often seen. More boys than girls tend to initiate conflict and to use more physical and verbally direct aggression. Conversely, girls are more likely to use strategies aimed at decreasing conflict with peers. During childhood, the magnitudes of average gender differences are moderate for physical aggression and small for

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verbal aggression. No meaningful average gender differences in indirect aggression (e.g., gossip, social exclusion) are indicated across studies; however, girls’ aggressive acts are more likely to be indirect than direct. During the course of childhood, direct aggression tends to decline for both girls and boys—but more for girls than for boys. Also, boys are overrepresented among children with very high levels of aggression. Cross-cultural comparisons indicate similar patterns of average gender difference in physical aggression (males higher than females), but there are cultural variations in the magnitude of the average difference. Contrary to popular views, aggressive behavior among children does not appear to be related to the differences between girls and boys in baseline testosterone levels. However, self-control, emotion regulation, and empathy—which are higher on average among girls than among boys—may mitigate the likelihood of physical aggression. In addition, various social agents are implicated in the development of gender differences in aggression. First, parents may play a role. Although parents generally disapprove of direct aggression equally in sons and daughters during early childhood, many parents are more tolerant of milder forms of aggression in sons than in daughters during middle childhood. However, some work indicated that, on average, European American parents were more disapproving of daughters’ verbal aggression than African American parents. Also, parents’ use of physical punishment—which can increase aggression in children—may be more likely with sons than with daughters. Second, peer groups also contribute to gender differences in aggression. On average, boys’ peer groups are more accepting of power-assertive strategies than girls’ peer groups. Furthermore, the recreational activities in which many boys engage, such as American football, may condone aggressive physical contact. Finally, media consumption may also contribute to gender differences in aggression. Television programs and video games targeted at boys often depict violence. Experimental studies suggest that repeated viewing of violent TV programming or playing violent video games can slightly increase the likelihood of aggressive thoughts and actions. The impact of violent media may be particularly problematic for  children who are already prone to aggressive behavior.

Academic Attitudes and Achievement

Across different academic domains (reading, writing, mathematics, science), girls attain higher grades than boys. Across Organisation for Economic Co-operation and Development (OECD) countries and in participating non-OECD countries, girls outperform boys on standardized reading assessments, with the size of the gender gap varying considerably across countries. In contrast, on standardized tests in mathematics and the physical sciences, boys show a slight advantage across many countries. (The magnitude of these gender gaps varies somewhat across different countries as well as across different ethnic groups within the United States.) Studies conducted mostly in OECD countries looking at adolescents’ ability beliefs and task values found that girls are more likely than boys to have positive views about reading and writing and general academics, whereas boys are more likely to have positive views about mathematics. These views tend to predict later motivation achievement, which may partly account for later gender gaps in some math-intensive science and technology fields. Young people who are LGBTQ often experience victimization in school because of their sexual or gender orientation. As a result, they tend to show lower average academic achievement than their non-LGBTQ peers. Victimization serves as a  mediator, with students who experience more ­victimization scoring even lower than nonvictimized peers. Socialization experiences may contribute to gender differences in academic attitudes and achievement. First, parents’ expectations and encouragement can be influential. For example, many parents believe that boys are better than girls in math and science. Also, parents have been observed to be more likely to encourage science learning (e.g., explaining and asking questions at science museums) in sons than in daughters. These gender stereotypical expectations and behaviors are usually unrelated to children’s actual competence, yet they tend to predict children’s later motivation and achievement. Second, although the research is mixed, some studies find that some teachers may treat girls and boys differently. This includes possibly directing more attention to boys than to girls (partly aimed at discipline) and being

Gender Socialization in Men

more cognitively demanding of boys than of girls in science classes. Third, peers may enforce gender stereotyped norms about academic achievement. In some lower-income neighborhoods in Western countries, researchers have observed that boys may devalue education as feminine and may sanction those who appear to do well in school. Also, the greater incidence of impulsive or aggressive behavior among boys may undermine their academic motivation. More generally, however, gendered peer norms may affect the kinds of subjects that children find more interesting. Girls may find that their friends value subjects such as reading more than math and science, while boys may experience the opposite pattern. Campbell Leaper and Harriet Tenenbaum See also Child Play; Children’s Social-Emotional Development; Gender Expression; Gender Identity and Childhood; Gender Self-Socialization; Gender Socialization in Adolescence; Gendered Stereotyped Behaviors in Childhood; Parental Expectations; Parental Messages About Gender

Further Readings Blakemore, J. E. O., Berenbaum, S. A., & Liben, L. S. (2009). Gender development. New York, NY: Taylor & Francis. Leaper, C. (2015). Gender and social-cognitive development. In R. M. Lerner (Series Ed.), L. S. Liben & U. Muller (Vol. Eds.), Handbook of child psychology and developmental science: Vol. 2. Cognitive processes (7th ed., pp. 806–853). New York, NY: Wiley. Leaper, C., & Farkas, T. (2014). The socialization of gender during childhood and adolescence. In J. Grusec & P. Hastings (Eds.), Handbook of socialization: Theory and research (2nd ed., pp. 541–565). New York, NY: Guilford Press. Leman, P. J., & Tenenbaum, H. (Eds.). (2014). Gender and development: Current issues in developmental psychology. New York, NY: Psychology Press.

Gender Socialization

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Men

Gender has been defined as the behavioral, cultural, or psychological traits associated with one’s

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sex. Early gender theorists posited that men and women had innate psychological differences that contributed to their respective, and distinct, gender roles. These characterizations are still sometimes used today. However, the concept of fixed gender roles has been widely criticized, and the current study of gender roles largely follows a constructionist perspective. That is, men and women learn what the appropriate thoughts and behaviors are based on their social environment. In addition, what is considered masculine differs across cultures and throughout time. For example, some cultures have considered homosexual relationships to be the antithesis of true masculinity, whereas others have viewed such relationships as a prerequisite to being considered a “true man.” Societal expectations about what is considered masculine are evident from the earliest stages of human development. A 2009 study by Keith E. Edwards and Susan R. Jones consisting of 10 college-aged men found that none of them could remember a time when they were not conscious of how men are supposed to be. This entry explores various factors associated with gender socialization in men, including gender expectations, intersectionality, and feminism, and offers suggestions for future research.

Gender Expectations for Men Research conducted in the United States has suggested that men are expected to conform and often do conform to the stereotypes of what it means to be a man. Boys and men are inundated with messages of an ideal masculinity at home, at school, and by images of stereotypical behavior in various media outlets. Socially valued gender roles for men often require men to be tough, powerful, intimidating, rugged, independent, hypersexual, and in ­control. Simply put, to be masculine is to be the opposite of feminine, which is traditionally stereotyped in sexist ways, such as the view that to be feminine is to be weak, subservient, and controlled by emotions. Any man who behaves in ways that are not traditionally masculine runs the risk of being labeled in heterosexist and sexist ways (e.g., called gay or a girl), further perpetuating rigid gender roles. One study examined how gender roles affect men over time. In their 2009 study on collegeaged men, Edwards and Jones found several

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distinct phases. The first phase was described as the feeling of a need to put on a mask. This symbolic mask was meant to portray an image of masculinity and to cover up parts of oneself that does not conform to societal expectations. This is done both consciously and unconsciously. Phase 2 involved “wearing” the mask and included behaviors typical of college-aged men such as frequent partying. In addition, wearing the mask served to reduce social disapproval for behaviors that are not considered masculine. An example of this would be crying around a group of male friends and then later laughing it off or making a joke about it. This phase also helped men with marginalized identities who experienced racism, classism, or homophobia to maintain a sense of masculinity. Eventually, these men often realized that there was a consequence to wearing the mask, which was the third phase. This phase included limited relationships with other men, demeaning attitudes and relationships with women, and a loss of authenticity and humanity. An awareness of these personal and social consequences lead to a slow change in behavior for each participant. As a result, these men were able to behave in ways that felt more authentic, such as being more emotionally expressive and choosing not to engage in risky behavior. Although conforming to certain gender role expectations comes at a significant cost, many men are unable to behave in more authentic ways. According to the gender role conflict model, personal and institutional sexism along with the fear of femininity for men are directly related to masculine ideology and men’s gender role socialization. Frequent areas of gender role conflict in men are conflicts between work and family relations; success, power, and competition issues; and restrictive emotionality. For example, a 2008 study described how a man’s tendency to remain calm in crisis situations might often be a benefit, but this same behavior could also prevent deeper emotional connections in relationships. Some scholars have suggested that conforming to these stereotypes can have significant psychological consequences. For example, it is widely noted that men are much less likely to seek out mental health services, preferring instead to “tough it out,” despite data that suggest that men are more likely to experience substance abuse problems and

commit suicide. Indeed, research has suggested that a greater endorsement of dominant masculine beliefs is significantly related to lower help-­ seeking behaviors in men. Scholars have suggested that an adherence to traditional views of masculinity also comes at a significant physical cost. Some researchers have speculated that one reason why women live on average 7 years longer than men is because of healthier beliefs and health practices that are directly related to gender roles, such as going to the doctor more frequently and engaging in less risky behaviors.

Gender and Intersectionality Research on men has increasingly moved toward a more nuanced examination of gender roles and masculinity. Driven by feminist theories, intersectionality, which has been defined as the study of intersections between forms of oppression and discrimination, has helped move the focus toward the experience of understudied and marginalized groups. For example, gender scholars note that one’s understanding of gender will be significantly influenced by factors such as race, social class, and sexual orientation, and the study of gender using samples of predominately White college students is not sufficient. According to some research, Black men in the United States often have a more expressive communication style and may be more likely to display emotion. This is in contrast to other racial groups. Latino men who value cultural expectation of machismo may feel greater levels of shame for emotional expression, similar to Asian and White men, whose cultural values often include restraint and stoicism. One’s social class standing affects behavioral expressions of masculinity. For the middle and upper middle classes, researchers note that masculinity is often organized around dominance and expertise, with an emphasis on leadership and professionalism. Scholars have noted that gay men’s expressions of masculinity are strongly influenced by their sexual orientations. That is, researchers have found that the gay community often values appearing masculine, while many gay men find traditional gender roles, such as emotional restraint around other men, to be incompatible with their sexual identity. Although there are gender roles that are reinforced at a societal level, it is important to continue to examine

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how these beliefs are influenced by one’s social identities.

Feminism and Gender Socialization in Men Men’s gender socialization has also been affected by strides in feminist theory and action, as well as men’s involvement in feminist social movements. Since the 19th century, men have involved themselves in feminist writing and political organizing, primarily as “allies”—men who harnessed their relative social power to support goals of women’s liberation. Men became more active throughout the second wave (the early 1960s through the late 1980s) and third wave (the early 1990s to the early 2000s) of feminist organizing. Although many early feminist scholars perceived women’s liberation to be the core objective of feminism, third-wave or postwave feminists argued that men’s liberation was as crucial as the liberation of women to the objectives of feminism. For example, Black feminist author bell hooks stresses the importance of including men in the movement for gender equality. She argues not only that men are obligated to join the struggle but also that men, particularly men of color and sexual minority men, should be freed from the harmful restrictions imposed on them in terms of how they should think, feel, and behave. The push for inclusion of men’s liberation within feminism led to enormous debate. Many women posed a challenging question: What, exactly, did men need to be liberated from? Largely in response, men’s studies (also referred to as men and masculinities studies) emerged as an interdisciplinary academic field in the 1970s and throughout the 1980s. Scholars began to integrate feminist critiques of patriarchy into discussions of issues faced by men, including depression and anxiety, shame around gender nonconforming behavior, and the impossibility of meeting a masculine ideal. In particular, they began to argue that the manner in which boys are socialized leads to a cohort of adult men who are emotionally immature, are violent, and have maladaptive strategies for coping with psychological distress. Alongside this emerging academic field, a men’s liberation movement began to grow, arguing for a restructuring of gender norms and social expectations to liberate men from the traps of masculinity.

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In 1982, sociologist R. W. Connell introduced the notion of hegemonic masculinity: a set of practices that promote the dominant social position of men over women. Connell argued that Western culture idealizes a particular form of maleness and masculinity: strong, muscular, and emotionless. Hegemonic masculinity both subordinates women and restricts the emotional expressiveness of men. It isolates men from women and other men by disallowing them to form close bonds or express vulnerability. As a consequence, men whose behavior or gender presentations do not align with typical masculine ideals (e.g., men of color, gender nonconforming men, and sexual minority men) are punished, ridiculed, and marginalized. Connell and others have since argued that, as a result, men are afraid to admit e­ motional weakness and instead turn to psychologically damaging ­ strategies of relief, such as drinking excessively, engaging in violence, and committing suicide at disproportionate rates. Men who conform to more traditional gender roles also tend to present with higher rates of psychological issues, including intimacy issues, depression and anxiety, substance abuse, lower self-esteem, and greater overall distress. In the late 1990s through the early 2000s, men’s scholars began to propose new forms of masculinity and new ways of socializing boys and men. Educator and activist Michael Kaufman, for example, wrote in 1994 that men have contradictory experiences of power. As individuals, men hold enormous capacities to exert control in their lives and in the lives of others. Along with the benefits of such privileges, however, men also face significant negative psychosocial consequences, including pain, isolation, and alienation—a sort of distancing from oneself and denial of one’s complexity due to restrictive gendered expectations. This state is contradictory in that men are socialized into power, yet this power can also result in social isolation, violence, and restrictive gender norms. Kaufman writes that the privileges and power men would lose by involving themselves in feminism would be worth the loss of fear, pain, and violence men experience as a result of the sheer impossibility of living up to masculine ideals. He also presents new notions of what it may mean to be a man—soft, caring, and engaged in gender equality.

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In recent years, more men have begun to identify as feminists, viewing feminism as a critical social movement with the potential to radicalize how women and men are socialized. They have proposed new ways for men to learn how to embody their gender: as caring, strong, empathetic people. In contemporary academia, male feminists lead much of the men’s studies and pro-feminist scholarship. Critical race theorists have also called for a deeper cross-cultural analysis of the relevance of feminism within the lives of men of color.

Suggestions for Future Research The study of men’s gender socialization has come a long way in recent decades. The conceptualization of fluid and socially constructed gender roles, rather than static biologically determined roles behaviors, has allowed for a better understanding of the complex factors that affect men. However, there is much work to be done, as evident in continued avoidance of help-seeking behavior for psychological distress and higher instances of physical maladies. Future research would benefit from situating gender socialization in men within a multicultural framework, with increased e­mphasis on how social identities and marginalized statuses affect men. Although studies have unequivocally shown how multicultural factors influence wellbeing, much can still be done to fill the existing gaps in the literature. Jacob S. Sawyer, Aaron Samuel Breslow, and Melanie E. Brewster See also Femininity; Feminism and Men; Men’s Studies

Further Readings Edwards, K. E., & Jones, S. R. (2009). “Putting my man face on”: A grounded theory of college men’s gender identity development. Journal of College Student Development, 50(2), 210–228. Shields, S. A. (2008). Gender: An intersectionality perspective. Sex Roles, 59(5), 301–311. Vogel, D. L., Heimerdinger-Edwards, S. R., Hammer, J. H., & Hubbard, A. (2011). “Boys don’t cry”: Examination of the links between endorsement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds. Journal of Counseling Psychology, 58(3), 368–382.

Gender Socialization

in

Women

Socialization is a lifelong process of learning about, and performing, societal norms that one is taught. Socialization occurs along a developmental continuum throughout the life span; it is an interactive process and takes place between the individual and the society. While people of all different cultures are socialized to think and behave in certain ways, socialization for women relates to how they learn and perform in gendered ways in society. Thus, women observe, imitate, and internalize what it means to be a woman—sharing their gender identity, their personality traits, and other ­psychological outcomes. This entry discusses the conceptualization of gender socialization and how gender socialization is shaped by the intersection of individual factors that include culture, ethnicity, and social class.

Conceptualization of Gender Socialization Developmental psychologists describe how socialization for children begins in the family and is shaped by peer interactions, work, and school; socializations are then defined and redefined within the social changes that occur throughout one’s life. To understand gender socialization in women, it is first necessary to understand the process in children. Joan Grusec and Maayan Dividov discuss in their research that socialization for children results in a child acquiring social, emotional, and cognitive skills that are developed within the parentchild relationship. They assert that parents provide socialization experiences along specific domains that are focused on protection, reciprocity, control, guided learning, and group participation. From girl child to woman, the process moves along the age continuum. The ways in which women express their gendered identity are shaped by childhood and adolescent socialization experiences with socialization agents. These agents are family, peers, school, and work. For this reason, social scientists consider gender to be socially constructed. These socialization experiences guide a woman’s thinking and behavior. There is no “right” or “wrong” way to be socialized as a woman. Rather, judgments made about women’s behaviors are evaluated

Gender Socialization in Women

against the prevailing social norms of the time, the norms of the family, and within a social context of historical events. One important historical event to consider is the women’s movement—which raised issues of gender equity and created gender consciousness. This social movement influenced women’s gender socialization along with the family, peers, work, school, and the media. How the family socializes a woman to behave in a certain way at various times within her lifetime is influenced by social situations and historical eras. One example is how a woman understands what type of behaviors or thoughts she has when acting “feminine” or not “feminine.” Whether a behavior is valued or despised depends on the socialization experiences the woman has throughout her lifetime and her desire to accept or reject these gendered socialization norms. Another example of gender socialization relates to a woman’s feeling of obligations toward others. For example, depending on her age, she may feel that she must help care for her aging parents if she is unmarried or not partnered. The socialization message from the family and peer group may be that if she has no family of her own, then caregiving to elderly parents is her responsibility. Alternatively, a woman who is decades younger and who is also unmarried or without a partner may not feel this obligation to her elderly parents. Thus, the generational difference is created in a societal context regarding women’s roles that have become more flexible than 50 years ago. If the family continues to expect that the woman be a caregiver, regardless of her age, she may experience conflict between what she is expected to do by the family and by society.

Intersectionality and Socialization of Women While the preceding examples aimed to demonstrate the ways in which socialization may manifest, they do not address intersectionalities—or the understanding that a woman’s life is shaped by multiple forces and identities. As psychologist Stephanie Shields discusses, an intersectional approach considers the multiple factors that influence the socialization of women. It is not one factor alone; rather, it is the interaction of factors that influence how a woman thinks and behaves. Some

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of these factors can be sexual orientation, religion, culture, ethnicity, age, socioeconomic status, and/ or immigration status. These factors are person specific. In the aforementioned example, consider the role of culture and socioeconomic status that can influence a women’s socialization as to her role in caregiving for elderly parents. Culture and ethnicity influences one’s identity and personality in both conscious and unconscious ways. Culture is expressed through ethnic groups that engage in patterns of behavior that are nuanced and unique from other groups. Accordingly, ethnicity and culture influence gender socialization in multiple ways. For instance, people may not identify just as women but rather as women of different ethnic or cultural backgrounds (e.g., a Latina or an Irish Catholic woman); many women embrace and express ethnic group patterns that are understood to be congruent to their specific cultural or racial group. These gendered behaviors are replicated across the life span of a woman and are taught by families, community members, teachers, friends, and others. In this way, the intersection of culture and gender determine concepts such as gendered family obligations, gender roles and expectations, and family role identities (e.g., daughter, sister, spouse, niece). Although some women may not wish to emulate all or some of these patterns of behavior, many older women report engaging in similar behaviors as their mothers or women of previous generations. Thus, the socialization of women serves the function of maintaining the family cultural and ethnic group norms and values from generation to generation. Previous scholars have examined how racial socialization may be influenced by gender. Racial socialization involves the messages (both verbal and nonverbal) that are transmitted from older generations to younger generations about experiences with race and racism. For African Americans, racial socialization is often very direct and intentional—in that older generations ensure that children and young adults are well prepared for the realities of racism (e.g., preparing them that others may mistreat them because of their race, coping with overt racism or racial microaggressions). The ways in which African Americans are racially socialized are typically contingent on their gender—in that boys are taught certain messages

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about race, while girls are taught other messages. For instance, boys specifically are taught about how to interact with police and other law enforcement officers, given the prevalence of unarmed Black men who are killed by police officers; concurrently, girls are taught specifically how to speak or behave in academic settings, knowing that Black women are targeted by both racism and sexism. Some scholars view the utility of understanding race from gendered perspectives, while others attest that they may promote rigid gender roles within the African American community. Social class is another factor that influences gender socialization. Social class is an individual’s subjective appraisal of their social location compared with others. Social class is not income, ­education, and occupation (otherwise known as ­socioeconomic status), but rather, it is the values, norms, and expectations of how someone should act because of their financial wealth, education, neighborhood, and other factors. With various social class groups, women are taught particular behaviors that are viewed as normative, expected, or celebrated. For example, poor women and upper-middle-class women may learn different types of speech or language; they may also have different pressures on how they should dress, behave, or raise their children. Sometimes, gendered messages are obvious (e.g., being told specifically about what is accepted in a certain social class), and at other times, they are subtle (e.g., observing that women behave in certain ways and feeling pressured to conform). Either way, social class expectations influence gender socialization, which may affect psychological outcomes like selfesteem, performance and achievement, or mental health. Religion may also influence gender role socialization, particularly for religious groups that uphold traditional gender roles. For some religious groups, there are gender role expectations for career and educational pursuits, as well as family roles. While men may also experience gender role expectations, women of many religious groups are socialized to serve or adhere to men’s needs. For instance, in the Church of Latter-Day Saints, Mormon women are expected to be conventionally feminine (e.g., to be gentle and nurturing). Mormon women cannot hold executive leadership roles in the church or seek careers outside the

home; instead, they are encouraged to rear children and to assume support roles for their husbands. In other religions, women are socialized on how to dress. For example, in Hasidic and Orthodox Judaism, women are expected to wear modest clothing (covering their elbows and knees), and married women are required to cover their hair. Furthermore, in many traditional religious groups, women are not allowed to engage in any sexual behavior outside marriage, while men of the same religious groups may have some leeway. For instance, in many conservative Christian and Muslim communities, women are expected to be pure and to save their virginities for their husbands. In some religious communities, women who engage in sexual behaviors outside marriage may be stigmatized or even shunned altogether. Accordingly, the messages learned from gender socialization within traditional religious communities may be more rigid than the messages learned from nontraditional religious communities or from atheists or agnostics who do not affiliate with any religion at all. Karen Fraser Wyche See also Feminist Identity Development Model; Feminist Psychology; Gender Discrimination; Gender Role Socialization; Gilligan’s Moral Development Theory; Institutional Sexism; Internalized Sexism; Media and Gender; Patriarchy

Further Readings Brewer, L. (2001). Gender socialization and the cultural construction of elder caregivers. Journal of Aging Studies, 15(3), 217–235. Carter, M. J. (2014). Gender socialization and identity theory. Social Sciences, 3, 242–263. doi:10.3390/ socsci.3020242 Reid, P., Lewis, L., & Wyche, K (2013). An intersectional framework for a multicultural analysis of gender. In F. Leong (Ed.), Handbook of multicultural psychology: Vol. 1, Theory and research (pp. 379–394). Washington, DC: American Psychological Association. Sears, K. (2012). Improving cultural competence education: The utility of an intersectional framework. Medical Education, 46, 545–551. Worell, J., & Goodheart, C. (Eds.). (2006). Oxford handbook of girls and women’s psychological health. New York, NY: Oxford University Press.

Gender Stereotypes

Gender Stereotypes Gender stereotypes are overgeneralized beliefs about the characteristics of individuals based solely on their gender, regardless of the actual diversity among members of various gender groups. The beliefs reflect perceivers’ knowledge and expectations about women, men, transgender, and other gendered people. The content of stereotypes typically includes personality traits, behaviors, physical features, roles, preferences, attitudes, skills, and interests, among others. Stereotypes are relevant to the psychology of gender because they shape how people process information about gender and influence judgments made about members of various gender groups. Stereotypes serve as a schema, or lens, through which individuals view their social world. This entry provides a brief overview of gender stereotypes, including history, ­origins and purpose, types and forms, consequences, and methods to reduce gender stereotypes.

Brief History The term stereotype was first brought to public attention by journalist Walter Lippmann in 1922 to refer to “images in our heads.” The term was based on a printing process that used fixed casts to print images, and later the term stereotypy was used to describe a pathological state that reflected rigid, unchanging behavior. Lippmann also used the term stereotype to reflect fixed thinking, highlighting that stereotypes create “pseudo environments” or “fixations” in individuals’ minds that do not necessarily reflect reality. In this sense, stereotypes are social schemas, or cognitive structures, that organize our information about the social world and influence information processing. Although holding stereotypes was once thought to be abnormal, cognitive psychologists have noted that stereotypes are necessary to process large amounts of information quickly. Humans are bombarded with so much sensory information every second that cognitive shortcuts and filters are necessary to make daily living possible. Thus, humans are often referred to as “cognitive misers” who take shortcuts in processing information and making judgments, which can be surprisingly accurate (e.g., research on first impressions based on

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“thin slices” of behavior) but can also be grossly inaccurate.

Origins and Purpose Gender stereotypes originate from grouping individuals by gender into categories such as women, men, transgender, two spirit, among others. Once people are classified into gender groups, they are assumed to share characteristics, and their unique qualities are often overlooked. This social categorization process is the first step in simplifying information processing. Once humans are classified into gender groups, in-groups and out-groups can be determined, or groups to which one belongs and groups to which one does not belong, respectively. This designation allows for differentiating among various gender groups, which often leads to differential valuing of groups. Besides simplifying information processing, gender stereotypes can be used for self-enhancement or boosting self-esteem. If someone is feeling down, the person can apply a negative gender stereotype to someone (e.g., women are bad at math) and can therefore feel better about oneself. Stereotypes also serve to affirm our values and beliefs. For example, by stating that women ought to be mothers and not have a career, individuals are expressing their belief in family values. Gender stereotypes are often reinforced in society and reflect cultural norms.

Types and Forms Gender stereotypes come in many forms: They can be positive or negative, explicit or implicit, and prescriptive or descriptive. Gender stereotype also share common dimensions such as communion and agency and attractiveness bias. Each concept is described next. Positive and Negative

Gender stereotypes can be positive in that they bestow positive qualities on a particular gender group, for example, that women are warm, friendly, and caring, whereas men are competent, confident, and assertive. On the surface, this may not seem problematic; however, these positive stereotypes suggest that all women and all men should have

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these respective qualities. It is possible for women to have some qualities associated with men and for men to have some qualities associated with women, or to lack qualities associated with their gender group. Thus, the rigid categories, although apparently positive, are limiting for how members of gender groups express their personality and behaviors. People use these stereotypes to make judgments, and if members of gender groups do not conform to these expectations, they face negative consequences. The greatest attention has been paid to negative stereotypes as they are easier to detect as harmful and problematic. Examples include women are overly emotional, irrational, and incompetent, whereas men are hot tempered, violent, and lack empathy. If these negative expectations are applied to all women and all men, this grossly exaggerates the gender expectations of men and women. In addition, gender stereotypes do not take into account situational influences on behavior and instead describe these personality traits as innate aspects of one’s gender. Explicit and Implicit

A second classification of gender stereotypes is whether they are consciously or unconsciously held by the individual. Much of the research has focused on explicit gender stereotypes, or those that are conscious and controlled that can be freely reported on a questionnaire or in conversation. However, a more insidious form of gender stereotypes is that which operates implicitly, or without awareness and control. According to dual-process theories, behavior can operate both automatically (implicitly) and systematically (explicitly). That is, someone can have both an implicit and an explicit stereotype toward someone based on gender, and these stereotypes can be expressed consciously or unconsciously through behavior. In addition, automatically activated stereotypes can have a particularly strong influence on a wide range of social judgments and behaviors. When dual gender stereotypes exist, the implicit stereotype is activated automatically, while the explicit stereotype requires motivation to be retrieved from memory. If the explicit stereotype is retrieved, it can override the implicit stereotype; otherwise, people report the implicit stereotype.

Implicit stereotypes influence uncontrollable responses, such as nonverbal behaviors, even when the explicit stereotype is retrieved from memory. This explains why implicit gender stereotypes often predict prejudicial behavior above and beyond explicitly reported gender stereotypes. Prescriptive and Descriptive

Men and women are subjected to both descriptive and prescriptive stereotypes, which outline how others think men and women are and how others think men and women should behave, respectively. Descriptive bias occurs when men and women are not deemed to have the appropriate masculine or feminine characteristics for a given situation or job. Prescriptive bias occurs in reaction to counterstereotypic behavior, such as when a woman behaves in an assertive manner and is deemed “rude” and therefore experiences negative backlash. Agency and Communion

Many gender stereotypes can be organized based on two fundamental dimensions of social judgments: agency and communion. Agency is the extent to which a person believes another person is competent and able to carry out their motives. Communion is the extent to which a person is warm and caring and determines whether others like the person. The stereotype content model documents many forms of gender stereotypes that vary on these two dimensions. For example, stayat-home mothers are typically viewed as low in agency but high in communion, whereas career women are viewed as high in agency but low in communion. In contrast, the typical man is viewed as high in agency and communion. Attractiveness Bias

Research has consistently demonstrated that those who are more attractive experience many advantages over their less attractive counterparts, or the “what is beautiful is good” stereotype. However, biases based on attractiveness may have particularly detrimental effects for women because men place a heavy emphasis on women’s attractiveness in mate selection, more so than women do

Gender Stereotypes

for men. Also, in the United States, women tend to be judged based on appearance to a greater extent than men, with women being held to higher standards of beauty and subjected to greater expectations of devoting resources to enhancing their appearance. One area in which physically attractive people receive preferential treatment is in the hiring context. Attractiveness is particularly important for women in this context, as unattractive women are the least-preferred applicants after attractive men, attractive women, and unattractive men.

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Self-Fulfilling Prophecy

Gender stereotypes affect one’s behavior toward members of various gender groups. How one treats an individual can affect how the individual responds. Thus, if one treats a person in accordance with a gender stereotype (e.g., expecting a woman to be incompetent in science), the person may pick up on subtle cues and respond unfavorably, such as performing poorly in a job interview, and the perceiver’s stereotype may appear to be confirmed. The self-fulfilling prophecy is a pernicious cycle that makes gender stereotypes more resistant to change.

Consequences of Stereotypes Gender stereotypes have negative consequences for the individuals and gender groups targeted by them as well as for the advancement of gender equality in society. Gender stereotypes may limit individuals’ life aspirations and put unnecessary restrictions on their behavior. Stereotype Threat

Stereotype threat is the fear and anxiety that members of stereotyped groups experience when they worry that their behavior will be judged based on a negative stereotype. The experience of stereotype threat often results in lower achievement in academic and work domains. A prominent example of this process is the effects of the stereotype that girls and women are not as competent in mathematics as boys and men. When in evaluative performance situations, such as highstakes academic tests, girls and women may worry that if they perform poorly they will inadvertently support this negative stereotype. They might be worried that their poor math performance reflects poorly on them and/or on their gender group as a whole. Stereotype threat is situationally induced, such as by priming gender before an exam, and therefore can be eliminated. Indeed, women who learn about the harmful effects of stereotype threat on women’s math performance are less likely to be negatively affected by it in the future. However, many girls and women are unaware of this psychological phenomenon, and it is considered as one of the causes of gender gaps in math and science education and career achievements.

Leadership Aspirations

Compared with men, women are evaluated less favorably by others for leadership roles. This finding can best be explained by role congruity theory, which is grounded in social role theory and examines the extent of congruity between gender roles and leadership roles. When women do break through traditional gender stereotypes and display agentic behaviors characteristic of leaders, they are also evaluated unfavorably because they are displaying behaviors incongruous with their gender. When women are in leadership roles, there is evidence that they underpredict their performance compared with men. This may be the result of a lack of self-confidence, learned gender roles, and self-sexism among other explanations. This is a particular concern because leader self-awareness is a precursor for leader effectiveness. In other words, this could create a self-fulfilling prophecy and continue the unfortunate cycle of women’s perceived lower leadership performance. Hiring Discrimination

Studies that have examined applicant gender in conjunction with other factors (e.g., physical attractiveness, student vs. employee raters, type of job, and qualification level) have consistently supported a preference for male applicants in selection situations, even when equally qualified females apply for the same job. This access discrimination often prevents women from entering the workforce or results in women being placed in lowerlevel positions.

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Gender Studies in Higher Education

Hiring discrimination is especially likely to occur when women are applying for male-dominated jobs and when raters endorse traditional gender stereotypes (e.g., associating women with communality and men with agency). Interestingly, this discriminatory link does not hold for androgynous women. Women are also discriminated against in promotion decisions. This glass ceiling effect describes invisible barriers that seem to prevent women from reaching top levels within organizations. Similarly, the sticky floor effect describes the situation of women who are intentionally selected into lowlevel jobs with little chance of promotion. This phenomenon does not exist for (predominantly White) men, however, as they are often quickly promoted to higher level positions, even in femaledominated jobs in what has been appropriately termed the glass escalator effect. Changing Stereotypes

Research on reducing gender stereotyping has shown that diversity education and self-­awareness training are effective. People need to make a conscious effort to recognize the use of gender ­stereotypes among themselves and their loved ones. Because gender stereotypes affect how people process information, if they are aware of the stereotypes, they can minimize how the stereotypes affect their judgments. For example, instead of looking for evidence to confirm gender stereotypes (e.g., a dumb blonde), one can look for contrary evidence (e.g., a woman scientist who happens to be blonde). Bettina J. Casad and Breanna R. Wexler See also Gender Microinequities; Gendered Stereotyped Behaviors in Childhood; Gendered Stereotyped Behaviors in Men; Gendered Stereotyped Behaviors in Women; Microaggressions; Sexism; Stereotype Threat and Gender

Further Readings Kite, M. E., Deaux, K., & Haines, E. L. (2008). Gender stereotypes. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of women: A handbook of issues and theories (2nd ed., pp. 205–236). Westport, CT: Praeger. Wood, W., & Eagly, A. H. (2010). Gender. In S. T. Fiske, D. T. Gilbert, & G. Lindzey (Eds.), Handbook of social psychology (Vol. 1, pp. 629–667). Hoboken, NJ: Wiley.

Gender Studies in Higher Education Gender studies programs in higher education provide students with an interdisciplinary approach to the study of gender. As a relatively new field of study, these programs focus largely on advocacy, activism, and representation, with a particular emphasis on the experiences of women. Typical coursework found in gender studies range from introductory methods and theories to the psychological and biological determinants of gender development and expression. This entry briefly introduces the history of gender studies programs in U.S. universities, common curriculum within these programs, the application of feminist theory, major goals of gender studies, and finally the impact that these programs have on students.

The Evolution of Gender Studies in Higher Education Gender studies programs are a relatively new addition to many university and college campuses, having first been introduced in the early 1970s. These programs were largely created as a reaction to the first-wave feminist movement that took place in the United States during the 1960s and were initially oriented toward activism and the promotion of gender equality. Since their onset in the early 1970s, approximately 650 gender studies programs have been instituted in universities, colleges, and community colleges across the country. In the decades since their inception, gender studies programs have become increasingly interdisciplinary in their focus. Many of these programs include crossover courses that branch into the fields of psychology, sociology, law, b ­ iology, business, communications, and cross-­ cultural studies, just to name a few. Unlike many other fields of study, such as mathematics and psychology, that have a fairly regimented c­ urriculum that only slightly differ between ­ universities, gender studies programs vastly differ in terms of their course offerings and concentrations.

Gender Studies in Higher Education

Common Curriculum in Gender Studies Programs Reflecting the interdisciplinary nature of gender studies programs, the curriculum found in these programs spans a wide array of subject areas. These differences largely stem from the diversity of the faculty affiliated with these programs. Most institutions of higher education do not offer graduate degrees in gender studies. Therefore, gender studies faculty tend to come from a number of ­different backgrounds, producing a great deal of variability in the curriculum. Introductory Level Courses

Perhaps the most common courses found in gender studies programs are introductory courses in women’s and gender studies and feminist theory and ethics. These courses provide the ­ foundational knowledge necessary to obtain an undergraduate degree in gender studies, ensure that students are able to evaluate information using a feminist lens, and inform students of feminist methods in research. While much of the curriculum from introductory courses on research methods overlaps with material that students learn from other research methods courses, particularly those required in psychology programs, feminist methods courses tend to include more information on ethnographic research and the use of qualitative data. These methods are indicative of the field’s focus on the lived experiences of individuals. Pop Culture and the Arts

Other courses typically found in these programs focus on gender as it relates to pop culture and the arts. Examples include courses on gender and literature, gender and media studies, and women in art and theater. In this context, many programs feature courses on the contributions of minority women. Body image and objectification are often major focuses of these courses, as students are encouraged to evaluate how the ­ media portrays male and female bodies and how those portrayals map onto social behaviors and expectations.

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Advocacy and Activism

Stemming from the roots of gender studies programs, another common focus is coursework centered on advocacy and activism. These include courses in women and the law; gender in the workplace; global gender issues; race, class, and gender; and gender and violence. These courses are meant to shed light on inequality, with a particular focus on the disadvantages that women experience in their different social roles. Students in these courses develop a greater awareness of the prevalence of discrimination and are better able to identify instances of discrimination in their everyday lives. Students in these courses are often required to get involved with some form of community outreach related to gender issues. Cultural Differences

Cross-cultural courses are yet another major theme. The specific cultural contexts of these courses, however, largely depend on the location of the institution and the backgrounds of the individual faculty members within the program. That being said, within the United States, courses on the history of American feminism and transnational feminism are particularly common. Courses that focus on global gender relationships often base their comparisons on power differentials (i.e., the relative power of men in comparison with women) within each country. Psychological and Biological Underpinnings of Gender

Finally, psychological and biological underpinnings of gender development and behavior are also widespread topics of study, specifically in the context of psychology of gender and human sexuality courses. By focusing on human development through social learning, genetics, anatomy, and cognitive functioning, these courses attempt to provide a theoretical background regarding gender specific behaviors and abilities. These ­ courses in and of themselves tend to be interdisciplinary in nature. Psychology of gender courses often include perspectives on gender research from developmental, cognitive, clinical, community, and social psychology. Furthermore, human

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sexuality courses typically include biological, psychological, cultural, communications, advertising, and evolutionary perspectives. While the exact courses provided tend to differ across universities, one commonality remains at the center of each of these programs: the implementation of feminist theory in curriculum development.

Feminist Theory and Its Application in Gender Studies Feminism is a philosophy that is largely misunderstood. In its most basic form, feminism is the belief that men and women should be treated equally. A more inclusive definition describes feminism as the belief that all people should be treated equally, regardless of gender identity, sexual orientation, race, ethnicity, religion, social class, and so forth. Gender studies programs typically subscribe to this latter definition, which is reflected in the curriculum. Feminist theory, as it applies to gender studies in higher education, is the application of feminism to theoretical and philosophical discourse in an attempt to better understand gender inequality and to further address said inequities (e.g., gender discrimination in the workplace, gender pay gap, sexual harassment, sexual assault, developmental differences). This emphasis on feminist theory informs many of the goals and mission statements set forth by these programs.

Common Goals and Mission Statements With its roots in advocacy and activism, gender studies programs often have mission statements oriented toward gender inclusivity, steering away from heteronormativity, and ending inequality. Reflecting this, one of the primary goals of these programs is to help students develop an understanding of the differences between sex and gender. In doing so, educators emphasize the social construction of gender and the pervasive impact of heteronormativity (i.e., the common belief that people fall into distinct gender categories of either female or male and that these categories provide distinct roles) on gender norms and expectations. Building on this initial goal, another major objective of gender studies programs is to examine

the impact of social structures on perceptions of gender and, more specifically, how gender interacts with politics, economics, the law, upward mobility, and education. This goal often broadens the scope of gender studies to include the intersection of gender, race, and class. By educating students on the inequities that stem from social structures, these programs expand the focus from information to action. In this vein, another major goal is going beyond the simple awareness of discrimination to promoting social justice. This typically involves encouraging civic engagement among students and promoting careers in fields related to social justice. Finally, in recognition of the importance of developing and disseminating new knowledge on gender, another common goal among these programs is to educate students in the research methods used by feminist scholars. Through their focus on inspiring students to affect personal and social changes, and learning to think critically about the impact of social factors on the development and representation of gender, gender studies programs in higher education have been shown to affect students in meaningful ways.

Impact of Gender Studies Courses on Students A number of studies have been conducted to examine the short-term and long-term effects of participation in gender studies courses. In the realm of personal changes, students have been shown to develop a greater awareness of sexism in society, gender discrimination, and male privilege. Students also tend to adopt more egalitarian attitudes, positive attitudes toward women, and nontraditional behaviors (i.e., behaviors that are not considered typical for the members of their gender). Changes in confidence and assertiveness have also been reported, as well as an increased locus of control. In addition, gender studies students also report fewer gender stereotyped attitudes and greater willingness to identify themselves as feminists at the end of their gender studies course than they were at the start. In terms of affecting social changes, gender studies courses have been shown to increase students’ interest in feminist activism and feminist causes.

Gender Studies in K–12 Education

Students also demonstrate fewer gender ­stereotyped relationships with others and less resistance to discussing topics related to oppression. Importantly, students also often educate others about what they learned in these classes. Overall, gender studies courses in higher education have deep and long-lasting impacts on students’ perspectives and career paths. By providing students with a feminist lens, these programs allow students to explore issues related to gender diversity and expression and to carry on a tradition of advocacy, activism, and representation. Furthermore, the interdisciplinary nature of these programs promotes a broad focus on the study of gender, including social, psychological, and biological perspectives. Megan A. Carpenter See also Education and Gender: Overview; Feminism: Overview; Gender and Society: Overview; Gender Development, Theories of; Gender Nonconformity and Transgender Issues: Overview; Heteronormativity; Media and Gender; Title IX

Further Readings Armstrong, A. H., & Huber, J. (2015). Where are we headed? What’s in our way? How can we get there? Thoughts from directors of women’s and gender studies programs. Journal of Women and Social Work, 30, 216–231. doi:10.1177/0886109914544718 Berger, M. T., & Radeloff, C. (2014). Transforming scholarship: Why women’s and gender studies students are changing themselves and the world (2nd ed.). New York, NY: Routledge. Fahs, B. (2011). Breaking body hair boundaries: Classroom exercises for challenging social constructions of the body and sexuality. Feminism & Psychology, 22, 482–506. doi:10.1177/ 0959353511427293 Flood, M. (2011). Men as students and teachers of feminist scholarship. Men and Masculinities, 14, 135–154. doi:10.1177/1097184X11407042 Helgeson, V. (2012). Psychology of gender (4th ed.). New York, NY: Routledge. Johnson, S. P., & Weber, B. R. (2011). Toward a genderful pedagogy and the teaching of masculinity. Journal of Men’s Studies, 19, 138–158. doi:10.3149/jms.1902.138 Stake, J. E., & Hoffmann, F. L. (2001). Changes in student social attitudes, activism, and personal confidence in

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higher education: The role of women’s studies. American Educational Research Journal, 38, 411–436. Teich, N. M. (2012). Transgender 101: A simple guide to a complex issue. New York, NY: Columbia University Press.

Gender Studies Education

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K–12

Gender studies in K–12 education refers to the intentional inclusion of interdisciplinary educational content that is focused on how gender, including gender identity, gender expression, and biological sex, is socially and culturally constructed. As such, gender studies includes how race, religion, ethnicity, class, location, and disability intersect with both gender and sexuality and thereby affect the experiences of individuals and society at large. Although college and university contexts increasingly reflect and explore both the theories and research related to gender studies, the K–12 education context has less directly incorporated this material. That said, the importance of gender studies in K–12 schools is arguably critical because educational institutions both shape and reflect individual and cultural expectations and prejudices related to the meanings of masculinity and femininity. Accordingly, a history of gender studies in schools is provided, followed by a discussion of how gender studies has and can be implemented as well as infused within K–12 schools. Specifically, examples are provided at the elementary, middle, and high school levels. Gender studies as a field grew out of the women’s movement and advocacy activities in the 1970s, in which women began to protest the ways in which educational (and other) institutions made women invisible and empowered men, while society concurrently ignored the profound role of gender socialization. Gender studies in education can facilitate critical thought in how young people are socialized and prepared for the future. Although gender studies grew out of the women’s movement, it has since influenced and been influenced by other associated disciplines, including LGBT (lesbian, gay, bisexual, and transgender) and queer studies. Gender studies theorists also

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commonly utilize critical theories (e.g., critical race theory, intersectionality, and postcolonial theory) and have expanded beyond Western culture to explore increased global concerns. The following sections explore how gender studies are, or could be, utilized in traditional K–12 settings by teachers and other school professionals.

Elementary School The elementary years are often referred to as middle childhood, with an age range of 5 to 10 years, Grades K to 5 in the United States. According to Jean Piaget, children in this stage experience more logical, flexible, and organized thought than was previously possible. However, cultural and educational practices have a profound impact on children’s ability to process information and develop mastery of experience. These cultural and educational practices play a significant role in long-term development. Furthermore, during middle childhood, children begin to develop a more refined self-concept, making frequent social comparisons with peers as they develop their sense of self. Education, culture, and parenting styles have interconnected effects on development during this period. At the same time, emotional experience becomes more dynamic, including feeling a more diverse range of emotions, including pride, guilt, and other more complex emotions. Toward the end of middle childhood, peer groups become profoundly influential on development, as children seek lasting friendships and peer acceptance. Gender stereotyping becomes more concrete during late middle childhood, yet children can develop a more flexible range of “acceptable” gender behaviors. Children begin to receive feedback from peers, friends, family members, and media about what typical gendered behaviors look like and begin to form self-evaluations of themselves based on perceived masculine or feminine traits and qualities. Indeed, the Centers for Disease Control and Prevention recommends that students in second grade be able to identify the ways in which peers and family influence health practices and perceived norms. In elementary education, children learn about gender through the aforementioned channels as well as through specific educational programming. Educators have opportunities to challenge

stereotyped images of “acceptable” gender behaviors and facilitate a culture of a classroom that promotes difference in play and other socialized roles. Early career exploration, science, and health education classes all can include information related to gender, including potentially biased information regarding career choices and gendered occupational stereotypes; educators can introduce the idea of male and female leaders in a variety of fields, challenging traditional stereotypes of gender fit in specific fields. Furthermore, work by elementary school counselors focused on personal, social, and emotional development can affect elementary students’ understanding of gender, and engagement with parents and other student stakeholders can provide resources for adults to challenge their gender stereotypes and learn how to accept differences, so that this message can be reinforced in the home and elsewhere. Schoolwide programs focused on character education and healthy lifestyle choices may also include information related to gender and how to facilitate safe environments for differences found within the school environment.

Middle School During Grades 5 through 8 in the U.S. educational system, youth can range between the ages of 10 and 15 years. This developmental period is often referred to as early adolescence, and it is marked by rapid and often uneven changes across physical, cognitive, personal, social-emotional, and moral domains. What follows is an explanation of how, why, and in what capacity gender studies can be an appropriate developmental fit for youth in a middle school setting, across each of these domains. Physical development in the middle school years is rapid and often includes the changing body shape and size associated with manifestations of sexual maturation. As there is wide variation in the timing of the onset of puberty, there are vast differences across middle school youth in their increases in height, weight, and body hair, as well as in the onset of the broadening of hips and development of breast in females and the widening of shoulders and deepening of voice for males. Nonetheless, the physical developments culturally associated with masculinity and femininity can present educators with an opportunity to address them through a gender studies lens. Thus, health or physical

Gender Studies in K–12 Education

education teachers could incorporate gender s­ tudies theory into their lessons. While cognitive and personal domains of development are different, the changes evident in middle school youth can intersect with and ­ inform one another. Cognitively, youth move from concrete operational thinking to formal operational thought. This change is marked by the ability to take multiple perspectives, hypothesize, and engage in abstract thought; as such, middle school youth become more capable of applying gender studies concepts, examining how socialized gender roles are transmitted, or the ways in which people express and discern others’ masculinity and femininity. Because the ability to engage in formal operational thought, and the philosophizing that comes with it, can be inconsistent in the middle school years, intentionally developed small groups might be the preferred format for such lessons. The personal development in middle school years builds off the cognitive changes, permitting increased abstraction, and includes increased self-awareness, sense of autonomy, and an exploration of identity. As such, incorporation of gender studies content could provide middle school youth added knowledge, awareness, and skills to navigate these developmental tasks. While such l­essons could be undertaken within the school counseling curricula, they also could be infused into global or world history, wherein gender studies concepts are introduced and examined through a historical lens and the economical and governmental implications and intersections could also be explored. Social-emotional and moral development are also interrelated in the middle school context, as youth often have formed close bonds with a ­preferred peer and can take this person’s perspective. At the same time, from a social-emotional perspective, middle school youth have increased recognition of the varied types of group belonging and exclusion taking place socially. This new awareness can create what David Elkind has referred to as an imaginary audience, which can generate intense and difficult-to-manage emotions. In addition, more pronounced gender differences emerge with respect to establishing one’s social capital. Conventional morality is typical in the middle school years, including an increased internal frame of reference for justice, while also understanding more complexities within interpersonal

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relationships and social order. Given these developments in the middle school years, gender studies can provide a grounding organizational lens through which to view self, other, and society. One way in which educators could facilitate this learning is through the application of gender studies concepts to literature, drawing out the social and interpersonal implications as well as the moral implications for individuals, groups, and society.

High School Throughout the high school years (Grades 9–12 in the United States), the age of adolescence ranges between the ages of 15 and 18 years. From a developmental perspective, this period can be referred to as late adolescence and/or young adulthood. During this time, developmental changes to physical, cognitive, and social-emotional areas are experienced. Psychologist Erik Erikson proposed a life span model of development stating that an individual develops as a number of social crises are navigated. Successful resolution of these crises, as stated by Erikson, leads individuals to establish trust in others and to develop an emerging sense of social identity. As individuals transition from childhood to early adulthood, Erikson labeled the crisis “identity versus role confusion” as adolescents attempt to identify their emerging identity and role. Therefore, educators may find delivering a gender studies–inclusive curriculum at this time in the psychosocial development of adolescents to be both developmentally appropriate and critical to adolescents’ understanding of gender. Although adolescents at this age have the ability to acknowledge and question traditional gender stereotypes, gender biases can still be found throughout the school environment through gender-­ influenced course selections, curriculum structure, and textbook content. Education and the school environment play critical roles in the development of gender identity of adolescents and young adults as these institutions are at the center of the development of social and cultural values of students. Thus, it is important for school personnel to commit to constructing a curriculum and environment that supports gender studies in high school. The following provides a brief overview of key developmental changes observed during adolescence and identifies both opportunities and barriers for integrating gender studies during the high school years.

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During the high school years, puberty and corresponding growth spurts tend to slow in females. Males, however, tend to experience either a delayed start or continual growth in height and weight compared with their female peers. As a result, there may be observed deviations in the physical characteristics of individuals across genders of the same chronological age. In addition, one’s sense of body image may evolve as these anatomical and physiological changes are experienced. As students continue to enter this period of late adolescence, they will develop a greater capacity for moral reasoning and they will transition from the concrete thinking associated with childhood to more complex, abstract thinking. Insight, perspective taking, and systematic problem-solving skills also continue to develop. Individuals may begin to examine the value systems of others, question authority, seek out peer support and approval, and experiment with alternative lifestyles as means of constructing their identity. Formations of new own moral systems, sexual identities, and negotiations within social and intimate relationships will also occur. As such, educators need to provide students with a supportive environment and the resources to encourage critical self-reflections of their emerging views of gender during this time. Teachers of English and literature courses can integrate gender studies into their curriculum by including course content that equally demonstrates and deconstructs strong characters across all genders. Such opportunities can challenge student views of their own gender while understanding the thoughts and feelings of the other. In social studies courses, teachers can discuss gender roles that are embedded within cultural institutions. For example, using films that focus on historical figures of all genders can provide all students an opportunity to learn from the experiences and perspectives of other individuals who identify with their gender. Such critical examinations of gender through these curriculums during this period of cognitive and socialemotional growth would be developmentally appropriate. In physical education and/or health classes, teachers could acknowledge and facilitate ­discussions that critique social and cultural expectations of body image. School librarians could s­ upport gender studies by assisting teachers in identifying and expanding media resources (e.g., books, websites, magazines) in curriculums to utilize nontraditional examples of role models across all genders.

Lack of time and space in curriculum, fear of parental backlash, limited access to resources, and differences in personal values and beliefs are frequent barriers cited by teachers to integrating gender studies into high school education. Teachers can explore the Common Core curriculum across subject areas to find potential intervention points that can easily facilitate gender studies while honoring required curricula. Gender studies encourages students to reflect on their own ideas and emerging beliefs and provides an opportunity to acknowledge perspectives of gender differences while also examining them within a cultural context. Opportunities for critical reflection can assist students in preparation for college-level thinking, increase self-acceptance of personal differences, and facilitate success in subsequent relationships and career prospects. Melissa Luke, Kristopher M. Goodrich, Jaime Castillo, and Alan Miller See also Adolescence and Gender: Overview; Cultural Gender Role Norms; Education and Gender: Overview

Further Readings Centers for Disease Control and Prevention. (2004). National health education standards. Atlanta, GA: Author. Retrieved from http://www.cdc.gov/ healthyyouth/sher/standards/index.htm Long, M., & Conger, D. (2013). Gender sorting across K–12 Schools in the United States. American Journal of Education, 119(3), 349–372. Ozkaleli, U. (2011). Butterflies for girls, cars for boys: Gender in K–12. Social Change, 41(4), 567–584.

Gender Tracking

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Education

Gender tracking is the practice of directing the education of male and female students into different paths based on gender and societal norms and expectations. Sometimes, this tracking is systematic and institutionalized, and sometimes, it is unconscious and covert. Gender tracking can begin as early as preschool and have far-reaching effects in determining the social status, future earning potential, worldview, and self-worth of men and

Gender Tracking in Education

women long after they have left school settings. Gender tracking is a broad term that can encompass gender segregation in education such as the establishment of women’s colleges. The term also encompasses more covert subconscious aspects such as gender expectations from teachers and peer pressure to conform to social norms.

Gender Tracking in Elementary Education Gender tracking often begins while children are still in the womb. As soon as many parents discover the gender of their child, they begin choosing “boy names” or “girl names.” They begin selecting appropriate toys and clothes for that gender and decorating a nursery in accordance with what society deems appropriate for that gender. When children begin school, teachers often expect boys and girls to play with toys that have been designated for a certain gender. Peer pressure then forces children to become exclusive friends with children of the same gender. As children progress in elementary school, the tracking becomes more pronounced. Boys are often called on to help the teacher carry or move items, while girls are given classroom clerical duties. Research has also indicated that elementary school teachers favor boys and often call on them more than girls. In response, girls become less likely to raise their hands to provide correct answers or volunteer because they internalize their subservient status to boys in the classroom. All this being said, girls are perceived as smarter, are better readers, and tend to earn higher grades. Boys are far more likely to be recommended for special education services than are girls. Teachers also tend to expect more disciplinary problems from boys. Boys who become severe disciplinary problems are perhaps only conforming to teacher expectations.

Gender Tracking in Secondary Education Gender tracking becomes embedded in the psyche of society and students themselves by the time they reach secondary school. Gender tracking occurs in different ways in three settings in secondary school: (1) tracking among low-achieving students, (2) tracking among high-achieving students, and (3) tracking in sports and extracurricular activities.

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The gender expectation differences among lowachieving students is generally more institutionalized. Teachers maintain low expectations of both low-achieving boys and low-achieving girls, but the tracking of boys and girls is embedded in vocational education. Because it is assumed that these low-achieving students will not proceed onto college, they are regulated to courses that will lead to a manual trade. The tracking occurs also in which trades are deemed most fitting for each gender. While boys are trained in masonry-, auto ­mechanical–, or industry-focused courses, girls are geared toward courses in cosmetology, child care, and food preparation—and the earning potential of the former far exceeds that of the latter. Students also internalize these expectations and assume that this is the most appropriate work for them. Gender tracking among high-achieving students takes a different form. It is assumed that all of these students will proceed onto 4-year colleges. However, boys are assumed to be interested in hard sciences such as mathematics, engineering, and physics. Girls, on the other hand, are expected to excel in the humanities and social sciences. Teachers and society assume that they will take an interest in languages, literature, psychology, and sociology. There are two exceptions in which male and female students are seen as equally likely to excel. History and biology are popular with male and female students, as nearly equal numbers of boys and girls go on to law school or medical school on completion of their undergraduate education. However, tracking still occurs in those professional school settings. Tracking in law and medical school is beyond the scope of this entry. Tracking also occurs in secondary education in terms of sports and other extracurricular activities. The federal law Title IX of the Education Amendments of 1972 guarantees equal access to educational opportunities for all students. Because of this, there are equal opportunities for boys and girls to participate in high school sports. Gender segregation is prevalent in high school, college, and professional sports. This stems from the belief that men and women possess different levels of bodily strength. To ensure that students are competing with and against persons of comparable body strength, nearly all schools separate boys and girls into different teams. Such segregation can prevent bodily injury. The tracking occurs in which sports

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Gender Variant Role Expression in Childhood

are deemed appropriate for which gender. Many schools have boys’ and girls’ basketball, soccer, and lacrosse teams. However, the most violent sports such as football, wrestling, and hockey are nearly exclusively male. Social pressure also perpetuates segregation. For example, high school boys may be reluctant to join the cheerleading squad.

Gender Segregation in Education Gender segregation was initially the norm in education. Boys’ and girls’ schools and women’s and men’s colleges are traditional forms of education in the United States. Tracking in these institutions was quite obvious. The genders were trained for different life tracks, so it therefore made sense to separate them since they were learning different material and had different learning styles. Gender segregation has been ruled illegal in public educational settings, but many private schools and colleges continue to offer services to only one gender. This is not seen as universally negative. Research has indicated that women in all-female settings are more likely to display their full potential since they feel no need to be subservient to men. They are also more supportive of each other. It becomes impossible for instructors to favor men in the said settings since there are no men in the environment. Women reap all the benefits of being in such settings. Gender tracking remains a controversial issue with long-lasting positive or negative effects. It is often unconscious, but it is sometimes institutionalized and overt. Troy Jones See also Behavioral Theories of Gender Development; Doing Gender; Gender Equality; Gender Norms and Adolescence; Gender Socialization in Childhood; Gendered Stereotyped Behaviors in Childhood; Teacher Bias

Further Readings Catsambis, S., Mulkey, L. M., & Crain, R. (2001). For better or for worse? A nationwide study of the social psychological effects of gender and ability grouping in mathematics. Social Psychology of Education, 5(1), 83–115.

Feniger, Y. F. (2011). The gender gap in advanced math and science course taking: Does same-sex education make a difference? Sex Roles, 65(9–10), 670–679. doi:10.1007/s11199-010-9851-x Forde, C. C. (2014). Is “gender-sensitive education” a useful concept for educational policy? Cultural Studies of Science Education, 9(2), 369–376. doi:10.1007/ s11422-012-9432-0 Houtte, M. V. (2005). Global self-esteem in technical/ vocational versus general secondary school tracks: A matter of gender? Sex Roles, 53(9–10), 753–761. doi:10.1007/s11199-005-7739-y Long, M. C., & Conger, D. (2013). Gender sorting across K–12 schools in the United States. American Journal of Education, 119(3), 349–372. Phillips, C. C. (2009). Student portfolios and the hidden curriculum on gender: Mapping exclusion. Medical Education, 43(9), 847–853. doi:10.1111/j.1365-2923 .2009.03403.x Southworth, S., & Mickelson, R. A. (2007). The interactive effects of race, gender and school composition on college track placement. Social Forces, 86(2), 497–523.

Gender Variant Role Expression in Childhood Gender role expression in prepubertal gender variant children has been a topical and controversial issue since the late 1990s. In many Western societies, the topic has generated debates among professionals, self-help organizations, and society at large. This entry describes the terminology used in, and some approaches to, gender role expression in childhood.

The Concept of Gender Identity The concept of gender identity was first formulated in the mid-1960s, referring to the perception of oneself as a male, female, or other. In some people, this perception is at variance with the physical appearance of one’s body and is a subjective state. With the emergence of the concept of gender identity, it became possible to make sense of human experiences that had until then been ill defined and not understood. Incongruity between gender assigned at birth and one’s self-perceived gender identity with behavioral manifestation was often

Gender Variant Role Expression in Childhood

referred to as gender dysphoria. The word dysphoria is used to signal the presence of distress in those people who present with this incongruence. There has been debate as to whether or not the category of gender dysphoria should be retained in psychiatric classifications, as this condition is now seen as an atypical identity development rather than a psychiatric condition. However, the need to respond to the distress of these people and the wish to ensure a service that provides a combination of psychological, social, and physical interventions has led to the retention of this category in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), along with the criteria necessary to indicate the presence of gender dysphoria.

Gender Dysphoria The DSM-5 diagnostic criteria for gender dysphoria in children require the presence of a strong disharmony between one’s perceived gender and assigned gender, of at least 6 months’ duration. The features described include an intense desire to belong to the other gender or the conviction that one is the other gender and behavioral manifestations. Examples include a preference for clothing and roles in make-believe play stereotypical of the other gender, a wish to play with playmates of the other gender, and a strong dislike of the sexual aspects of the body. The condition is associated with significant distress or impairment in some areas of function. The DSM-5 requires that a specific number of features are present to make this diagnosis.

Gender Variance Gender variance and gender nonconforming children are terms used to indicate the presence of some features of gender dysphoria but not all the characteristics necessary to make a diagnosis. These terms are generally more acceptable to the children and families who experience diversity in gender identity development, because it is felt that they are nonstigmatizing and offer a nonbinary view of gender identity. However, as physical interventions have proved helpful with a select group of these children, precise criteria are deemed necessary by professional specialists in the field and

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service users to decide the appropriateness of physical intervention, such as the use of hormone blockers at the beginning of puberty and cross-sex hormones later on.

Approaches to Gender Variant Role Expression in Childhood Since the late 1990s, the question has arisen whether gender variant prepubertal children should be allowed to live in their perceived gender? Parental attitudes are often influenced by perceived social norms and religious beliefs, which are in contrast with their child’s wish for self-­expression and emotional well-being. In contemporary Western society, repression of one’s own feelings and perceptions are viewed as contributing to psychological difficulties and negatively affecting mental well-being. With regard to children with gender dysphoria, the expression of these perceptions in the social context has raised a number of controversies and caught the attention of the media. Follow-up studies of prepubertal children with gender dysphoria and variance (previously defined as gender identity disorder) have shown that in about 30% of these children, gender dysphoria persists into adolescence and beyond. Given the variability of outcomes, some specialists have taken the view that it is better for prepubertal children not to transition socially early to avoid the difficulties of returning to their natal gender if the gender dysphoria does not persist. In contrast, other specialists have taken the view that it is important to affirm the perceived gender identity of the child, as this supports the child’s development and well-being. There is no clear research evidence to date that can guide approaches to gender role expression in childhood. Whichever approach is chosen, it is important to consider that in the social environment, and particularly at school, these children can be teased, victimized, or bullied for their diversity. This is confirmed by extensive research evidence. The adverse social context can lead to the development in the child of symptoms of anxiety, which in some cases include physical presentations such as upset stomach, dizziness, and headaches. In other cases, it can lead to difficulties in attending school, in participating in school activities, or in school

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refusal. It is therefore necessary for parents and school staff to devise strategies that address and change these adverse conditions in the social environment. Preventive strategies include providing information and education to staff and pupils at the school and in other social contexts and changing their cultural attitude. In some cases, including in well-established cases of gender dysphoria, the features of gender variance may disappear with time. It is also worth noting that clinical experience shows that parental response, which supports the intense wishes of the child to live in the perceived gender identity and role, does not necessarily influence the course of gender identity development. However, parents’ maintaining an open mind regarding the outcome of gender variance and dysphoria in childhood may facilitate the process of change to the gender assigned at birth in the child if this occurs. The role of professionals in the process of gender variant role expression may involve working with the family to evaluate pros and cons and to facilitate decision making regarding what is in the best interests of the child in that particular social context. Good communication and collaboration among the multidisciplinary team of professionals involved with the family (e.g., psychologists, psychiatrists, teachers, and others) is of utmost importance to avoid confusion and distress in the child and family. Cultural considerations are also important for understanding gender identity. In some cultural backgrounds, gender expression may be more fluid. For instance, many Native American tribes and communities accept the notion of “two-­ spirited individuals”—or people who identify with more than one gender, sexual orientation, or both. Accordingly, if these children were to express their gender identity in nonbinary ways, such behavior may not be viewed as variant or raise concern. Regarding social transition in childhood, the World Professional Association for Transgender Health (WPATH) in its standards of care published in 2012 suggests that families take different views regarding the extent to which they allow their children to socially transition to another gender role. WPATH recognizes that professionals can help families with the timing and process of gender role transition and with finding intermediate solutions or compromises when appropriate. The WPATH

guidance also draws attention to the notion that a change back to the gender assigned at birth can sometimes be distressing to the child and that this potential distress should be considered by professionals and families. The approaches outlined emphasize the importance of autonomy within the family. Autonomy involves the exercise of self-regulation and implies taking responsibility for decisions made. A family’s autonomy can also be influenced by a number of psychological and social factors such as insecure attachment patterns or group pressure to conform to a particular view. Many specialists have taken the view that professional counseling may assist the family in the decision-making process regarding gender role expression during childhood, ­aiming to enhance the capacity for autonomy in the family, which in turn can lead to betterinformed decisions regarding the best interests of the child and of their gender identity development in particular. Domenico Di Ceglie See also Gender Dysphoria; Gender Identity and Childhood

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Ceglie, D. D. (2014). Care for gender dysphoric children. In B. P. C. Kreukels, T. D. Steensma, & A. L. C. de Vries (Eds.), Gender dysphoria and disorders of sex development (pp. 151–169). New York, NY: Springer. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., . . . Zucker, K. (2011). Standards of care for the health of transsexual, transgender, and gender nonconforming people (7th Version). International Journal of Transgenderism, 13, 165–232. Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137, e20153223. Steensma, T. D., Biemond, R., de Boer, F., & CohenKettenis, P. T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Journal of Clinical Child Psychology and Psychiatry, 16(4), 499–516. doi:10.1177/ 1359104510378303

Gender Versus Sex Steensma, T. D., & Cohen-Kettenis, P. T. (2011). Gender transitioning before puberty? Archives of Sexual Behavior, 40(4), 649–650. doi:10.1007/s10508011-9752-2

Gender Versus Sex Psychologists use the term sex to refer to the biological aspects (e.g., hormones, chromosomes, gonads, genitals) of being male, female, or another configuration of sex and the term gender to refer to the psychological, social, and cultural aspects (e.g., gender identity, gender expression, gender roles) of being a man, a woman, or some other gender. The distinction between sex and gender is not particular to psychology and is used widely across the humanities and social sciences. However, the terms sex and gender are often conflated and used interchangeably both in popular culture and in some academic work. This conceptual error has important consequences for popular understandings as well as for research and clinical practice in psychology. The distinction between these terms was created to correct the once widely held assumption that gender roles were innate and fixed by demarcating the difference between the biological aspects of being male, female, or another configuration of sex, which are generally constituted by basic biological and genetic developmental processes, and the psychological, social, and cultural aspects of being a man, a woman, or another gender identity, which depend on socially located understandings of what it means to be a particular gender in a particular place at a particular time. For example, a newborn baby can be said to have a particular sex but not a gender. From the perspective of the dichotomous conceptualization of sex that is prevalent in contemporary Western culture, a baby born with XX chromosomes, ovaries, and a vulva would be considered female; a baby born with XY chromosomes, a penis, and testes would be considered male; and a baby born with a different combination of chromosomes and/ or anatomy would be considered intersex. They cannot have a gender, however, because they are not yet aware of the cultural meanings associated with being a woman or a man in the time and

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place in which they live. In addition, research shows that as many as 1.7% of babies would not fit into the dichotomous categories of female/male and would instead have genitals that are not clearly recognizable as female/male or chromosomal configurations other than XX or XY (e.g., XXY, XYY, XO, XXXX). Awareness of these people’s lives calls into question the assumptions of the two-sex model and has encouraged ­psychologists to acknowledge the diversity of biological sex.

Conflation of Sex and Gender Despite the progress made in the public awareness of transgender people in Western society during the second decade of the 21st century, many people still conflate sex and gender, thinking that if one knows something about an individual’s genitals or gender presentation, they can infer other characteristics or traits that are related to gender stereotypes. As the growing public awareness of ­transgender experiences has shown, one’s sex has no inherent relation to one’s gender identity, gender expression, or sexual identity. This has relied on a growing understanding of the distinction between sex and gender. The experience of transgender public figures is only comprehensible if an audience can conceptualize the distinction between the sex an individual was assigned at birth and their psychological experience and social expression of gendered subjectivity. The conflation of sex and gender has historical roots in the way our culture and our discipline have made sense of, and spoken about, these very terms.

History The original use of the term gender does not refer to humans at all but rather to grammatical classes of nouns. Sex, however, had been used to refer to what we would now refer to as the conflation of sex and gender since the 16th century. When the term sex began to take on erotic meanings in the 20th century, and especially after it began to refer to sexual intercourse in the 1930s, gender rose in popularity to replace sex as the most common way to refer to what we would now refer to as the conflation of sex and gender. In the late 1950s and early 1960s, these terms came to have a more

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formalized meaning in the field of sexology’s study of intersex and transsexual people. Gender was now used to differentiate the psychological experience of sex from its biological aspects. In the 1970s, the concept of gender continued to be developed as feminist theorists used the term to refer to the aspects of being a man or a woman that were not determined by biology. This move to further emphasize the psychological, social, and cultural aspects of gender allowed for a critique of the psychological literature on “sex differences,” which had so long understood women as a naturally inferior binary opposite of men. Thus, gender differences in reasoning, mathematical skills, emotions, and so on could be seen not as products of the inherent distinction between men and women but rather as constructed by a social psychological context in which one’s sex was used to sort individuals and socialize them into different roles.

Binaries However, much of this research continued to conceptualize sex and gender as binaries. Sex and gender were often thought of in binary pairs: male/ female (sex) and man/woman (gender). However, there are a large number of sexes and an infinite number of genders. Gender Beyond the Binary

While gender is theorized in psychology as multidimensional, context specific, and changing across time and place, it is still often reduced to unidimensional and dichotomous check boxes in most psychological research. Not only does gender encompass wide variation across and within individuals with regard to their expression of gender, but it also varies widely across and within individuals with regard to their subjective experience of gender identity. Gender identity and gender expression can change throughout an individual’s life span, and contrary to previous belief in some areas of psychology, a stable and coherent gender identity is not necessary and not a marker of mental health. Each person’s gender identity—the way they experience gender and relate to cultural conceptions of masculinity and femininity—is unique to each individual. In addition, it is multidimensional, consisting of many facets of human

experience—how one relates to their body, how they feel about their relation to gender stereotypes, and other subjective experiences. Gender expression is also multidimensional, encompassing the physical body, clothing choices, hairstyles, jewelry, voice, interaction style, and more. The possibilities for combining cultural signifiers of masculinity and femininity with an individual’s particular embodiment offers an array of choices of gender performance that reach far beyond what is captured in a binary understanding of gender. Because gender identity and gender expression have an infinite number of possible variations, and they function as dynamic and fluid in different social contexts and across the life span, it is not useful to conceptualize gender as a binary opposition between woman/feminine and man/masculine. Sex Beyond the Binary

Sex is often conceptualized as a binary category (female/male). However, as previously discussed, some individuals do not fit into the categories of female/male. In addition, relying on a conceptualization of sex as a binary obscures the variation in genetics, anatomy, and physiology that is present within groups of females and males. Furthermore, what have been conceptualized traditionally as markers of biological sex, such as genitals, secondary sex characteristics, hormonal profiles, and reproductive abilities, are increasingly malleable in the hands of contemporary technology. This section discusses each of these three reasons why binary conceptualizations of sex are not useful to psychological theory, research, and practice. One of the aspects of the binary conceptualization of sex that is most clearly not useful is its complete erasure of the experiences of individuals who do not fit into the categories of female and male. Research estimates that up to 1.7% of the population is born with an intersex condition and activism to prevent surgical “reassignment” at birth to more male or female appearing genitals has raised awareness of the presence of intersex individuals in our society. Their lives point to the need for an understanding of a greater range of biological diversity than the female/male binary allows for. In addition, the female/male binary erases the vast variance in genetics, anatomy, and physiology

Gender Versus Sex

that exists within the categories of female and male. Indeed, research shows that on most biological measures, there is more difference within the categories of female and male than across them. Contemporary controversies over the sex of elite female athletes considered “too masculine” are an entry point into the complicated science of variation within sex. Elite female athletes have been banned from sports because of naturally occurring high testosterone levels, a condition known as hyperandrogenism. However, there is no objective way to draw a line between “female” and “male” levels of testosterone, because its presence in the body varies not only with regard to time of day, time of life, and social status, but it also varies widely among females and among males. Correspondingly, there is no objective level of high enough testosterone levels for males, despite what advertisements for doctors willing to administer testosterone to aging males or to those who feel they are otherwise lacking might suggest. Beyond hormones, variation within and across sex exists with regard to lung capacity, brain function, bone size, and metabolic rate. Brain function is a particularly interesting site of variation because it is used as evidence of the “innate” psychological differences between males and females yet is also surprisingly plastic. Evidence shows that brain structures are experience dependent and that the differences found across groups of females and males may be due to the accumulated effect of repetitive performances of gender roles, and not necessarily to any innate difference. The biological aspects of sex vary not only due to natural differences between individuals or as a result of experience throughout the life span. Today, they may also be more actively chosen and manipulated. Advancements in technologies such as contraception, artificial insemination, hormone therapy, sex reassignment surgery, and the possibility of artificial wombs, cloning, and same-sex reproduction show that our bodies have much more potential for living, reproducing, and therefore categorizing human beings than was previously thought. The widespread use of hormonal contraceptives by females across the Western world has brought about a major shift in the meaning of sex and sexuality. By manipulating sex hormones, sex has become decoupled from reproduction, and the female body is no longer necessarily linked to

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pregnancy and childbirth. On the other hand, males are increasingly not necessary for conception as technologies create ways to fertilize ­without traditional heterosexual cisgender intercourse. Furthermore, surgeries can create or modify genitals, and the psychopharmacological application of hormones can shift the “sex” of an individual’s brain and body. Sex has often been conceived of as static and innate, versus the constructedness and fluidity of gender. However, contemporary research shows that not only are traditional markers of sex constantly shifting across contexts and throughout an individual’s life span, but they are also increasingly being actively shifted and manipulated through technological means.

Implications The ways in which psychologists conceptualize gender and sex have implications for how people understand their own gendered and sexed lives, as well as those of other people. As a discipline involved in constructing contemporary understandings of these concepts, the stances psychology takes influence public knowledge about sex and gender. In addition, the ways in which psychologists conceptualize gender and sex have implications for the research they carry out in their discipline. The methodological approaches, procedures for collecting data, and analytic techniques they use will shift if they conflate sex and gender or if they acknowledge the differences among psychological, cultural, and biological aspects and refuse to rely on reductionist binaries that force the multiplicity and variety of human life into a strict dichotomous ­ classification. It may be most useful for psychology to not think of gender versus sex but instead focus on gender and sex. The biological and p ­ sychological/ cultural aspects of sex and gender deserve to be analyzed in relation to each other, even if they are conceptually held as discrete concepts. Examining how gender and sex function in mutually constitutive ways in any psychological situation of interest will allow psychologists to more deeply mine the profound variations of human life. Patrick Sweeney See also Cisgender; Doing Gender; Gender Nonconformity and Transgender Issues: Overview; Gender Roles:

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Overview; Genderqueer; Heteronormativity; Male Privilege; Neurosexism; Trans*

Further Readings Fausto-Sterling, A. (2000). Sexing the body: Gender politics and the construction of sexuality. New York, NY: Basic Books. Fine, C., Jordan-Young, R., Kaiser, A., & Rippon, G. (2013). Plasticity, plasticity, plasticity . . . and the rigid problem of sex. Trends in Cognitive Sciences, 17(11), 550–551. Golden, C. (2004). The intersexed and transgendered: Rethinking sex/gender. In J. C. Chrisler, C. Golden, & P. D. Rozee (Eds.), Lectures on the psychology of women (pp. 137–152). Boston, MA: McGraw-Hill. Johnson, J. L., & Repta, R. (2012). Sex and gender: Beyond the binaries. In J. Oliffe & L. Greaves (Eds.), Designing and conducting gender, sex, and health research (pp. 17–39). Thousand Oaks, CA: Sage. Karkazis, K., Jordan-Young, R. M., Davis, G., & Camporesi, S. (2012). Out of bounds? A critique of policies on hyperandrogenism in elite female athletes. American Journal of Bioethics, 12(7), 3–16. Preciado, P. B. (2013). Testo-junkie: Sex, drugs, and biopolitics in the pharmacopornographic era. New York, NY: Feminist Press. Stainton-Rogers, W., & Stainton-Rogers, R. (2001). The psychology of gender and sexuality. Philadelphia, PA: Open University Press.

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Society: Overview

Gender is a social construct that is introduced to an individual from the instant that a person is born. When parents and family members first meet a baby, one of the first questions that family members and friends ask is whether or not the child is a boy or a girl. From that moment on, gender influences the ways in which the individual is treated in society—ranging from how parents teach, dress, or discipline the child to the types of chores, responsibilities, or expectations that family members may have of the child. Children and adolescents learn how they are supposed to behave or speak, what activities they should be interested in, or even who they are supposed to date or be attracted to. As the individual becomes an adult, gender may influence significant decisions

like career choice, what types of parents they may aim to be, or whether they want to become parents at all. Gender can even affect innocuous behaviors such as the way in which they shake someone’s hand, the way they sit or walk, the amount of time they spend grooming themselves, and the ways in which they socialize with their peers. Gender can also affect psychological constructs like self-esteem, emotional expression, or leadership abilities—all of which may affect their familial, romantic, and social relationships, as well as their ability to thrive. Gender is socialized, in that individuals learn implicit and explicit messages about gender ­expectations—or the societal, cultural, or familial values, beliefs, or understandings about how one should act due to one’s biological birth sex. Some people may conform to gender expectations more easily—which often allows them to navigate more effortlessly in society than individuals who do not conform to gender expectations. For instance, ­cisgender, heterosexual men who have stereotypically masculine interests (e.g., playing or watching sports) may find peers with similar interests more easily or are likely to experience less stigma than cisgender, heterosexual men who have stereotypically feminine interests (e.g., enjoying musical theater, opera, or ballet). In a similar manner, while gender norms involving career trajectories for women have evolved, it is still generally expected for women to engage in traditional gender roles involving marriage and family (e.g., getting married to a man and having children). Women who make different life choices (e.g., career-oriented women who do not get married or have children) may be celebrated for their professional successes, while still experiencing stigma regarding their marriage or family choices (e.g., being asked if they feel “incomplete” because they never had children or being presumed to be not “happy” because they are single). Because of gender norms and societal sexism, individuals who belong to marginalized groups may experience additional obstacles in life, as a result of their gender, sexual orientations, and gender identities. Throughout history, women have been viewed as inferior to men; and across most cultures, women have been encouraged to be subservient to men in their lives (e.g., their fathers, their husbands, their male family members, and

Gender and Society: Overview

their male colleagues). In most regions around the world, lesbian, gay, bisexual, and queer people have been pathologized as mentally ill—resulting in many nonheterosexual people to deny their sexual orientation identities and to masquerade as heterosexual. For transgender and genderqueer people who may have participated in gender nonconforming behaviors from a very early age, it is common to hear and learn negative messages throughout their lives. Such messages may include that their gender identities are socially inappropriate, psychologically inept or pathological, or even religiously immoral. As a result of these messages, transgender and genderqueer people may struggle with accepting their gender identities or  with celebrating their authentic selves. When women and LGBTQ (lesbian, gay, bisexual, transgender, and queer) people are socialized to ­ believe that their gender, sexual orientation, or gender identity are abnormal or deficient, they may develop an internalized oppression, which may negatively affect their worldview, their confidence, their ability to succeed, or their ability to thrive in society. This entry explores topics related to gender and society—focusing on a breadth of issues related to the diverse ways in which gender manifests in people’s everyday lives. First, the various manifestations of gender-related discrimination are e­ xamined—covering issues related to sexism, ­heterosexism, and transphobia (and the intersections of each with racism). Second, gender-related issues are examined through the lens of systemic and institutional ­ sexism—highlighting various legislation and ­government-related issues, while describing the evolution of different institutions such as athletics or the military. Finally, the current state of gender in U.S. society is reviewed, focusing on some of the major concerns involving gender in the United States, particularly related to the 2016 presidential election and its aftermath.

Gender-Based Discrimination in U.S. Society Since the early 1900s, women researchers and ­psychologists have investigated the legitimacy of gender role norms instilled in society—challenging sex differences in intellectual and cognitive

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abilities, physical abilities, and social-emotional abilities. Over time, researchers like Karen Horney and Carol Gilligan supported the idea that gender did indeed influence psychological development and that such differences were a result of societal sexism and gender role expectations. Many of ­ their male colleagues at the time combatted these beliefs—with some scholars citing that boys and girls developed similarly and that any gender discrepancies were due to girls’ deficiencies or weaknesses. However, as empirical research began to investigate the influence of gender on human development, some societal views shifted, and women were presumed to have similar cognitive and social capabilities as men. In the 1990s, Janet Swim and her colleagues began to uncover the various ways in which sexism manifested in everyday life—citing the ­ presence of  overt sexism (e.g., old-fashioned discrimination toward women), covert sexism (e.g., ­well-intentioned bias toward women), and subtle sexism (e.g., normative expectations of men as ­ superior). These types of sexism tend to persist due to three central themes: (1) gender role stereotypes, (2) sexual objectification, and (3) the overall view of women as inferior to men. Researchers such as Elizabeth Klonoff and Hope Landrine examined how frequently women encounter sexist events in their everyday lives—measuring incidents like unfair sexism at work or school, unfair sexism in personal relationships, and sexist degradation and objectification. Over the years, research has found that women are discouraged from pursuing academics (particularly science, technology, engineering, or mathematics) and that women are rewarded for their looks instead of their intellect. Despite these experiences, women are still often teased or judged on their looks (by both men and women), bombarded with unrealistic societal expectations or standards of beauty, and even harassed or tormented with unwanted and unprovoked sexual or romantic attention from men. As research on sexism and gender differences persisted, research on heterosexism began to emerge in the 1950s, when Evelyn Hooker empirically challenged whether gay men should be considered mentally ill—eventually leading to similar studies with lesbian women. In the 1990s, Gregory Herek described how lesbians and gay men encountered homophobia and heterosexism (through hate

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crimes, sexual prejudice, and stigma), which then had negative impacts on their mental health. In the early 2000s, Ilan Meyer first introduced the concept of “minority stress,” which highlighted the ways in which belonging to a historically marginalized group (e.g., being an LGBTQ person) could influence psychological distress. Since then, researchers have uncovered how heterosexism and transphobia could negatively affect LGBTQ people’s mental health—signifying the need to address and decrease anti-LGBTQ discrimination in society. Although the term microaggressions was first coined by Chester Pierce in the 1970s, Derald Wing Sue and his colleagues began to write about racial microaggressions—or the subtle forms of discrimination that affected people of color—in 2007. Because modern societal norms had stigmatized overt racism in everyday life, people of color reported experiencing racism in more subtle, wellintentioned, or unconscious ways. For instance, Black Americans described being followed around in stores while they shopped, whereas Asian ­Americans and Latina/o/x Americans shared how people were surprised when they spoke English without an accent. Shortly after, researchers began to examine how microaggressions also affected people based on gender, sexual orientation, and ­ gender identity. Cisgender women and LGBTQ people revealed the multitude of ways in which people have experienced sexist, heterosexist, and transphobic bias. More recently, microaggressions have been examined through an intersectional lens—highlighting the ways in which people encounter discrimination as a result of their multiple identities. For instance, studies with women of color have revealed microaggressions that occur due to racism, sexism, and the intersection of both, while studies with LGBTQ people of color uncover microaggressions based on racism, heterosexism, and the intersection of both.

Systemic and Institutional Discrimination in the United States While sexism and heterosexism can manifest in a multitude of interpersonal ways, there are many ways in which sexism can also be exhibited systemically and institutionally. First, on systemic levels, sexism and heterosexism can be seen through

laws and the legal system. For instance, the women’s suffrage movement resulted in the Nineteenth Amendment to the U.S. Constitution, enacted on August 26, 1920, which allowed for White women to vote in the United States. Although there were still many obstacles for women of other racial groups to vote, Native Americans were legally able to vote across all 50 states in 1957; and with the Voting Rights Act of 1965, Black women were legally able to vote across all states in 1965. Furthermore, sodomy laws have been in existence in the United States for centuries, legally permitting the arrests of people who engage in same-sex behavior—as homosexuality was considered legally and morally wrong. Sodomy laws eventually led to the psychiatric and medical pathology of nonheterosexuality (e.g., homosexuality, bisexuality); in fact, in 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) first listed homosexuality as a sociopathic personality disturbance. As a result, mental health practitioners continued their historical attempts to “cure” nonheterosexuals of their disease for about two decades—until the disturbance was removed from the DSM in 1973. Today, the American Psychological Association, the American Psychiatric Association, and other professional health organizations consider it unethical for any psychologist or helping professional to attempt to change an individual’s sexual orientation. Despite this, transgender and genderqueer identities have continued to remain pathologized—with gender dysphoria continuing to be included in the fifth edition of the DSM, published in 2013. Since the early 1900s, federal, state, and local legislation regarding sexual violence has evolved significantly. First, rape shield laws began to emerge in the 1970s as a way of limiting the admissibility of a survivor’s sexual history when their rapist is on trial. Relatedly, marital rape (or spousal rape) laws also began to take effect in various states across the United States in the 1970s; in 1993, marital rape was deemed illegal across all 50 states. In the 1970s, the idea of date rape (also known as acquaintance rape) was first introduced, resulting in the dispelling of societal notions of rape as only being stranger assaults. Furthermore, the Violence Against Women Act of 1994 provided billions of dollars toward the investigation and prosecution of violent crimes

Gender and Society: Overview

against women, particularly in enforcing the automatic and mandatory restitution for those who were convicted. Laws regarding women’s reproductive health have also evolved throughout the past century. As of 1936, the dissemination of contraceptive information through the mail was no longer prohibited and information regarding birth control was no longer considered obscene. In 1942, the Planned Parenthood Federation was created as a way of initiating a national network of birth control clinics across the United States. While laws on ­ abortion varied across the states, the historic Roe v. Wade (1973) Supreme Court case legalized abortion across all 50 states (considering their state’s regulations regarding abortions and women’s health). Despite the normalization of Planned Parenthood and women’s health organizations, many politicians continue to advocate against the repeal of women’s reproductive rights. For LGBTQ people, there were many instances of heterosexism and transphobia that were instilled through federal, state, and local laws. For instance, President Barack Obama signed three executive orders that overturned anti-LGBTQ federal laws. First, he put an end to the “Don’t Ask, Don’t Tell” policy that prevented lesbian, gay, bisexual, and queer people from openly serving in the military; years later, transgender people were also permitted to serve in the military. Second, President Obama signed the Matthew Sheppard Act (2009), which expanded the Hate Crimes Act of 1969 to include federal protections for hate crimes based on sexual orientation and gender identity. Finally, he signed federal legislation that proclaimed sexual orientation and gender identity as protected classes, which legally prevented anti-LGBTQ discrimination for federal employees. For many, one of the most hindering pieces of heterosexist legislation involved marriage equality. Although Massachusetts was the first state to legalize same-sex marriage in 2004, it was not until the Supreme Court ruled to legalize samesex marriage in 2015 that marriage equality was legal across the country. However, other lesser known laws were also important for equitable rights for LGBTQ people; for example, intimate partner ­ violence survivors of same-sex couples became protected by federal law when President Obama signed the Violence Against Women

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Reauthorization Act of 2013, which allowed for same-sex couples to be legally viewed as families. Finally, there have been many ways in which sexism and heterosexism have manifested through a variety of institutions. Over the years, there have been strides to be more inclusive of women in male-dominated careers like military, law enforcement, and science, technology, engineering, and mathematics (or STEM) fields. Over the years, there has been a steady increase in the number of women as military personnel and combat officers; as police officers, lieutenants, chiefs, and captains; and as scientists, professors, researchers, a­ stronauts, engineers, technologists, and mathematicians. The number of women athletes in professional sports has increased, as have the number of LGBTQ athletes who are public and open about their ­sexual orientations and gender identities. In criminal justice systems, there has been an increase in ­advocacy—particularly in becoming more gender inclusive and culturally competent in working with transgender and gender nonconforming people. For instance, in recent years, there has been an advocacy for the criminal justice system to house prisoners in facilities that match their gender identities, to allow prisoners to have access to ­ their gender affirming medical treatments, and to avoid putting transgender prisoners in solitary ­confinement due to the lack of gender nonbinary facilities.

Current State of Gender in American Society On January 21, 2017, an estimated 2.5 million people (mostly women) participated in the ­Women’s March—which has since been documented as the largest national protest in American history. Organized by women, participants gathered in ­ Washington, D.C., New York, Los Angeles, San Francisco, Chicago, and dozens of cities in the United States and across the world. The march, which occurred the day after the 2017 presidential inauguration, was initiated to communicate the disdain that women had toward newly  elected president Donald Trump and his a­ dministration— whom they viewed as sexist and against women’s rights. Some protesters were especially unhappy with the defeat of Hillary Rodham C ­ linton— the first woman to ever win the presidential

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nomination of a major political party. Clinton, who had served as secretary of state, senator from New York, and First Lady of the United States, had won the popular vote by almost 3 million but lost in the electoral college. In many ways, the U.S. presidential election of 2016 is symbolic of the state of gender-related issues in U.S. society. First, while women’s rights and opportunities have increased significantly since the early 20th century, women may still be stereotyped as being inferior to, or less capable than, men. For instance, although Secretary C ­ linton had a vast amount of experience (with former President Obama endorsing her as “the most qualified person to ever run for president of the United States”), she lost to an opponent who had never held public office. In this way, Clinton’s loss was symbolic of the societal notion that a highly qualified woman is still not as capable or prepared for a position in which a man has significantly less experience. Second, while women may legally have equal opportunities as men (e.g., women can vote, own property, attain higher degrees of education), there are still many barriers that may prevent them from achieving in similar ways as men. As of 2017, there still had never been a female president or vice president of the United States, and the majority of elected officials (e.g., governors, senators, representatives) are men (and most of those elected officials across all levels are White). Similarly, the Fortune 500—which highlights the chief executive officers of the most profitable companies in the United States—regularly consists mostly of White men. In any given year, there are typically about 20 chief executive officers of color, about 20 women, and fewer than 2 women of color in these positions. So although women legally have the same opportunities as men do, there are still many barriers that may prevent women from succeeding in the same ways as men. Furthermore, while overt and conscious sexism may have become socially accepted over time, sexism has continued to persist through the societal expectations of women’s appearances. For example, throughout Clinton’s career, she has consistently been scrutinized for her looks and age—with many news commentators discussing her appearance in ways in which they do not describe her male opponents or colleagues. Women are judged

on their hairstyles, their clothes, their makeup, whether or not they look tired, and whether or not people believe they are aging well. Like Clinton, women in political or powerful positions are often expected to balance a fine line between two extremes: they are judged on (1) whether or not they smile—whether or not they are warm or personably relatable—or (2) whether or not they are too forceful or persistent. Regarding their bodies, women are presented with unrealistic expectations of size and standards of beauty—with most women being shamed for being too fat or overweight and others who are shamed for being too thin. While men (of all ages and racial groups) are often forgiven for carrying extra weight, women are not— particularly when they are public figures. Similarly, while women are often described as looking “tired” or “haggard” when they age, men are described as “distinguished” (if anyone even comments on a man’s age or appearance at all). Many scholars and political analysts have described the blatant and covert ways in which  Clinton had dealt with gender-related ­microaggressions—such as her opponent Donald Trump referring to her as a “nasty woman” or accusing her of playing the “gender card” because she advocated for women’s rights issues. Other microaggressions involve the “double standard” that ­Clinton experienced that her male opponents typically did not. For instance, throughout the election, she was heavily criticized for past political decisions (e.g., hosting a private e-mail server), while Trump was not criticized for his own legal issues (e.g., being sued for sexual harassment, sexual assault, and racial discrimination) or political mishaps (e.g., having a documented history of flipflopping on various issues). Similarly, Clinton has even been viewed as responsible for her husband’s marital indiscretions, while Trump was hardly criticized for being married three times (with one relationship that he openly described as starting while he was still married). Finally, while advocacy for women’s rights has increased significantly in the public opinion in the past several years, the presidential election of 2016 demonstrated that some forms of blatant sexism are viewed as acceptable or forgivable. Weeks before the election, audio recordings were released of the Republican presidential candidate privately telling a television host about “grabbing a woman

Gender and Society: Overview

by the pussy.” While many Americans believed that the scandal would result in the candidate losing the election, many political commentators dismissed such comments as being “locker-room talk” and continued to support the candidate. Weeks later, millions of Americans voted for the candidate and elected him to become the 45th president of the United States. Similar to the 2016 presidential election, the Women’s March on Washington, D.C., (and in many other cities across the United States and around the world) is also symbolic of many other issues that complicate the discussion of gender issues in society. First, while the Women’s March aimed to be inclusive of all women, many participants believed that issues related to race, gender identity, and others were dismissed or overlooked. For instance, some participants questioned why the movement was not initially led by women of color—particularly when the majority of women of color (especially Black women) voted for C ­ linton, while the majority of White women voted for Trump. Some viewed the exclusion of women of color (and the promotion of a colorblind, feminist space) as a reflection of the continuous and historical dynamics of the women’s rights movement. For instance, while White women have been organizing for gender equality since the mid-1800s, women of color have consistently been excluded from the conversations. In 1851, Sojourner Truth gave her famous speech “Ain’t I a Woman?”, which presentday scholars now recognize as the first time a woman of color addressed racism within feminist communities. Racism continued to persist throughout the women’s rights movement, with many ­historians citing Susan B. Anthony and other suffragettes as being White supremacists. In present times, some tensions persist between White women and women of color regarding the inability of White women to acknowledge their White privilege and how their experiences may differ due to race, social class, and other identities. Another critique of the Women’s March was the emphasis on the experiences of cisgender women—or women who identify with a female birth sex. Many women wore pink “pussyhat” knit caps, which organizers described as being symbolic of their vaginas. While this was meant to be a form of empowerment (particularly in embracing and ­ celebrating cisgender women’s

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vaginas), some transgender women perceived the overemphasis of vaginas during the march as being exclusive of transgender and gender nonconforming people. Although subtle and likely unintentional, these pussyhats (and subsequent signs like “Power to the Pussy”) communicated that having a vagina was a criterion for being a woman. Hence, such sentiment normalized the experiences of cisgender women—while excluding, dismissing, or minimizing the experiences of transgender women. Similar critiques have been made regarding the ways in which feminist movements have failed to address other intersectionalities. For instance, many White feminists have critiqued Muslim women for wearing hijabs—often stating that the cultural and religious head covering is a form of female oppression. However, many Muslim women describe wearing a hijab as an empowering, feminist choice. For many, wearing a hijab could be a self-proclaimed sign of modesty or humility, a method to protect themselves from male chauvinistic gazes, a way to proclaim their Muslim identity, or even an opportunity to express themselves through fashion. Relatedly, issues related to feminism and equity are often dismissed when failing to examine intersections with race and socioeconomic status. For example, when feminists describe that women earn 77 cents for every dollar that a man makes, they fail to recognize the applicability of this statistic with race. By failing to acknowledge that for every dollar a man makes, a Black woman will earn 66 cents and a Latina woman will earn 55 cents, White women ignore how their privileged identities affect their socioeconomic ­status and financial wealth. Last, the Women’s March also reignited ongoing debates of the definition of feminism—a controversy that has been in existence for decades. While feminism is typically defined by the belief in the equality of the sexes, feminists from different generations, perspectives, racial groups, and regions of the world may hold varying interpretations of what this means. For instance, traditional feminists may interpret feminism to refer to the equality of men and women—failing to acknowledge the spectrum of gender identities that may fall along the binary (e.g., genderqueer people, agender people, transgender people). In fact, some Trans-­Exclusionary

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Radical Feminists (or TERFs) believe that feminist advocacy should be reserved for cisgender women; many have been vocal of their belief that transgender women are not “real women” and therefore should not benefit from feminism. Many women of color equate feminism as being exclusively for White women, which has resulted in the promotion of “womanism”: an alternative to feminism that centers its perspectives on women of color. Because women’s narratives have been historically based on White e­xperiences, womanism ensures that intersectionalities are always addressed and that White ­ privilege and White supremacy are always deconstructed. For instance, while traditional feminists may proclaim that women could vote in 1920, womanists will proclaim that women could not vote until 1965 (since women of color could not vote until then). Finally, traditional or conservative feminism may involve the notion that any type of sexualization of women is oppressive and dehumanizing. As an example, some feminists have labeled performers like Beyoncé or Britney Spears as anti-feminists, because of their sexually seductive performances (which some feminists presume are intended for the male gaze). However, modern feminists may label Beyoncé and Spears as the ultimate feminists, because they own their sexuality, feel empowered in their own bodies, and perform for themselves and for other women (and not for the male gaze). Future generations will be tasked with providing critical analyses and further unpacking who gets to define feminism and how such definitions will influence the promotion of gender equity for all genders in society. Kevin L. Nadal See also Feminism: Overview; Gender Discrimination; Gender Role Socialization; Gender-Based Violence; Institutional Sexism; Media and Gender; Microaggressions; Multiculturalism and Gender: Overview; Rape Culture; Sexism

dynamics, and impact (pp. 193–216). New York, NY: Wiley. Davis, A. Y. (2011). Women, race, and class. New York, NY: Vintage Books. Drake-Burnette, D., Garrett-Akinsanya, B., & Bryant-Davis, T. (2016). Women, creativity, and resistance: Making a way out of “no way.” In T. Bryant-Davis & L. ComasDíaz (Eds.), Womanist and mujerista psychologies: Voices of fire, acts of courage (pp. 173–193). Washington, DC: American Psychological Association. Erickson-Schroth, L. (Ed.). (2014). Trans bodies, trans selves: A resource for the transgender community. New York, NY: Oxford University Press. Lundberg-Love, P., Nadal, K. L., & Paludi, M. A. (Eds.). (2011). Women and mental disorders. Santa Barbara, CA: Praeger. Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association. Swim, J. K., Hyers, L. L., Cohen, L. L., & Ferguson, M. J. (2001). Everyday sexism: Evidence for its incidence, nature, and psychological impact from three daily diary studies. Journal of Social Issues, 57, 31–54.

Gender-Based Violence Gender-based violence (GBV) is discrimination, aggression, and human rights violations that affect women and girls disproportionately because of their gender. Shelah Bloom defined GBV as an allencompassing term referring to violence that occurs due to patriarchal gender role expectations and power differences based on gender within a society. GBV, often referred to as interpersonal violence, often results in physical, sexual, emotional, or economic suffering or harm. This entry begins with a brief description of different types of GBV, followed by information on the effects of GBV. Then follows a discussion of the causes of GBV within a socioecological model as well as avenues for prevention and intervention.

Further Readings Adichie, C. N. (2014). We should all be feminists. New York, NY: Vintage Books. Capodilupo, C. M., Nadal, K. L., Corman, L., Hamit, S., Lyons, O., & Weinberg, A. (2010). The manifestation of gender microaggressions. In D. W. Sue (Ed.), Microaggressions and marginality: Manifestation,

Types of GBV Child Abuse and Neglect

Childhood physical abuse (CPA) is the administration of serious physical punishment or intentional exposure of a child to unreasonable physical

Gender-Based Violence

strains that can cause injury to the child. Examples include being pushed, hit, slapped, or grabbed, or having something thrown at the child, usually with accompanying physical sequelae (e.g., bruises, cuts, abrasions, or broken bones). According to the Adverse Childhood Experiences study conducted by the U.S. Centers for Disease Control and Prevention (CDC) from 1995 to 1997, 28.3% of children experienced CPA. UNICEF reported that between 4% and 55% of children worldwide experience CPA. Childhood sexual abuse (CSA) is sexual behavior forced on a child or sexual interactions between a child and a person much older (usually 5 years or more) with or without coercion. Examples include genital touching, masturbation, or attempted or completed oral, anal, or vaginal intercourse. The CDC Adverse Childhood Experiences study found that 20.7% of children experienced childhood sexual abuse during their childhood; UNICEF reported rates up to 22% depending on the country. Childhood emotional abuse (CEA), also referred to as psychological abuse, is behavior of a caregiver to a child that demeans, degrades, intimidates, humiliates, or belittles the child with the purpose of lowering the child’s self-worth, selfesteem, sense of identity, or human dignity. Examples include name-calling, verbal threats, yelling, insulting, isolating, confining, and humiliating. The CDC reports that approximately 10.6% of U.S. children experience CEA during childhood; according to UNICEF, rates of CEA worldwide range between 24% and 38%. Childhood neglect is the failure of a caregiver to provide developmentally appropriate physical and emotional care for a child. Physical neglect occurs when a caregiver does not provide adequate food, clothing, shelter, hygiene, medical care, appropriate schooling, or adequate supervision or abandons the child. Almost 10% of U.S. children report a history of physical neglect. Emotional neglect includes acts on the part of the caregiver (including withholding affection, ignoring the child, rejecting the child) that results in a failure to meet emotional needs for stimulation and human interaction. Fifteen percent of U.S children report emotional neglect. Intimate Partner Violence

Intimate partner violence (IPV) includes physical, sexual, and/or emotional abuse by an ­

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intimate partner. IPV often includes intimidation, isolation, minimizing and denying abuse, using children, using male privilege, financial control, coercion, and threats in addition to physical, sexual, or emotional abuse. Other terms used ­ interchangeably for IPV include domestic violence, domestic battery, dating violence, intimate terrorism, and spousal abuse. Types of intimate partners can include a current or former spouse, boyfriend or girlfriend, cohabitating partner, or someone whom the victim dated. Research has shown that between 20% and 33% of women report experiencing IPV during their lifetime. While 7.4% of men have reported experiencing IPV, women are almost four times more likely than men to experience violence at the hands of an intimate partner and two times more likely to be physically injured. Sexual Assault

Sexual assault is sexual contact or behavior that is forced on the victim or to which the victim did not give consent. Examples of sexual assault can include unwanted sexual touching, genital touching or fondling, forced masturbation, forced penetration of the perpetrator’s body, and forced or coerced oral, anal, or vaginal intercourse. Rape, a term used interchangeably with sexual assault, usually refers to the legal definition of sexual penetration that is forced or without consent. Almost 20% of women report rape, while almost 40% of women report other forms of sexual assault. About 1.7% of men report rape, while 23.4% report other forms of sexual assault. Sexual Harassment

Sexual harassment occurs when a person receives unwelcome sexual advances or other requests of a sexual nature that may interfere with their ability to complete their work or advance in their field, or that create a setting that is hostile or intimating. Types of sexual harassment include verbal harassment (e.g., name-calling, sexual jokes at the victim’s expense), unwanted or inappropriate touching, sexual advances from coworkers or clients, and unwanted sexual texts or e-mails. Other behavior that is consistent with sexual harassment include catcalls, whistling, and referring to an adult woman with a patronizing name (honey, babe, girl). Recent research has shown that

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one in three women have been sexually harassed in the workplace. Stalking

According to the U.S. National Center for ­Victims of Crime, stalking is a pattern of behavior directed toward a person that would instill fear in most reasonable people. Examples of stalking behaviors include repeated unwanted phone calls, e-mails, or texts; following, tracking, or spying on a victim; leaving unwanted gifts; spreading rumors about the victim in person or on social media; or showing up or waiting at places without a reason. The key component of stalking is that the behaviors need to occur repeatedly and instill in the victim fear for his or her safety or the safety of loved ones. Studies have shown that 8.1% to 15.2% of women and 2.2% to 5.7% of men experience stalking during their lifetime. Human Trafficking

The United Nations has defined human trafficking as the recruitment and transportation of a person through force, threat of force, coercion, ­ deception, or abuse of power for the purpose of exploitation of that person. Types of exploitation can include prostitution, other sexual activities, slavery, forced labor, or organ removal. Human trafficking occurs in all countries; the majority of trafficked humans are women and girls exploited as part of sex trafficking. Of the 20.9 million ­victims of human trafficking identified by the International Labor Organization, 26% are children and 55% are female. Honor Violence

Honor violence includes forced child marriage, honor killings, and female genital mutilation (FGM). A forced child marriage happens when a person is threatened, tricked, or coerced to marry without their consent; they often experience violence and possibly death if they refuse. The International Center for Research on Women report that one in three women in nonindustrialized countries are married before their 18th birthday, while one in nine are married before they turn 15. Honor killings are homicide committed by a family member

when the victim has been perceived to bring shame or dishonor to the family because of engaging in sex before marriage, being raped, dressing inappropriately, engaging in homosexual behavior, refusing to enter an arranged or forced marriage, or being in a relationship not approved by the family. Approximately 5,000 honor killings occur globally every year. FGM is a procedure in which the female genitalia are completely or partially removed during childhood, usually with the intention of ensuring virginity until marriage. According to UNICEF, more than 130 million girls and women have undergone FGM before their 15th birthday.

Effects of GBV GBV commonly leads to bruises, scrapes, cuts, and abrasions. The physical sequelae of GBV can lead to permanent scarring, broken bones, internal bleeding, and death. Sexual violence and FGM can lead to tearing and scarring of the genitalia, anus, and breasts. CEA and fear associated with other forms of GBV can alter brain structure and functioning. GBV can lead to structural alterations in the parts of the brain associated with the sensation and perception of pain and pleasure. GBV has also been linked to an underdeveloped prefrontal cortex and medial temporal lobe (the areas associated with emotional control and self-awareness) and an overdeveloped limbic system (associated with the fightor-flight reflex). GBV is associated with decreased hippocampal volume, an underdeveloped language center, and a smaller corpus callosum. GBV can lead to alterations in levels of neurotransmitters, cortisol, thyroid, and other neuroendocrine function, as well as decrease a survivor’s immune response. GBV can lead to mental health problems, including posttraumatic stress disorder, depression, anxiety, substance abuse and addiction, eating disorders, dissociative disorders, suicidality, self­ harm, and sexual problems. GBV can lead to the development of personality disorders, attention deficit problems, impulse control problems, encopresis and enuresis, and separation anxiety. GBV can negatively affect emotional regulation, cognitive functioning, and behavioral control. While some survivors of GBV exhibit resiliency and posttraumatic growth after GBV, a large proportion of GBV survivors experience long-term psychological damage as a result of violence.

Gender-Based Violence

Survivors of GBV experience negative impacts on interpersonal functioning. According to Jennifer Freyd, GBV that is perpetrated by a parent or guardian can be experienced as a serious betrayal of the caregiver-child relationship. As a result, GBV survivors have problems attaching to and trusting others. They may also fail to learn or learn inappropriate relationship skills—survivors may have limited ability to develop and maintain healthy relationships. GBV survivors may have reactive attachment tendencies and fail to understand and respect healthy boundaries between people. Depending on the type of GBV, survivors may become overly sexual within typically nonsexual relationships (i.e., worker-boss). In addition, GBV survivors may continue the cycle of violence by becoming aggressive within their own romantic relationships or family systems. GBV has a significant economic impact on the survivor and on the community. For the survivor, GBV can have costs associated with lost wages, medical visits, shelter, and legal actions. In terms of economic impact on the broader community, the World Health Organization reported that the direct cost of GBV has reached 3.3% of the gross national product of the United States and an estimated $40.2 billion in the United Kingdom. Community costs can include lost productivity, lost earnings, medical and mental health treatment, legal and criminal justice costs, welfare and other public services, housing costs, and victim compensation costs.

Causes of GBV: A Socioecological Model To understand the dynamic nature of GBV, experts have adapted Urie Bronfenbrenner’s socioecological model to explain how GBV occurs (see ­Figure  1). In the socioecological model, multiple levels interact to increase an individual’s risk for GBV. Interpersonal, organization, community, and societal factors influence one another and the individual over time; this dynamic interplay of multiple systems shows the complex nature of the causes of GBV as well as provides multiple avenues for prevention and intervention. Intrapersonal factors are characteristics of the individual that increase vulnerability to GBV. They  can include biological factors, such as

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Figure 1 The Socioecological Model of Causes of Gender-Based Violence Source: Adapted from Bronfenbrenner (1979). Note: A visual representation of the dynamic interaction of multiple systems on the risk for gender-based violence. 

neurotransmitter deficits, hormone imbalance, substance intoxication and withdrawal, and traumatic brain injury. Evolutionary theory posits that humans, especially male humans, are biologically predisposed to aggression to promote species survival. Psychological intrapersonal factors can include poor emotion regulation, poor impulse control, negative maladaptive cognitions, maladaptive learned behaviors, poor social skills, and current mental health problems. Intrapersonal ­factors can include demographic factors, such as age, race, ethnicity, education, occupation, income, sexual orientation, gender, and gender identity. A history of witnessing or experiencing GBV can increase the risk for GBV. Changes to the brain due to childhood exposure to GBV make people more likely to react with aggression, fear-based avoidance, and impulsive actions when faced with conflict and stress. Albert Bandura’s social learning theory suggests that children who experience GBV learn from their parents that GBV is an acceptable way to handle conflict and to interact within relationships. Interventions at the intrapersonal level can include counseling and therapy, social skills training, medication, and demographic changes. Interpersonal systems are the relationships with family, friends, and other influential people (e.g., teachers, coworkers, neighbors) that have a direct influence on a person’s daily life. Dysfunctional family systems, family conflict, and poor parenting can increase the risk for GBV. Travis Hirshi’s social control theory suggests that social bonds with

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others help us internalize what behaviors are right and what behaviors wrong. Therefore, while interactions with those who disapprove of GBV decreases risk, association with extended family, friends, and neighbors who engage in or condone GBV increases the likelihood of violence. Feminist theory proposes that traditional family structures are mostly patriarchal—they embrace a hierarchy based on hegemonic masculinity where men are dominant over women and hold the power. In families that strongly subscribe to patriarchal family structures, men control family decisions and often the behavior of women and children; real or perceived challenges to this power may result in GBV, especially in family systems where family honor is more important than female well-being. Interventions at this level can include family therapy, ­education on GBV, and bystander intervention. Organization systems are those formal (e.g., schools, workplaces, churches, military) or informal (e.g., sports, hobbies) institutions that have an indirect impact on people through their policies, procedures, or subcultural norms. Conflict theory (or the theory that battles over resources are at the core of our society) applied to GBV suggests that organizations are often built on inherently unequal relationships (e.g., boss-worker; teacher-student; clergy-parishioner), which are easy to exploit, setting the stage for GBV. Organizational structures and practices (e.g., religious law, reporting policies, and command structures) often make it difficult for victims of GBV to report violence or decrease its prevalence. Subcultural theory s­ uggests that certain institutions with firmly established boundaries (e.g., sports, police forces, military, certain religions) adopt norms and lifestyle preferences that support hegemonic masculinity. GBV is often accepted if not glorified as part of these subcultures. The work of psychologists Stanley Milgram and Philip Zimbardo also suggests that under constrained conditions anyone can perpetrate violence because of contexts and pressures that support and encourage GBV. Interventions at this system level can include organization policies and procedures that support equality and social norms campaigns. Community systems refer to the availability of resources, social services, policies, laws, and other environmental factors that increase the risk for GBV. Areas that are high in poverty, unemployment,

and population density increase the risk for GBV. The lack of community-based resources, such as child care, education (especially for girls and women), medical and mental health resources, and gender sensitive criminal justice systems, will also increase the risk for GBV. Destabilized government, weak or ineffective laws and policies regarding GBV, few legal rights for victims, and poor financial support for victims and victim-centered advocacy also lead to higher rates of GBV. Other community influences on GBV include the economic vulnerability of women and children; the intersectionality of oppression based on race, disability, immigrant or refugee status, and sexual orientation; environmental stress caused by natural and human-made disasters; and the role of media (e.g., pornography, film, music, videos, and advertising) in desensitizing the population to violence while using oppression and sex to sensationalize. Prevention efforts at this level seek to increase community resources, community-wide education and awareness cam­ paigns, stronger laws against GBV, and positive media campaigns. Societal factors refer to social norms, attitudes, ideologies, and cultural values that influence other systems to create and maintain a culture that perpetuates GBV. Gender role socialization theory posits that the dominant culture throughout most of the world indoctrinates men to be aggressors and females to be victims. When paired with hegemonic masculinity, social norms are created in which women and girls are required to be pure, subservient objects over which men have power and control. Violence is seen as an acceptable way to resolve conflict. The presence of GBV is denied and minimized, and survivors are blamed for their victimization. Hegemonic social norms lead to social, educational, economic, and health policies that maintain male social and economic power and female inequity, as well as a lack of political will to implement law and policy changes. Social norm campaigns; national and international education, laws, and policies; and political and social movements are needed to create change at this level. Sociohistorical factors refer to people’s transitions over the life course as well as interactions of the individual with the different systems. They include an individual’s interaction with social and political movements and changes in laws and

Gender-Based Violence in Athletics

social norms. Sociohistorical factors also include changes to laws, cultural norms and expectations, and environmental changes over time. Changes in laws that define, prohibit, or allow GBV; changes in norms that once saw women and children as powerless property to the rise of feminism and equality; and political movements and upheaval such as the women’s and civil rights movements interact with other socioecological systems to influence risk for GBV. Melanie D. Hetzel-Riggin See also Acquaintance Rape; Campus Rape; Date Rape; Emotional Abuse; Gender-Based Violence in Athletics; Gender-Based Violence in the Media; Intimate Partner Violence; Military Sexual Trauma; Perpetrators of Violence; Physical Abuse; Posttraumatic Stress Disorder and Gender Violence; Psychological Abuse; Rape; Rape Culture; Sexual Abuse; Sexual Assault; Sexual Coercion; Sexual Harassment; Spousal Rape; Stranger Rape; Victim Blaming; Violence and Gender: Overview

Further Readings Bloom, S. (2008). Violence against women and girls: A compendium of monitoring and evaluation indicators. Chapel Hill, NC: MEASURE Evaluation. Retrieved from http://www.cpc.unc.edu/measure/publications/ ms-080-30 Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Browne-Miller, A. (2012). Violence and abuse in society: Understanding a global crisis. Santa Barbara, CA: Praeger. Centers for Disease Control and Prevention. (n.d.). About the CDC-Kaiser ACE Study. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/ about.html Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14(4), 245–258. doi:10.1016/S0749-3797(98) 00017-8 Koss, M. P., White, J. W., & Kazdin, A. E. (2011). Violence against women and children: Navigating solutions (Vol. 2). Washington, DC: American Psychological Association.

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Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence and health. Lancet, 360(9339), 1083–1088. Merry, S. E. (2009). Gender violence: A cultural perspective. Malden, MA: Wiley-Blackwell. O’Toole, L. L., Schiffman, J. R., & Edwards, M. L. K. (2007). Gender violence: Interdisciplinary perspectives (2nd ed.). New York: New York University Press. Tjaden, P., & Thoennes, N. (2000). Full report of the prevalence, incidence, and consequences of violence against women: Findings from the National Violence against Women Survey (NCJ 183781). Washington, DC: U.S. Department of Justice. White, J. W., Koss, M. P., & Kazdin, A. E. (2011). Violence against women and children: Mapping the terrain (Vol. 1). Washington, DC: American Psychological Association. World Health Organization. (2004). The economic dimensions of interpersonal violence. Geneva, Switzerland: Author.

Gender-Based Violence in Athletics In 1993, the UN Declaration on the Elimination of Violence against Women officially defined the term gender-based violence (GBV) in Article 1 as any act or threat of acts related to public or private arbitrary deprivations of liberty or coercion that results in the psychological, physical, sexual suffering or harm of women. Athletics is defined as games, sports, or exercises that athletes engage in. In this entry, GBV is related to athletics. The entry concludes with seven guiding principles to promote safe sport for all.

Gender-Based Violence There are many facets of GBV. In fact, according to the World Health Organization, 35% of women in the world have experienced nonpartner and/or intimate partner physical/sexual violence. GBV may occur before a girl is born (e.g., sex-selective abortion in northern India) and/or continue into her later years (e.g., elder abuse in industrialized countries). GBV also varies across cultures; while sexual and domestic violence occur in all cultures, cultures vary in the way they punish or condone sexual and domestic violence. Although many

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countries have instituted laws against domestic violence, sexual assault, and other forms of GBV, challenges still exist in enforcing these laws.

GBV in Athletics According to Peter C. Terry and John J. Jackson, athletics have the ability to bring peoples together to debate important topics. On the other hand, athletics can also perpetuate idealized forms of masculinity and directly legitimize women hating, which can lead to GBV. GBV in sport, therefore, has become a global, public health issue because aggression and violence occur in both private (e.g., locker rooms) and public (e.g., arenas, neighborhoods) domains. For example, in the United States, Canada, and Germany, athletes who have perpetrated violence on others have been prosecuted in court; U.S. football players at the collegiate level (e.g., Vanderbilt football rape trial) as well as the professional level (e.g., the Aaron Hernandez m ­ urder trial) have been brought to trial for off-field violence against women, men, and the repercussions.

Guiding Principles for Safe Sport for All According to the Women’s UN Report Network, there are seven guiding principles that promote sport that is open and safe for all, but especially for girls and women. Briefly, these include upholding the human right to participate in play, sport, ­leisure, or recreation for women and eliminating barriers to this participation; removing cultural barriers that are violent to women; allocating required resources for delivering awareness programs about violence against women; striving to involve all participants in programs aimed at decreasing violence against women; meeting women’s basic safety needs and not exacerbating v­iolence against them through organized sport programs; remembering that ­victims of violence are human beings with agency and dignity; and holding ourselves accountable for caring about decreasing violence against women ­ and working with all stakeholders involved in women and girls’ sport experiences. Leslee A. Fisher and Terilyn C. Shigeno See also Sexual Abuse; Sexual Assault

Further Readings Baird, S. M., & McGannon, K. R. (2009). Mean(ing) to me: A symbolic interactionist approach to aggression in Sport Psychology. Quest, 61(4), 377–396. Brackenridge, C. (2001). Spoilsports: Understanding and preventing sexual exploitation in sport. London, England: Routledge. Heise, L., Ellsberg, M., & Gottmoeller, M. (2002). A global overview of gender-based violence. International Journal of Gynecology & Obstetrics, 78(1), S5–S14. Stein, R. (2015, April). Gender based violence and sports: A critical examination. Retrieved from http://ghcorps. org/?s=Gender+based+violence+%26+sports%3A+A+c ritical+examination Tenenbaum, G., Stewart, E., Singer, R. N., & Duda, J. (1997). Aggression and violence in sport: An ISSP position stand. The Sport Psychologist, 11, 1–7. Terry, G., & Hoare, J. (Eds.). (2007). Gender-based violence. London, England: Oxfam GB. Terry, P. C., & Jackson, J. J. (1985). The determinants and control of violence in sport. Quest, 37, 27–37. UN Women. (2015). Ending violence against women. Retrieved from http://www.unwomen.org/en/whatwe-do/ending-violence-against-women United Nations. (December, 1993). General assembly: Declaration on the elimination of violence against women. Retrieved from http://www.un.org/documents/ ga/res/48/a48r104.htm WordPress.com. (February, 2012). Wilfred Lemke receives guiding principles on addressing GBV in sport today [Web log post]. Retrieved from https://nowspar. wordpress.com/?s=%22guiding+principles%22 World Health Organization. (2016). Violence against women. Retrieved from http://www.who.int/ mediacentre/factsheets/fs239/en/

Gender-Based Violence in the Media Gender-based violence includes several forms of violence, including sexual assault, intimate partner violence, and stalking. While men can be victims of gender-based violence, women are at an overwhelmingly higher risk. Almost one in three women around the world experience intimate partner sexual violence. Within the United States alone, almost 20% of women report having been raped; of the perpetrators who are reported, 91.9% are

Gender-Based Violence in the Media

intimate partners or acquaintances. For men, the rate is 1.4% and 52.4%, respectively. This higher risk faced by women is symptomatic of the gender discrimination and normative gender roles that reinforce the systematic devaluation of women. Media—and the depictions of violence perpetuated against women in the media—is one of the key ways in which the current systematic devaluation of women is reinforced. This violence is problematic because media sets a dominant reality by exposing its audience to events they would not experience otherwise. Thus, the regular consumption of violence through media molds viewers’ cognitions and perceptions in a way that encourages violence. Indeed, research shows that early childhood television viewing is linked to later aggressive—even criminal—behavior. This link persists even after controlling for other factors, such as childhood neglect, psychiatric disorders, parental education, and neighborhood violence. After discussing the pervasiveness of genderbased violence in the media, this entry examines how the media frames gender-based violence and the resulting repercussions. The entry concludes with strategies for reducing the negative impact of gender-based violence.

Pervasiveness of Gender-Based Violence in the Media Not only is gender-based violence pervasive but it is also widespread across multiple types of media. On network primetime television, aggressive acts occur approximately 68 times per hour. A content analysis of top-grossing U.S. films from 1950 to 2006 found violent content in 89% of the films analyzed. A particular genre of film that combines violence and sexual titillation is the so-called slasher films. These types of films are ­premised on an antagonist who violently kills a series of ­victims—often with a bladed tool. An analysis of 50 popular North American slasher films showed that female characters who engage in sexual behavior were more likely to die than female characters who did not engage in sexual behavior. In addition to these explicit and physical forms of gender-based violence, instantiations of genderbased violence in the media also include those that perpetuate inequality and sexual objectification. For example, popular music videos reinforce

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stereotypical gender displays, in that women are characterized as subordinate sexual objects, while men are portrayed as aggressive dominant figures. The sexual objectification of women and hierarchical status positioning of men, along with depiction of men as aggressive, form part of the social fabric that reinforces the normalization of genderbased violence in the media. Furthermore, violence in the media is also portrayed through heteronormativity and cissexism. Gay and bisexual men are often portrayed as weak or effeminate, while lesbian and bisexual women are viewed as overly sexualized and exoticized. The few examples of transgender and gender nonconforming people in mainstream media that exist usually portray them (particularly transgender women) as less than human, comical, or psychotic.

Framing of Gender-Based Violence in the Media Another subtle way in which media perpetuates and normalizes female victimization is the manner in which gender-based violence is framed in the news media and other forms of communication. The framing of the dominant narrative of genderbased violence sets the foundation for the societal meshing of violence, gender, and misogyny and reinforces this dominant narrative as the social norm. Trivialization of Violence

Media coverage of domestic violence exemplifies the method by which framing and creation of the dominant narrative reinforces patriarchal norms, which, in turn, trivializes violence against women. Acts of intimate partner violence are framed as individual episodes of violence, rather than contextualizing the violence within the broader social fabric as occurring within institutions and norms that condone violence. When violence is framed as episodic, the overarching social issues that affect intimate partner violence are lost, and the victim is isolated, shamed, and blamed. Research shows that as many as 86% of women who need treatment for intimate partner violence do not receive it because of shame or fears of future violence. Similar to depiction of intimate partner violence, stalking—repeated, unwanted,

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and malicious following and harassment of another person—is also framed to trivialize the victim and disregard the societal context of the violence that is occurring. Stalking is depicted as more gender equivalent, more deadly, and shorter than actual stalking cases. This misinforms the public about the real dangers of stalking, which may make a person less likely to contact legal authorities when they become a victim of stalking. Omission of Female Agency and Power

In addition to trivialization, media coverage of gender-based violence is also framed to omit female agency and power. In analysis of newspaper coverage of sexual assault, only 36.7% of the articles mention female resistance to violence; and even when female resistance is mentioned, it is usually to depict the failure of such attempts. This erases female agency and resistance to sexual assault, informing women that resistance to ­gender-based violence is ineffective. Another example of framing is the use of the word alleged when referring to the victim of sexual harassment. This word choice automatically casts doubt onto the victim’s case, subtly demonstrating favor for the perpetrator, because it is the victim who is described as alleged, not the perpetrator. In addition to negating female agency and power, media coverage also serves to increase selfblame. Messages that urge women to be wary of binge drinking because of increased vulnerability to rape and other forms of violence displaces blame for sexual assault on to the victims. Analysis of news articles about sexual assault found that 65.4% of the 156 articles about a highly publicized sexual assault case endorsed at least one rape myth. (Rape myths are widely held beliefs about sexual assault that trivialize sexual assault and attempt to place blame on the victim.) By excusing male violence and encouraging female self-blaming for gender-based violence, inherently unequal power dynamics between men and women are upheld.

Further Repercussions of Gender-Based Violence in the Media The prevalence of gender-based violence in the media is important to address because the

consumption of media has been linked to greater acceptance of gender-based violence. Media exposure has also been linked to antisocial behavior, which is partially characterized by hostility and aggression toward others. For example, cumulative exposure to aggressive media has been found to increase risks for teen dating violence victimization as well as teen dating violence perpetration. For example, the general consumption of television is linked to an increase in rape myth belief in both male and female viewers. Research has shown that after viewing material that objectifies women, men are more likely to harass women. Furthermore, while there is some literature on how portrayals of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the media influence people’s attitudes toward LGBTQ people, there is a dearth of research that highlights whether negative media portrayals may lead to violence toward LGBTQ people. Given the increasing ­violence toward LGBTQ people, particularly transgender women, it would be important for scholarship in this area to persist.

Reduction in Negative Impact of Gender-Based Violence Gender-based violence in media can be harmful because of its widespread prevalence and wideranging repercussions. However, researchers have explored ways in which the impact of genderbased violence in the media can be reduced. While reducing the overall consumption of media is one solution, it may not be easy to do in today’s mediadominated society. Instead, researchers have investigated interventions that alter the media violence viewing experience, promote media literacy, and use media productions to change violent attitudes and behaviors. In altering the viewing experience, the viewer is also exposed to alternative and critical viewpoints from those being expressed on the media. A comment, such as “If they acted like that in real life, nobody would like them,” has been shown to be effective, in children between ages of 6 to 12 years. Encouraging children to focus on the feelings of the victim of violence has also been found to be effective. In addition, promoting media literacy has been shown to increase the viewer’s own competency in analyzing and evaluating media messages

Gender-Biased Language in Research

to lower their susceptibility. However, this research has resulted in mixed findings. In using media productions to change violent attitudes, researchers have noted the distinction between programming that glorifies violence and programming that portrays the repercussions of violence. The latter has been found to lower participants’ support for traditional gender stereotypes. In addition, research has also found that exposure to articles endorsing rape myth made participants more likely to side with the defendant in a sexual assault case, whereas exposure to articles challenging rape myth made participants more likely to side with the victim in a sexual assault case. In all three types of interventions, however, the  long-term efficacy of the intervention effects are unclear and more research is required before fully effective approaches for the reduction of  aggression and gender-based violence can be implemented. Cole Playter, Michael Larkin, and Chu Kim-Prieto See also Cultural Gender Role Norms; Gender Role Socialization; Institutional Sexism; Media and Gender; Rape Culture; Sexism

Further Readings Bleakley, A., Jamieson, P. E., & Romer, D. (2012). Trends of sexual and violent content by gender in top-grossing U.S. films, 1950–2006. Journal of Adolescent Health, 51(1), 73–79. Cantor, J., & Wilson, B. J. (2003). Media and violence: Intervention strategies for reducing aggression. Media Psychology, 5(4), 363–403. doi:10.1207/ S1532785XMEP0504_03 Galdi, S., Maass, A., & Cadinu, M. (2014). Objectifying media: Their effect on gender role norms and sexual harassment of women. Psychology of Women Quarterly, 38(3), 398–413. Kahlor, L., & Eastin, M. S. (2011). Television’s role in the culture of violence toward women: A study of television viewing and the cultivation of rape myth acceptance in the United States. Journal of Broadcasting & Electronic Media, 55(2), 215–231. Wallis, C. (2011). Performing gender: A content analysis of gender display in music videos. Sex Roles, 64(3–4), 160–172.

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Gender-Biased Language in Research Language shapes attitudes, perceptions, expectations, precision of findings, and directives. In a time when women have achieved significant strides across many fields and female national leadership continues to grow, there is a need to revisit genderbiased language in research. Language bias is the subtle and overt use of words that overemphasize, exclude, invalidate, or subsume various groups and subgroups (e.g., age, disability, race and ethnicity, sexual orientation, gender) through word usage. This entry first reviews historical and current contexts and then examines gender bias in research training. The entry concludes with recommendations for avoiding gender-biased language in research.

Historical Context An analysis of historical context supports a longstanding bias of excluding women through the use of pseudogeneric “he” or “man” to refer to all individuals (e.g., mankind). Specifically, genderbiased language creates or promotes unfair and unnecessary comparisons among genders while discounting the experiences, contributions, and voices of individuals who represent a particular conceptualization of gender. Use of such masculine terms in generic contexts serves to reinforce ideas of importance or bias of males and in turn reflects male societal dominance and superiority. For example, the use of the generic “he” leads readers to assume that only males are referenced and in the process excludes women as possible referents. Such exclusionary language renders other gender groups invisible. As academia strives to establish excellence in scholarship, it is critical to understand the role and influence of gender-biased language in research. The call to understanding the power of language in research is one of social justice, advocacy, equity, and competence. Historically, the English language is masculine dominated, and thus specific processes must be implemented to ensure balanced description. First, it is important to differentiate the concept of gender from sex, which defines individuals via ­

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biological processes and physiological characteristics. The term sex is also used to address sexual behavior and thus differs from gender. Instead, gender is a socially defined construct. A given society assigns attributes, roles, behaviors, and activities that are considered “appropriate” and within the “social roles” of gender. Yet roles vary greatly among societies as reflected within families, education, job and career opportunities, finances, and health care. Gender is a fluid and dynamic construct yet rarely defined as such (i.e., it is conceptualized as a dichotomous or binary construct). For example, many studies report the number of females and males; however, whether the options of transgender, gender expansive, gender nonconforming, genderqueer, or even an open-ended item to allow for self-identified gender description showing evidence of this understanding is questioned.

State of the Literature A review of the literature demonstrates a trend of gender stereotypes where male masculinities and female femininities are examined within the scope of ascribed and restricted gender roles. Language bias occurs via the use of male pronouns, gendered terms, and sex and gender stereotyping. Moreover, a review of psychological research indicates an increase in the inclusion of female participants, a decrease in overgeneralized single-gender studies, and greater representation of gender comparative studies. Despite changing times, there remains relatively limited research that has examined the role and meaning of gender differences. Showing progress, however, more current literature evidences research that expands current questions to explore the dimensionality of participants and deep-­ structure processes and understanding of gender meaning, identity, expression, and importance. Moreover, various calls to researchers highlight the guidelines for fair gender language. Yet less emphasis has been placed on educating researchers to engage gender inclusive research agendas to best inform the field. Consequently, gender is still not central to researchers’ conceptualization and analyses of social issues, fostering a need to further examine and understand their roles in scientific inquiry.

Gender Bias in Research Training Current training in psychology and education programs often take a traditional approach in incorporating the study of gender in research. Specifically, curricula seek to train students in understanding the basics of research, yet efforts to include gender (among other diverse constructs) and gender processes within the research agenda are less apparent. Reduced emphasis is placed on educating students on gender specific theories and conceptual frameworks that could inform students to develop g­ ender informed research questions and methodologies. Limiting scholarship development, training programs tend not to focus on graduate students understanding new cultural and gender terms and the political, social, and cultural contexts of the participants and their realities. Although there exist guidelines for psychological practice with transgender or gender nonconforming individuals and a growing literature base to help students not engage sexist language and research designs, as of 2016, a set of guidelines for teaching researchers to shift from a gender binary and gender-biased perspective and language (and subsequent discussion about gender differences) does not exist. Similarly, embedded in good methodology and design, the selection of instruments that equally emphasize gender values within the scales’ items is critical for accurate assessment of gender processes in research. Graduate students would benefit from learning about gender-biased scales, the role of stereotypes in interpreting results, and the significant implications for research and practice.

Recommendations to Avoid Gender-Biased Language in Research The following is a list of recommendations that are synthesized from the current literature to assist in avoiding gender bias in language: 1. Use gender neutral, collective terms or avoid pronouns altogether in writing. Also, avoid terminology that renders a gender invisible within the broader context of a pronoun or description. 2. Develop research questions and hypotheses that extend beyond gender differences to include gender meaning and identity.

Gendered Behavior

3. Select scales and instrumentation that equally emphasize gender values within the scale construct items; else use emic, or group specific, scales for gender specific studies. 4. Alternate gender examples in discussion and interpretation of findings, ensuring that the examples themselves are not stereotyped or biased. 5. Interpretation of results and development of manuscripts and reports should specify for whom the information is intended rather than assume equal application to all genders without considerations or caveats.

Jeanett Castellanos and Alberta M. Gloria See also Gender and Society: Overview; Gender Fluidity; Gender Pronouns; Gender Stereotypes; Gender Versus Sex

Further Readings American Psychological Association. (n.d.). General guidelines for reducing bias [Supplemental material]. Retrieved from http://supp.apa.org/style/pubmanch03.00.pdf American Psychological Association. (n.d.). Reducing bias by topic [Supplemental material]. Retrieved from http://supp.apa.org/style/pubman-ch03.12.pdf McHugh, M. C., Koeske, R. D., & Frieze, I. H. (1986). Issues to consider in conducting nonsexist psychological research: A guide for researchers. American Psychologist, 41(8), 879–890. doi:10.1037/0003-066X.41.8.879 Ritchie, T. D. (2009). Gender bias in research. In J. O’Brien, J. Fields, & E. Shapiro (Eds.), Encyclopedia of gender and society (pp. 713–715). Thousand Oaks, CA: Sage.

Gendered Behavior Gendered behavior is a fundamental expression of gender identity and gender socialization that occurs developmentally for an individual throughout the life span. Sex typically refers to biological attributes of an individual, such as anatomical and hormonal differences between men and women, whereas gender takes on a more sociocultural conceptualization of a person identifying themselves

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as a male or female within a society. Gendered behavior are ways in which an individual acts in accordance with their identified male or female gender. Gender socialization occurs as the individual navigates through their social environment and develops views defining gender. This socialization process occurs from birth, as a person observes differences in gender in terms of roles, behavior, and what constitutes appropriate interactions. Families may comment on physical characteristics, such as strength when talking about boys, while girls may be evaluated on expressiveness and fragility. Boys are stereotypically dressed in blue, whereas girls are often dressed in pink. When children begin to observe the behavior, expectations, and interactions of parents with themselves and others, they begin to construct a mold of what constitutes suitable or desired behavior based on gender. Children also learn from same-sex peers, which guides their behavior with others. Gendered behaviors are important as they often serve as a mirror of an individual’s gender identity and the gendered messages of society on the individual. Gender roles also appear to change over time, and it is pertinent to examine how changing attitudes, roles, and behaviors move society further in its conceptualization of gender. This entry first presents various theories of gendered behavior and then examines differences in gendered behavior.

Theories of Gendered Behavior Psychoanalytic theory views gender as separate from biological features and supports an idea that it is acquired, as are gendered behaviors. An individual first identifies gender differences through family interactions and learns what is desired in terms of gender roles and begins to unconsciously and consciously model these behaviors based on what is defined as masculine or feminine. This process also begins to help one conceptualize gender while prompting gendered activities. Girls are provided with appropriate or desired gender cues from their mother, but this is devoid for boys, as they are not modeled gender cues for appropriate behavior. Therefore, boys must search for gender identity through ways of thinking and behaving that they perceive are different from their mother

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who serves as a feminine symbol. For males, gender identity is processed by rejecting femininity and engaging in behaviors that they view as masculine, or unfeminine, throughout the life span. According to cognitive developmental theory, factors related to a child’s ability to conceptualize gender lead to the integration of gender roles and gender identity. This theory contends that gender is formulated by what information children take in from the environment, which then molds how they view gender and identify themselves, thus guiding gendered behaviors. In turn, acting consistently with their gender conceptualizations, individuals may feel rewarded by engaging in gendered behavior. Lawrence Kohlberg believed in three stages of gender typing. Gender typing is the process by which an individual adopts values, characteristics, and behaviors according to members of the same gender to which they belong. He believed that an individual must achieve gender identity, gender stability, and gender consistency. Gender identity is an individual’s identification that they are male or female as well as the categorization of others according to gender grouping. Once an individual processes information about their identified gender, the individual acts according to their thoughts about what is expected, leading to gender identity, or gender constancy. Gender stability is the idea that the gender identity is a stable component throughout the life span. Gender constancy is the belief that one’s sex is permanent, related to biological properties, and does not rely solely on superficial gender characteristics, such as hair length or clothing. After gender stability, an individual reaches gender consistency. Gender consistency is the belief that gender does not change despite appearance, dress, or activities. Children also do not feel fully expected to demonstrate only gender-typed behaviors; after they have identified themselves as male or female, their identity remains the same. This theory postulates that gender identity is the ability of individuals to identify themselves as male or female, given the information that they have processed from their environment, and that there is a belief in gender stability. This suggests that gender remains constant over the life span and the individual must act according to their gender identity, which motivates the presence of gendered behavior.

Gender schema theory suggests that children construct a schema based on gender knowledge. Schemas involve how an individual processes information that helps them classify their experiences, allowing them to interpret new information for future interactions. The more relevant the schema, the more an individual will understand, represent, and recall information related to gender. Gender schemas are created by an individual in deciding what is appropriate behavior depending on the situation. For instance, a woman may act in a way disconnected from gender roles at work but at home may engage in very traditional gender activities. Candace West and Don H. Zimmerman postulated that gender is created and carried on by individuals who serve as actors engaging and playing out roles in society. Behavior is dictated through gender and maintained through practice. An activity is linked to defining one’s identity as well as the distinction of being a man or a woman. Gender is viewed as something achieved related to a specific context but also infiltrates the identity of the individual. This theory is based on social constructivism and is one in which gender identity is fluid and affected by social interactions where one plays a gendered part, like an actor, expressing identity through behavior. Other literature supports a view that identity is developed through internalized socialization influenced by a control loop. Identity theory describes that gender identity starts from the family and is acquired by the individual. An individual has multiple identities that dictate how one acts alone or when playing a gendered role in a group. People adhere to person identities, role identities, and group identities. In the identity control model, an identity is triggered and goes through an internal feedback loop in which an individual evaluates their own views of self in relation to how they believe others perceive them. The individual has internalized meanings of their identity and then gains meaning from the feedback they receive, which further reinforces behavior. Irrational behavior is also learned because of identities learned from family and society. Sheldon Stryker supports a view that the development of gender identity and gender socialization is due to identity salience. He believes that individuals are actors performing a role in accordance

Gendered Behavior

with their identities. Gendered behavior is dependent on how relevant identities are for the actor given the situation. The more committed the actor is to the identity, the stronger the person will act according to the gender role. An identity will also be called for by the self or others in society. Also, if an individual believes that a situation is beneficial or that there may be some gained benefit, an identity will be invoked. The person may seek out situations and opportunities that allow themselves to engage in behaviors associated with that identity. The social-cognitive theory of gender suggests that an individual constructs beliefs about the roles of men and women from their social environment and imitates those behaviors. Children begin to identify what is appropriate gender behavior through modeled family interactions. Gender identity is influenced by experiences involving motivational and self-regulatory mechanisms that enable gendered behavior. Gendered behavior is supported through punishment and reinforcement. Gender reinforcement can be accomplished through verbal compliments of gendered behavior, such as an older sister saying to a younger sister, “Your long hair looks pretty.” Punishment can be described as a negative outcome for a particular behavior, such as a girl who likes to engage in playful wrestling behavior being viewed as being overly aggressive, resulting in rejection from female peers.

Gendered Behavioral Differences A person’s identity often involves membership in a group, from which the individual integrates attributes into their self-identity and behaves in accordance with their conceptualization of the group. When individuals begin socialization, they begin to become aware of desirable gendered roles and associated behaviors and adopt these as part of their self-concept. Men and women try to take on desirable gender-related characteristics when observing self-concept; however, both negative and positive qualities are subconsciously developed. This identity development begins at an early age and across different cultures. Negative attributes of gender identity include unmitigated agency, which is a negative element of masculinity and ­suggests that the individual is centered on themselves while excluding others. Unmitigated communion is a negative aspect of femininity, whereby

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the individual focuses on others while excluding themselves. Children seem to be more traditional in their thinking toward others in relation to gender. The conceptualization of femininity and masculinity may change over time, and individuals develop positive and negative gender attributes over gender incongruent attributes in their self-concept across the life span and across various contexts. There are also differences between boys and girls when examining verbal and physical behavior. Boys have positive interaction with peers in play and receptive vocabulary, while positive play for girls is often influenced by popularity. Children have been found to display gender differences in aggressive behavior. In infancy, boys appear to communicate more aggressively, and this increases as children grow older. Boys appear to use more bodily force after 24 months compared with girls in the same age range. There are also significant gendered behavioral differences for children when trying to resolve conflict. Boys appear to use physical force, whereas girls use verbal exchanges. Experiences of victimization also lead to different gendered reactions. In a study by Elizabeth Ewing Lee and Wendy Troop-Gordon, young girls who experienced victimization by their peers withdrew from feminine behavior and engaged in masculine behavior, whereas boys who experienced victimization demonstrated more feminine behaviors. Jennifer J. Esala found that mothers deterred their daughters from using physical violence in situations. Male adolescents also refrained from reporting their victimization to adults, as they felt that they did not have the power to stop the physical violence. Research has also found that gender is the strongest predictor of fear of crime. Women are more fearful of crime but are less likely to be victimized than men. Gender socialization may also teach women to fear unlikely scenarios. Women also engage in more constrained behavior, such as avoiding situations, or reliance on others, to avoid victimization compared with men. There are also differences when observing empathy. Male adolescents who were subject to high amounts of physical violence reported being numb to pain and having less empathy for other victims. Women in general have been viewed to be more empathetic than males, but this may stem from traditional gender socialization. Females are  also shown to more accurately identify facial

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expressions faster and are better at reading body language than men. However, men appear to recognize expressions of happiness more quickly and more accurately than women, whereas women recognize anger in men more accurately. Sexual behaviors are also influenced by gendered behavior and roles. Women who held more traditional gender roles for men used condoms less often, whereas women who were more conventional with their gender beliefs about women used condoms more often. Men who held more traditional views about men had fewer sexual partners. The role of gendered behaviors in sexual arenas is important to further examine when evaluating gendered behavior in various contexts. In addition, there are differences for individuals who hold more traditional gendered scripts when it comes to sex. Men appear to want recreational sex, whereas women desire relational sex. Devika Srivastava See also Gender Development, Theories of; Gender Nonconforming Behaviors; Gender Role Behavior; Gender Role Conflict; Gender Role Socialization; Gender Socialization in Childhood; Gender Socialization in Men; Gender Socialization in Women; Gender Stereotypes; Gender Versus Sex; Gendered Stereotyped Behaviors in Childhood; Gendered Stereotyped Behaviors in Men; Gendered Stereotyped Behaviors in Women; Identity Formation in Childhood

Further Readings Bell, L. C. (2004). Psychoanalytic theories of gender. In A. H. Eagley, A. H. Beall, & R. J. Sternberg (Eds.), The psychology of gender (pp. 145–168). New York, NY: Guilford Press. Berger, A., & Krahe, B. (2013). Negative attributes are gendered too: Conceptualizing and measuring positive and negative facets of sex-role identity. European Journal of Social Psychology, 43, 516–531. Berk, L. E. (2009). Child development (8th ed.). Boston, MA: Pearson. Blakemore, J. E. O., & Phillips, E. L. (2014, October). Do parents and children agree on children’s gender-related interests and traits? Poster session presented at the Gender Development Research Conference, San Francisco, CA. Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106, 676–713.

Carter, M. J. (2014). Gender socialization and identity theory. Social Sciences, 3, 242–263. Christov-Moore, L., Simpson, E. A., Coude, G., Grigaityte, K., Iacoboni, M., & Ferrari, P. F. (2014). Empathy: Gender effects in brain and behavior. Neuroscience & Biobehavioral Reviews, 46, 604–627. Eagley, A. H. (2009). The his and hers of prosocial behavior: An examination of the social psychology of gender. American Psychologist, 64, 644–658. Ensor, R., Hart, M., Jacobs, L., & Hughes, C. (2011). Gender differences in children’s problem behaviours in competitive play with friends. British Journal of Developmental Psychology, 29, 176–187. Esala, J. L. (2013). Communities of denial: The co-construction of gendered adolescent violence. Deviant Behavior, 34, 97–114. Ewing Lee, E. A., & Troop-Gordon, W. (2011). Peer socialization of masculinity and femininity: Differential effects of overt and relational forms of peer victimization. British Journal of Developmental Psychology, 29, 197–213. Fausto-Sterling, A., Coll, C. G., & Lamarre, M. (2012). Sexing the baby: Part 2: Applying dynamic systems theory to the emergencies of sex-related differences in infants and toddlers. Social Science & Medicine, 74, 1693–1702. Flouri, E., & Panourgia, C. (2011). Gender differences in the pathway from adverse life events to adolescent emotional and behavioral problems via negative cognitive errors. British Journal of Developmental Psychology, 29, 234–252. Gelman, S. A., Taylor, M. G., & Nguyen, S. (2004). Mother-child conversations about gender: Understanding the acquisition of essentialist beliefs. Monographs of the Society for Research in Child Development, 69(1), 100–142. Hay, D. F., Nash, A., Caplan, M., Swartzentruber, J., Ishikawa, F., & Vespo, J. E. (2011). The emergence of gender differences in physical aggression in the context of conflict between young peers. British Journal of Developmental Psychology, 29, 158–175. Hooghe, M. (2011). The impact of gendered friendship patterns on the prevalence of homophobia among Belgian late adolescents. Archives of Sexual Behavior, 40, 543–550. Jun, J., & Kyle, G. T. (2012). Gender identity, leisure identity, and leisure participation. Journal of Leisure Research, 44(3), 353–378. Kohlberg, L. (1966). A cognitive-developmental analysis of children’s sex-role concepts and attitudes. In E. E. Maccoby (Ed.), The development of sex differences

Gendered Behaviors in Adolescence (pp. 82–173). Stanford, CA: Stanford University Press. Lefkowitz, E. S., Shearer, C. L., Gillen, M. M., & Espinosa-Hernandez, G. (2014). How gendered attitudes relate to women’s and men’s sexual behaviors and beliefs. Sexuality & Culture, 18, 833–846. Leman, P. J., & Tenenbaum, H. R. (2011). Practising gender: Children’s relationships and the development of gendered behaviour and beliefs. British Journal of Developmental Psychology, 29, 153–157. Martin, C., & Ruble, D. (2004). Children’s search for gender cues: Cognitive perspectives on gender development. Current Directions in Psychological Science, 13(2), 67–70. Masters, N. T., Casey, E., Wells, E. A., & Morrison, D. M. (2013). Sexual scripts among young heterosexually active men and women: Continuity and change. Journal of Sex Research, 50(5), 409–420. Rader, N. E., Cossman, J. S., & Allison, M. (2009). Considering the gendered nature of constrained behavior practices among male and female college students. Journal of Contemporary Criminal Justice, 25(3), 282–299. Sinno, S. M., & Killen, M. (2011). Social reasoning about “second-shift” parenting. British Journal of Developmental Psychology, 29, 313–329. Stryker, S. (1994). Identity salience and psychological centrality: Equivalent, overlapping, or complementary concepts? Social Psychology Quarterly, 57, 16–35. West, C., & Zimmerman, D. H. (1987). Doing gender. Gender & Society, 1, 125–151.

Gendered Behaviors in Adolescence Adolescence (from the Latin word adolescere, meaning “to grow up”) is a period of significant physical and psychological human growth that marks the transition between childhood and adulthood. Typically occurring between the ages of 10 to 19 years, adolescence is a time of selfdiscovery, disorientation, and independence. It is also marked by the exploration of one’s identity in the context of ethnicity/race, gender, and sexual orientation. Recent clinical and media attention has highlighted the role of adolescent identity formation as it relates to one’s gender identity. This review highlights the cognitive, psychological, and

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emotional factors that influence gendered behavior in adolescence.

Adolescent Identity Formation During adolescence, individuals are faced with the challenge of exploring their own values, ethics, and morality. This process of discovering one’s distinct personality features is called identity formation or individuation. In large part, this process is heavily influenced by the physical, cognitive, and emotional changes that occur during adolescence. It is the reaction to, and integration of, these changes that establishes the individual characteristics that make up one’s identity. Adolescence is marked by the onset of puberty, which is the process of physical changes through which a child’s body develops primary and secondary sex characteristics. New hair growth, changes in body shape, and hormonal changes combine to help adolescents reach their full capacity for sexual reproduction. These changes can be exciting and joyous, as well as overwhelming and frustrating. By the time adolescents successfully navigate this period of their life, they will look, act, behave, and feel much differently, now that they are biologically prepared for sexual reproduction. For some, this may include changes in dress, changes in interests, and changes in relationships with people of the gender they are attracted to (e.g., heterosexual young men may develop romantic crushes on their female peers, whereas gay young men may develop romantic crushes on their male peers). The process of puberty is first initiated once a threshold level of body fat is reached. Once this occurs, the brain’s hypothalamus sends signals to the gonads to increase their production of sex hormones. In response to these signals, the ovaries (in girls) and the testes (in boys) release increased levels of estradiol and testosterone into the body, which stimulate libido and the growth of primary and secondary sex characteristics. Primary sex characteristics are physical bodily structures directly involved in reproduction. With respect to pubertal development, this is the production of ova, or eggs, in girls and sperm in boys. A wide range of secondary sex characteristics also develop. These sex characteristics are a result of increased sex hormones but are not directly related to

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reproduction. These changes include pubic hair growth, breast development, growth spurts, menarche, changes in one’s voice, underarm hair, and increased production of skin oils and sweat. For adolescents of both genders, these physical changes may influence their behaviors. For example, many young people may begin to shave unwanted hair (e.g., typically facial hair on young men and leg and armpit hair on young women). Furthermore, both female and male adolescents may become overly conscious of body odor or cleanliness— resulting in different hygienic behaviors. In addition to the physical and hormonal changes, adolescence also brings a range of cognitive changes. By the age of 6 years, the brain has already reached 95% of its adult size. However, it has been long understood that the brain does not reach maturation until the early 20s. Adolescent development marks an important time of establishing synaptic connections between neurons in the frontal lobe to aid in higher cognitive functioning, such as problem solving, planning, reasoning, and making moral judgments. It is during this time that the brain also improves in its efficiency. At the age of 11 or 12 years, massive synaptic pruning removes the unused synapses ­ leaving only the used synapses to be reinforced, strengthened, and thereby specialized. In addition, the process of myelination provides a fatty sheath around the axons of neurons making communication between neurons faster and more efficient. Synaptic pruning and myelination both occur ­during adolescence to help transform the brain and are important processes for adult cognitive functioning. As adolescents undergo physical and cognitive changes, they are also faced with developing a coherent sense of identity as it relates to others, coping with stress and learning to manage emotions. Establishing a sense of identity has been traditionally seen as a pivotal task of adolescent emotional development. Self-concept is the set of beliefs one has about oneself that sets one apart as distinct and separate from others. It is through the exploration of one’s attributes about oneself and one’s education and professional goals, interests, and values that help ultimately shape one’s personality. An important aspect of the identity formation process is to explore beliefs about one’s role within a social context, including racial/ethnic identity,

sexuality, and gender roles. It is through developing relationships with peers and engaging in different activities that young people may learn what they are interested in and what they are not interested in.

The Concept of Gender Identity Gender identity is one’s internal experience of oneself as male, female, both, neither, or some other variation. This intimate and private understanding of one’s membership into male or female categories can form the basis for personal attributes, social roles, social customs, activities, and behaviors. While many people use the terms gender and sex interchangeably, they are very distinct concepts. Gender is a wide range of characteristics created to distinguish between masculinity and femininity. Because these characteristics are socially constructed, these attributes are not ­constant. For example, while in previous eras participating in sports and active exercise was not considered to be feminine, historical events and cultural attitudes have shifted and changed the way in which society views female athletes. Conversely, sex involves biologically determined physical attributes (e.g., genitalia, sex chromosomes, gonads, sex hormones, and internal reproductive structures) that assign individuals as either male or female. Gender schema theory suggests that gender identity falls into four categories based on whether individuals process and integrate information aligned with their biological sex, aligned with the opposite sex, aligned with both sexes, or aligned with neither sex. Individuals who identify as cisgender believe that their gender corresponds to the sex assigned to them at birth. However, 5% to 12% of birth-assigned adolescent females and 2% to 6% of birth-assigned adolescent males find that their sex is different from their gender identity and identify as transgender. Furthermore, recent additions to the literature include genderqueer, gender fluid, and gender variant, which refer to individuals who do not identify with their assigned sex and do not identify with the gender binary of men and women. Rather, gender variant individuals believe that their gender exists somewhere along the spectrum of gender or outside the spectrum altogether.

Gendered Behaviors in Adolescence

Gender Identity Development Gender identity is a complex relationship between one’s biologically assigned sex and one’s internal recognition of the self as male, female, both, or neither. The exploration of this interplay contributes to the process by which adolescents begin to experiment with ways of appearing, sounding, and behaving. Research on the process of gender identity development has largely focused on the role of cognitive factors during childhood. Concepts of gender begin at an early age and pass through various stages. Between the ages of 18 and 24 months, most children are able to demonstrate socially reinforced characteristics and aspects of gender. In addition, children at this age are also seeking out same-sex role models to identify with (e.g., G.I. Joe, Barbie) and display a need to label things into neat and concrete categories. At this age, they are also able to label their own gender and the gender of others. This ability has been related to increased formation of gender scripts, or socially constructed narratives for how girls and boys should act. By the age of 5 to 7 years, children tend to display strong gender-typed preferences for stereotyped toys and styles of play, and they demonstrate preference for same-sex friendships. These stereotypes appear to be rigid at this age and are reinforced as children look to same-sex role models for social cues on behavior. A pivotal point in gender identity development is when children are believed to achieve concepts of gender stability and gender constancy. Gender stability is the understanding that one’s sex is irreversible, stable, and does not change. In this stage, children know that boys will grow up to be men and girls will grow up to be women. Gender constancy is the understanding that despite superficial changes to appearance and one’s preferences for activities, a person’s gender remains the same. For example, a man is still a man even if he engages in cross-sex activities like wearing makeup and high-heeled shoes. It is theorized that once children achieve both these concepts, they are motivated to imitate the behavior of members of their own sex in order to adhere to normative gender scripts. Gender stereotypes are further strengthened and reinforced during adolescence when social pressure to conform is at its peak. The gender

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intensification hypothesis posits that increased pressure to conform to socially constructed gender roles results in intensified gender role identification as firmly male or female. As the adolescent body undergoes the physical, cognitive, and emotional changes associated with puberty, the simultaneous increased interest in dating and forming relationships can result in hypermasculine and hyperfeminine behavior. For cisgender adolescents, this ­ process is a part of the heteronormative expectation when one’s biological sex, gender ­ identity, and gender expression align. However, for transgender or gender nonconforming (TGNC) adolescents, whose biological sex and gender identity do not align, this exacerbated pressure to conform presents additional and unique complexities to identity development.

Gender Variant Identity Development While research on TGNC identity development is in its fledgling stages, it does appear that TGNC adolescents undergo the same stages as cisgender adolescents. However, it appears that TGNC children typically display a developmental lag in understanding concepts of gender and learning socialized gender stereotypes compared with their cisgender counterparts. For example, gender variant children may not initially identify with samesex role models but, over time, show a delayed preference for models, toys, and activities that are stereotypically from the opposite sex. When recalling their childhood, TGNC adults report identifying as transgender as young as 2 years old. At this stage, children may indicate a desire to be another gender, show dislike or disgust toward their biological sex, and begin behaving according to the stereotypes of the preferred sex. However, childhood gender variant behavior does not always continue on into adulthood. Research indicates that only 15% of children displaying gender variant behavior continue to meet the criteria for gender dysphoria, a clinical mental health diagnosis used to describe individuals who experience significant distress from identifying as gender variant. It is hypothesized that the period between 10 and 13 years of age plays an important role in understanding whether or not childhood gender variant behavior persists or remits into adolescence. These formative years are marked by

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Gendered Organizations

a significant increase in physical changes, changes in environment (i.e., transitioning to high school) that result in being treated as one’s biological sex, and the beginning years of exploring one’s sexuality. Children displaying mild gender variant behavior that later remits into young adolescence ­suggests that gender is malleable before becoming fixed and rigid into later adolescence. When one’s gender identity develops disparately from one’s biological sex, several unique psychosocial and biological factors should be considered. The first studies on gender variant identity development focused on the role of maternal wishes for a daughter, paternal absence, parental reinforcement of cisgender behavioral patterns, and the symbiotic relationship between mother and son. However, evidence for these hypotheses are weak and have not been replicated. Modern theories hypothesize that gender variant behavior develops as a result of certain child/parent factors (e.g., childhood anxiety, parental psychopathology) combined with specific environmental factors (e.g., poor parental limit setting, maternal fear of male aggression, and a feminine appearance in boys or a tough appearance in girls). Biological factors suggest that gender variant behavior is the result of the brain not sexually differentiating in line with the chromosomes, gonads, and genitals. However, research on biological factors is currently limited to animal studies. In humans, research remains inconclusive and suggests that gender variant behavior is the result of small effects from many factors. Adolescence is a time of tremendous biological, cognitive, and emotional growth. Within this period of transition, individuals also explore their identity within the social context of gender. For adolescents whose gender and biological sex align, gender identity development follows a wellresearched trajectory. However, for gender variant adolescents whose gender does not align with their biological sex and may refute the notion of a gender binary altogether, little is known about how gender identity develops. It is the hope that with continued media attention and shifts in sociopolitical views, the field of psychology will be the pioneers to advance understanding of gender variant identity development. Krystel Salandanan

See also Emotions in Adolescence and Gender; Gender Identity and Adolescence; Identity Formation in Adolescence

Further Readings Bem, S. L. (1983). Gender schema theory and its implications for child development: Raising genderaschematic children in a gender-schematic society. Signs, 8, 598–616. Cohen-Kettenis, P. T. (2005). Gender identity disorders. In C. Gillberg (Ed.), A clinician’s handbook of child and adolescent psychiatry (pp. 695–725). Cambridge, England: Cambridge University Press. Erikson, E. H. (1968). Identity: Youth and crisis. New York, NY: W. W. Norton. Kohlberg, L. A. (1966). A cognitive-developmental analysis of children’s sex role concepts and attitudes. In E. E. Maccoby (Ed.), The development of sex differences (pp. 82–173). Stanford, CA: Stanford University Press. Priess, H. A., Lindberg, S. M., & Hyde, J. S. (2009). Adolescent gender-role identity and mental health: Gender intensification revisited. Child Development, 80(5), 1531–1544. doi:10.1111/j.1467-8624.2009 .01349.x Zucker, K. J., & Bradley, D. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York, NY: Guilford Press.

Gendered Organizations American sociologist Joan Acker first wrote about the theory of gendered organizations in 1990, and since then, it has been used to explain gender inequality in many types of businesses and organizations. Specifically, this approach helps scholars explore two main questions: (1) How and why does gender (masculinity and femininity) make a difference in organizations? (2) Why does gender inequality occur in organizations? This entry describes the theory, some examples of its empirical applications, and some limitations of the framework. The gendered organizations theory maintains that women are disadvantaged in workplaces because gender is embedded in organizations. Most organizations are characterized by ideal worker norms that favor workers who demonstrate a

Gendered Organizations

complete devotion to work, and who prioritize work over family. Because women more often do, or are expected to take on, the bulk of family and caregiving responsibilities, such norms typically favor men. Gendered workplace norms are bolstered by an organizational logic in which seemingly gender neutral policies benefit men workers more than women workers. Many jobs are also culturally constructed as more appropriate for one gender than another. Police work, construction work, and firefighting are culturally defined as “men’s work,” while nursing, social work, and ­elementary school teaching are seen as “women’s work.” These cultural constructions inevitably influence workers’ own gendered identities. For example, a male nurse might emphasize the masculine qualities of his personality and work responsibilities. Overall, the gendered organizations theory demonstrates that workplaces are not meritocracies, and regardless of merit and skill, women often face bias and discrimination that inhibit their ­success. It has been influential because it shifted scholars’ focus away from what individuals have or lack, and it helped them critically examine how organizations are structured. The gendered organizations theory has been applied to workers’ experiences in hundreds of workplaces and organizations. Some studies have employed the theory to assess whether workplaces can eradicate ideal worker norms. Erin Kelly and colleagues analyzed the implementation of a Results Only Work Environment (ROWE) initiative in a white-collar professional corporate office of Best Buy. They asked, “How do we change workplace cultures, particularly those characterized by ideal workers norms?” The ROWE initiative encourages workers to privilege productivity and results over number of hours present at their workplace (not “face time,” but instead what is produced). Ideally, it could permit workers to take time off to care for families without incurring professional penalties for doing so. Although the women interviewed were more favorable toward ROWE than men, most interviewees still embraced ideas reflective of typical ideal worker norms. Christine Williams and her coauthors explored the experiences of women in a male-dominated occupation and male-dominated industry: geoscientists in the gas and oil industry. They argued that workplaces (particularly corporate businesses)

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have changed since Acker first developed the gendered organizations theory. Some have attempted to implement policies and other work culture changes that appear to be gender neutral. They interviewed women geoscientists to understand if and how these supposedly gender neutral policies could undo some of the organizational logic discussed by Acker. They found that gender neutral policies do not erase gender bias at work. For example, the women they interviewed felt excluded from men’s informal work networks. Even though they were decisive and self-assured (as women are likely to be in male-dominated work environments), they reported that they felt uncomfortable being aggressive or assertive due to perceptions that assertive women are “bitches.” In female-dominated workplaces, the institutionalization of gender bias and discrimination is still seen. Numerous studies find that men (particularly White, heterosexual men) in female-­dominated occupations such as nursing, elementary school teaching, and social work experience advantages in hiring, promotions, and pay. Instead of a glass ceiling, these men encounter a glass escalator. Adia Harvey Wingfield’s research on African American male nurses found that they did not experience the glass escalator; rather, they experienced racism from patients and female coworkers. For example, some patients mistook the men for orderlies or custodians, whereas others brazenly refused care by African American male nurses entirely. Acker’s revised gendered organizations framework introduces the concept of inequality regimes, which moves her theory from one primarily focused on gender to one that also examines how race, class, and other statuses are part of inequality in organizations. Combining intersectional theory with gendered organizations theory allows researchers to understand how gender intersects with other social locations to create inequalities. Wingfield’s research on African American male nurses exemplifies this intersectional approach to studying jobs and organizations: Not all men experience masculine privilege at work. Rather, White, heterosexual, class-privileged men are more likely to enjoy the benefits of a glass escalator. The gendered organizations theory was influential by taking scholars from individual­ level explanations about women’s deficiencies to demonstrating the importance of structure and ­

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workplace cultures. Rather than seeing gender as something that individuals “have” (e.g., she is feminine, he is masculine), the theory interrogates the characteristics of workplaces, businesses, and organizations that construct and reinforce gender hierarchies. Regardless of skill, some groups of workers are automatically disadvantaged by workplace policies, cultures, and norms that tie ability and worth to social identities and value and reward particular sets of behaviors, appearances, and dispositions over others. The theory raises important questions about gender inequality at work. If all organizations are gendered, what are the potential solutions for lessening gender inequalities in workplaces? Can any organization be degendered, and if so, how? What would an organization free of gender inequality look like? One recent review of worker-owned businesses by Katherine Sobering and colleagues suggests that under some conditions, worker cooperatives and communes, as contexts concerned with social justice, may offer some alternatives to gendered organizations. Because there is a voluminous literature on gendered (and unequal) organizations, more studies on alternative (at least, more gender equal) organizations offer fruitful areas for future research. Also, the gendered organizations and inequality regimes frameworks have deemphasized sexuality, particularly heterosexism and homophobia in workplaces. Thus, examining sexual orientation–based inequalities in organizations presents another potentially rich area for future research. Patti Giuffre and Courtney Caviness See also Gender Discrimination; Gender Stereotypes; Women and Leadership; Women in Corporate Positions, Experiences of; Workplace and Gender: Overview; Workplace Sexual Harassment

Further Readings Acker, J. (1990). Hierarchies, jobs, bodies: A theory of gendered organizations. Gender & Society, 4(2), 139–158. doi:10.1177/089124390004002002 Acker, J. (2006). Inequality regimes: Gender, class, and race in organizations. Gender & Society, 20(4), 441–464. doi:10.1177/0891243206289499 Britton, D. M., & Logan, L. (2008). Gendered organizations: Progress and prospects. Sociology

Compass, 2(1), 107–121. doi:10.1111/j.1751-9020. 2007.00071.x Sobering, K., Thomas, J., & Williams, C. L. (2014). Gender in/equality in worker-owned businesses. Sociology Compass, 8(11), 1242–1255. doi:10.1111/ soc4.12208 Williams, C. L. (1992). The glass escalator: Hidden advantages for men in the “female” professions. Social Problems, 39(3), 253–267. doi:10.2307/3096961 Williams, C. L., Muller, C., & Kilanski, K. (2012). Gendered organizations in the new economy. Gender & Society, 26(4), 549–573. doi:10.1177/ 0891243212445466 Wingfield, A. H. (2009). Racializing the glass escalator: Reconsidering men’s experiences with women’s work. Gender & Society, 23(1), 5–26. doi:10.1177/ 0891243208323054

Gendered Stereotyped Behaviors in Childhood Over the course of childhood, children develop a complex understanding of gender and gender stereotypes. Starting at around the age of 2 years and continuing through childhood, the majority of children exhibit gendered behaviors that are stereotypical for their biological sex. Gendered behaviors entail an array of behaviors that express how feminine or masculine someone is. When children engage in gendered stereotyped behaviors, it means that they are behaving in a way that is consistent with their biological sex (i.e., male children act masculine, and female children act feminine). This entry provides a brief overview of the gender ­stereotyped behaviors children exhibit, the typical development of gender stereotypes, the biological and social factors influencing the development of gender stereotypes, and gender-atypical behaviors in children.

Examples of Gendered Stereotyped Behaviors Gendered stereotyped behaviors are multidimensional and include behaviors such as body ­language and mannerisms, speech patterns, a preference for playmates of one’s own biological sex, and preferences for same-gendered toys, interests,

Gendered Stereotyped Behaviors in Childhood

and activities. Gendered stereotyped behaviors also entail modes of dress (e.g., whether one wears skirts or likes to wear pink), hair length, and other aspects of one’s modifiable physical appearance that express one’s gender. Finally, these behaviors also entail engaging in fantasy play in which children act out stereotypical social roles consistent with their biological sex (e.g., a boy pretending to be a male superhero; playing games such as “house,” in which girls assume the role of mother).

The Development of Gender Stereotypes By the age of 2 years, children typically become aware of their biological sex and the rudimentary differences between boys and girls and will start to identify themselves as a boy or a girl. By the age of 2½ years, most children hold an understanding of gender stereotypical toys, activities, and careers. For instance, children at this age may associate “dolls” with girls and “cars” with boys. By the age of 3 or 4 years, children possess very strong gender stereotypes and readily engage in gendered behavior. Children in this age range demonstrate a preference for same-sex playmates and have a basic belief structure of the stereotypical types of play boys and girls do. This rudimentary knowledge may be expressed by statements and beliefs such as “Girls wear pink”; “Boys play football, and girls are cheerleaders”; “Girls have long hair, and boys have short hair”; “Boys don’t dance”; and “Boys don’t wear dresses.” Around this age, differences in play also emerge, with boys engaging in more aggressive, violent, rough-andtumble play than girls. Furthermore, during imaginative play, boys of ages 3 to 4 years tend to engage in play in which fantasy themes are enacted (e.g., they pretend to be superheroes), whereas girls prefer to engage in play that enacts family roles (e.g., they play “house”). Differences at the preschool age are very rudimentary and typically only follow along one dimension. That is, most children in this age group will be gender stereotyped in terms of play (e.g., playing with trucks or dolls) and appearance (e.g., short or long hair) but will not yet associate different personality traits (e.g., aggressive, caring, nurturing, and other gendered personality traits) with boys and girls.

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By the age of 5 years, children are more complex in their understanding of gender stereotypes and will associate not only aspects of play and appearance but also personality traits (e.g., aggressive, caring, nurturing, strong) with boys and girls. The sex-segregated play that first developed in the preschool years becomes further exaggerated and highly noticeable by the age of 5. Those children who hold the strongest beliefs in gender stereotypes will engage in sex-segregated play more than children with weaker beliefs in gender stereotypes. Conversely, children who are more flexible in their beliefs about gender, as defined by believing that gender stereotypes can be violated, have more positive attitudes toward children of the opposite gender, in comparison with children who are less flexible in their gender beliefs. Gender stereotypes become more complex after age 7 years. It is in these later years of childhood that children, even those who were rigid in their gender beliefs, will become aware that people can violate gender stereotypes. However, violating gender stereotypes is still typically frowned on by children in later childhood, and most elementary school–age children continue to engage in gender stereotypical behavior and exhibit a strong preference for associating with peers who are gender stereotypical. By adolescence, children have high gendered stereotype flexibility and understand that gender stereotypes can be and are violated. However, adolescents continue to experience strong social and peer pressure to conform to gender norms and, as a result, typically continue to engage in high levels of gendered stereotyped behavior.

Biological and Social Factors Influencing the Development of Gendered Stereotyped Behaviors Research suggests that gender and gendered stereotyped behaviors are caused by a combination of both biological and environmental factors. There is some evidence suggesting that biological factors influence gender development and predict the display of gendered stereotyped behaviors. For instance, the amount of exposure to testosterone children have in the womb predicts the extent to which they engage in gendered stereotyped behaviors in preschool. Furthermore, some (but not all)

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twin studies suggest a genetic component to gender and gendered behaviors. However, not all studies have supported the theory that gendered stereotyped behaviors have a biological basis. Therefore, more research in this area is needed before strong conclusions about the extent of biological influences on gendered stereotyped behavior in children can be drawn. Socialization and social processes play a large role in children’s gender development and engagement in gender stereotypical behaviors. Children’s expressions of gendered stereotyped behaviors are heavily influenced by their interactions with o ­ thers. Parents are early, primary socializing agents for children and can influence engagement in gendered stereotyped behaviors. From birth, parents treat children differently depending on whether they are boys or girls. Research finds that boys are more likely to have rooms with blue bedding and are more likely to be dressed in blue, white, and red. Girls are more likely to have rooms with pink or yellow bedding and are more likely to be dressed in pink and multicolored clothing. The types of toys parents provide to infants under the  age of 2 years also show significant gendered differences: Infant boys are more likely to be p ­ rovided with sports equipment, trucks, and tools, whereas infant girls are more likely to be provided with dolls, ­fictional characters, and manipulatives. As infants and toddlers grow into preschoolers, parents encourage gender stereotypical behaviors in their children, including gender stereotypical appearance, play, and mannerisms. Parents who themselves hold traditional beliefs about gender and gender roles are most likely to encourage gendered stereotypical behaviors in their children. Many parents intentionally or unintentionally punish or criticize children for failing to conform to gender stereotypes. Parents are generally more concerned with the gendered behavior of boys and are particularly more likely to pressure their sons to conform to gendered stereotypes, whereas daughters are given more leeway. Fathers are more likely than mothers to exert pressure to conform to gender stereotypes, particularly on their sons. These sex differences are largely thought to be due to differences in societal norms, which allow females greater flexibility within their gender role and expression of gendered behaviors. Older samesex siblings are also strong socializing agents.

Having an older sibling of the same sex increases the likelihood that a child will adhere to gendered stereotyped behaviors. Preschool, and specifically the interaction with teachers and peers in the preschool setting, is another strong and early socializing agent. ­Teachers and peers reward gendered stereotypical behavior in children and punish or criticize ­gender-atypical behaviors. Again, this is particularly true for boys, for whom there exist strong social norms against displays of femininity. Subtle cues about gender norms and expectations can also elicit stereotyped gendered behaviors in preschool children; in one study, when preschool teachers referred to classrooms of mixed-sex children as “boys and girls,” gendered stereotyped behavior increased in comparison with classrooms in which teachers used more gender-inclusive language (e.g., “children” or “class”). Specifically, children whose preschool teacher used gendered language held stronger gender stereotypes, and they played less with and had less positive attitudes toward opposite-sex peers, in comparison with children whose preschool teacher used ­gender-inclusive language. The media is yet another socializing agent thought to influence children’s awareness and acceptance of gender stereotypes. Research has found that print media geared for children (e.g., children’s storybooks and coloring books), children’s television programming, advertisements marketed toward children, and even educational software largely reinforce gendered stereotypes. For instance, television programming might portray male characters as leaders, as heroes, or as more aggressive, while portraying female characters as followers, in need of help, or demure, friendly, and focused on appearance. Research on educational software for preschoolers similarly found that male characters were more prevalent than female characters and were more likely to exhibit masculine qualities. Female characters were highly stereotypically feminine in appearance.

Gender-Atypical Behaviors in Children Most children, even those who hold strong stereotypes about gender, engage in some gender fluidity and, at least occasionally, violate the gender stereotypes associated with their biological sex.

Gendered Stereotyped Behaviors in Men

However, some children’s gendered behaviors are consistently and persistently atypical for their biological sex. These children may exhibit the body language, speech patterns, and mannerisms of, and may prefer interests and activities that are stereotypically associated with, the opposite biological sex. Children who consistently exhibit atypical gendered behaviors may not meet the Diagnostic and Statistical Manual of Mental Disorders criteria for gender dysphoria, depending on the presence or absence of other factors. Most researchers acknowledge strong and consistent gender-atypical behaviors in children as a normal, albeit less common, variation of child development, caused by a complex interaction of environmental and biological factors. Some research suggests that children exhibiting gendered behaviors atypical for their biological sex are more likely to identify as gay or transgender on reaching adulthood. However, much of the existing research has been conducted on samples of children referred for clinical treatment for their gendered behaviors. Therefore, more research is needed to determine whether, and to what extent, the expression of atypical gendered behaviors in childhood is related to adult outcomes. The development and expression of atypical gendered behaviors in children may not always be a cause for concern in and of itself. However, due to the strong social reinforcing and policing of gender roles and gendered behaviors, particularly for boys, children who do not engage in stereotypical gender behaviors are at increased risk for abuse, verbal and physical harassment, and bullying, which can lead to poorer mental health outcomes. Research finds that children who exhibit atypical gender behaviors are more likely to have poor relationships with, and be abused by, their immediate family members. This is particularly true for boys who exhibit feminine gendered behaviors, as boys are more socially constricted in their gendered behavior expression. Michele M. Schlehofer See also Biological Theories of Gender Development; Childhood and Gender: Overview; Cognitive Theories of Gender Development; Gender Socialization in Childhood; Gendered Behaviors in Adolescence; Parental Messages About Gender; Social Role Theory

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Further Readings Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106, 676–713. Eagly, A. H. (1987). Sex differences in social behavior: A social-role interpretation. Hillsdale, NJ: Lawrence Erlbaum. Elizabeth, P. H., & Green, R. (1984). Childhood sex-role behaviors: Similarities and differences in twins. Acta Geneticae Medicae et Gemellologiae: Twin Research, 33, 173–179. Fagot, B. I. (1977). Consequences of moderate crossgender behavior in preschool children. Child Development, 48, 902–907. Golombok, S., & Fivush, R. (1994). Gender development. Cambridge, England: Cambridge University Press. Knafo, A., Iervolino, A. C., & Plomin, R. (2005). Masculine girls and feminine boys: Genetic and environmental contributions to atypical gender development in early childhood. Journal of Personality and Social Psychology, 88, 400–412. Langlois, J. H., & Downs, A. C. (1980). Mothers, fathers, and peers as socialization agents of sex-typed play behaviors in young children. Child Development, 51, 1237–1247. Maccoby, E. (1998). The two sexes: Growing up apart, coming together. Cambridge, MA: Belknap Press of Harvard University Press. Martin, B. (2011). Children at play: Learning gender in the early years. Sterling, VA: Trentham Books.

Gendered Stereotyped Behaviors in Men Gendered stereotyped behaviors in men are centered on masculinity and the perceived notion that to be viewed within a context of strength a masculine gendered persona must be presented by the individual man to the world at large. In addition, stereotyped behaviors grounded in gender, oftentimes, do not account for the fluidity of gender or contextualize gender as a social construct, which perpetuates the gendered stereotypes of the past. Much like other individuals, men are subjected to notions garnered at home, in school, in mainstream media, and through social media about the behaviors that a man must exhibit in

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the context of life, love, career, and relationships, and many men feel the pressure to live a stereotyped life. Gendered stereotyped behavior often occurs as a result of succumbing to an external set of messages and, thus, an external locus of control that dictates the assumed, stereotyped behaviors that men should exhibit. These external forces have been socialized on men, and in turn, men have actively participated in these socialization processes. Overall, external locus of control and gendered stereotyped behaviors are restrictive toward other important social constructs such as gender presentation, gender role, gender identity, nurturing, kindness, love, and intimate relationships with both men and women; as such, they  present myriad challenges for the clinical practitioner.

Socialization of Men The study of the socialization of men has consistently focused on the deficits that men face and those that are created by men. Until recently, what had been lacking regarding the socialization of men was discourse focused on the strengths, resiliency, and positive traits of men, manhood, and masculinity. Within the current scholarly discourse, discussion regarding the positive aspects of manhood that can lead to expanded interventions is needed. Current understanding of the socialization of men is focused on Western normative ways of being that highlight power dynamics, violence against others, detached parenting, limited psychosocial development, and gendered behaviors toward those seen as inferior. However, this perspective fails to acknowledge the strength, resources, and resiliency of men. Thus, comprehension of the socialization of men requires a shift from a focus on deficits, pathology, and Western socialization to the strengths of men and an exploration of the impact of societal norming on men. Engagement in such a pursuit would serve to counteract the negative perspectives attributed to men and reframe the gender scripts that are interconnected with professional discourse on the socialization of men and the overall impact of this socialization on the gendered stereotypical behaviors attributed to men.

Restrictive Gender Scripts An understanding of masculinity provides a context with which to frame therapeutic interventions and at the same time combat the gendered stereotypes perpetrated on men and those that men perpetrate on others. An outgrowth of masculine language, thought, and behavior is the internalization of social expectations of gender, gender roles, and, subsequently, the gender scripts that are enacted by men. Gender scripts are born out of cultural norms that guide men in navigating emotions, thought processes, and behaviors. For some, the overarching gender script plays out as a stereotype, as there is adherence to norms that engender stereotypical behaviors from men. One gender script frames the emergent development of manhood as a social event born of learned behaviors and rituals and the development into womanhood as representative of a set of biological factors and events that are simultaneously seen as a weakness in the personhood of men. The events that highlight the emergent gender scripts for men are grounded in perceived behaviors and actions that a man must encounter, which simultaneously serve to perpetuate gendered behaviors. For example, one gender script that a man might experience is one of emotional stoicism; a perceived gender script for a woman would present as the opposite, whereby she is expected and encouraged to present a range of emotions in her personhood when compared with men. To this end, another script would have a man emphasizing his role as a fearless and aggressive individual, juxtaposed with a woman who would be expected to present a script of vulnerability. The reality is that the gender script for men is often representative of stereotyped behaviors that have been socialized into the individual’s way of being. Aggression in men is a socialized expression of anger, which is perceived as masculine and healthy. From a young age, most men have been socialized to express their anger externally through physical enactments such as fist fighting, pushing, or yelling. In our society, men are encouraged to express strength in their emotions, which means that many emotions such as hurt, sadness, and fear are not acceptable. Anger then becomes the emotion that  is deemed acceptable for men to express

Gendered Stereotyped Behaviors in Men

consistently and publicly. Such socialization translates into men overrelying on anger as their primary emotional expression, and into aggression, both physical and passive, manifesting more ­frequently in men. The toll of anger and aggression on men is evident. In the United States, 90% of all murders are committed by men. The national statistics regarding intimate partner violence are more comparable, with 1 in 3 women and 1 in 4 men having experienced violence from a partner. Male-based stereotypes about power and control can preclude male abuse victims from disclosing the abuse and seeking help.

Gender Roles Emergent gender roles for men are also said to evolve as a result of the external standards and expectations of others. This leads to the assumption that men may experience gender role conflict due to the struggle to conform to masculine roles that are defined by others, restrict emotionality, and deny any genuine expression of emotion. This occurs while at the same time anticipating the promotion of independent thinking, values, and norms of the expected behaviors and mannerisms of men. Stereotyped behaviors connected to gender roles may manifest in the form of seeking emotional control over intimate situations, placing careerrelated accomplishments as the benchmark for personal success, and seeking to exhibit power, control, objectification, and domination over women and other men as a means of evidencing success, power, and control. Conversely, male objectification is present in the media, with the ideal male body being presented as muscular, tall, and athletic. Men are socialized to envision a superhero physique as the ideal male body. Such an emphasis on muscularity correlates to increased risk for steroid use, experiences of body shaming, lower self-esteem, and anxiety. The pressure on men regarding their physicality can be further complicated by societal pressures to be silent and not verbalize any sign of potential ­weakness. Physicality, as a stereotyped behavior for men, is also present in recreational and sexual domains. For recreation, men are socialized and expected to participate in or be interested in physically dominating and aggressive

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sports and ­recreational pursuits. As sexual beings, men are consistently presented and perceived by society to be myopically focused on sex and their own sexual pleasure. Men are expected to follow gender scripts about sexual behaviors such as frequency, dominance of role, and number of sexual partners.

Sexuality Gendered stereotyped behaviors involving male sexuality find men engaging in high-risk behaviors as a result of external messages that have been internalized. The stereotyped behaviors of men may in part be due to the effects of patriarchal sexism. For the clinical practitioner, there is an inherent challenge to dismantle a gendered system of dominance and oppression that has been in existence for centuries. Stereotypical high-risk behaviors can include multiple sex partners and unprotected sex, coupled with an overarching quest to engage in marginalizing and othering behavior toward women and other men. In this context, intimate relationships are reduced to mere conquests, and the dignity and self-worth of women and other men are not affirmed. Some specific sexual stereotypes affecting men’s behavior include having more sexual fantasies than women, being more sexually aggressive, needing more sexual variety, and interacting with others in an impersonal manner. These sex-­ oriented stereotypes influence the relationships between men and their partners because they create impediments to developing healthy attachments and nurturing relationships. Men can also be perceived as less than and inadequate if they actively enact behaviors inconsistent with sexual stereotypes. When a man is focused on emotional intimacy, passive in a sexual encounter, or pursuing commitment and intimacy, others may perceive him as weak or insecure. The sexual ­stereotypes of male behavior also tend to be heteronormative in that they exist in a binary framework of intersecting stereotypes between men and women. Given that many men are gender nonconforming or attracted to other men or women who are not enacting stereotypical gender scripts, the stereotypes for men and their sexuality are restrictive and damaging.

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Identities of Men Attention to the multiple and intersecting identities of men and an understanding of how socialization has a significant impact on the perception of gender roles and lived experiences are needed. The convergence of identities and the lack of attention toward them has led to a fragmented dialogue attempting to focus on how best to contextualize the provision of therapeutic help to men. Gendered stereotyped behaviors manifest in the societal, cultural, contextual, and ecological norms, and these behaviors are inherent to the deficit socialization of men, providing a narrative that eschews vulnerability, femininity, intimacy, and affection at the expense of rational logical thought and physicality of behavior. What is left unattended is the disconnect to the multiple identities that men hold. These identities include the roles of father, brother, son, lover, intimate partner, and friend. While this list of identities is not exhaustive, it provides a context for the many identities that intersect in the lives of  men. In addition, it represents a series of starting points or avenues to be utilized to confront and  address the gendered stereotyped behaviors of men. Linwood G. Vereen See also Gender Role Conflict; Gender Role Socialization; Gender Socialization in Men; Hegemonic Masculinity; Help-Seeking Behaviors and Men; Power-Control and Gender; Sexuality and Men

Further Readings Englar-Carlson, M., & Kiselica, M. S. (2013). Affirming the strengths in men: A positive masculinity approach to assisting male clients. Journal of Counseling and Development, 91, 399–409. doi:10.1002/j.1556-6676 .2013.00111.x Kimmel, M. S. (2013). The gendered society (5th ed.). New York, NY: Oxford University Press. Kiselica, M. S. (2011). Promoting positive masculinity while addressing gender role conflicts: A balanced theoretical approach to clinical work with boys and men. In C. Blazina & D. Shen-Miller (Eds.), An international psychology of men: Theoretical advances, case studies, and clinical innovations (pp 127–156). New York, NY: Routledge.

Gendered Stereotyped Behaviors  in Women Most definitions of stereotypes link stereotyping to more general cognitive structures, or schemas, that help organize concepts and information. Some further link the stereotypes to consensus in a culture or group about the nature of the stereotypes. ­Stereotypes describe characteristics presumed to be common in a social group, such as traits, occupational choices, activity preferences, or role relationships. Gender stereotyping may be different from other stereotypes based on social categories such as race, ethnicity, religion, or sexuality, in that gender for women may be associated with privilege in ways that membership in other social categories may not. Gender stereotyping may intersect with sexism, or biased attitudes based on gender, in that sexism may be based on stereotypical conceptions of women’s behaviors.

Origins of Stereotyping The origins of stereotyping have been argued to be in the role relationships that are present in a ­culture or society. If, for example, women are generally in subordinate roles with primary responsibility for child care, traits that are associated with such behaviors are then assigned to or associated with women. Stereotypical traits that are viewed as compatible with child care, relationship maintenance, and being subordinate are sometimes called expressive traits. Associated with this division of labor would also be the expectation that women would conform to the roles and their associated characteristics. The perpetuation of stereotyping is also explained based on the general cognitive functions that help humans process information efficiently and automatically. Much research has demonstrated a general tendency for biased information processing based on gender and gender stereotypes. Measures of implicit bias have been used to show that individuals may more quickly and ­efficiently process information that is stereotype consistent and that these cognitive biases are correlated with biased behaviors.

Gendered Stereotyped Behaviors in Women

The following is an example. There are many occupations that remain highly gender segregated, such as nursing (predominantly female) or computer science (predominantly male). An explanation for these types of occupational outcomes based on gender stereotyping would be that women might be drawn to nursing and avoid computer science because nursing is compatible with the types of caring behaviors traditionally associated with women and because of negative social pressures, whether explicit or subtle, when a maledominated occupational choice is mentioned. These associations of women with nursing and men with computer science would further occur automatically and potentially not be questioned. An alternative view of stereotyping, and a longstanding controversy in the field, is the claim that stereotypes exist because individuals accurately observe behaviors and how they are associated with gender. Just as one learns that there are different categories of fruits, and different characteristics of fruits by category, so one also learns the same about gender. There have been some attempts to assess this issue quantitatively, either through examining gender differences across many domains or through relationships between specific stereotypes and corresponding behaviors. Cross-cultural research has also been employed to address the question, and in addition to basic comparisons of women’s characteristics across differing cultures, there has been research that has tried to correlate various indices of gender equity (e.g., income, education, child care access) in a culture with women’s characteristics. There are many problems with the “stereotypes are true” approach. First, role theorists would argue that until the role relationships in a culture change significantly, women will be expected to maintain stereotype-consistent behaviors. Second, much of the data on behavior are self-reports of behavior, and there may be expectations or rolerelated constraints on women that lead to selfreports of stereotypical characteristics. Third, interpretations of behaviors or characteristics may be affected by the stereotypes themselves. Women may respond assertively in dealing with a child care crisis, but that behavior may not be viewed or  labeled as “assertive” because the context is stereotypically feminine. Finally, there are not

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many behaviors in which there are large gender differences, so to claim that a stereotype is true when there is a large overlap between women and men in the behavior is debatable. In part because “women” is a very broad category, and also because women are always members of other social categories that vary in status and privilege, there is also work that examines subgroups of women’s stereotypes. One area that has received a lot of attention is based in sexuality. Descriptive components of gender stereotypes include beliefs about the features that women possess, while prescriptive aspects include beliefs about the features that women should possess. In the context of women’s sexuality, both components of gender stereotypes often lead to discrimination. For example, from a descriptive p ­erspective, a female job candidate might be bypassed for a trial attorney position because she is identified as having gender stereotypic qualities (e.g., compliant and soft-spoken), regardless of her actual interpersonal style, and because being an attorney is thought to require stereotypically masculine qualities. From a prescriptive component, a woman who rejects a male CEO’s advances may be sexually harassed. An even more relevant example was highlighted in the media in 2016, when a presidential candidate made demoralizing characterizations about a news correspondent, a White woman, during a debate. The candidate demeaned the woman during and after the debate, making derogatory comments including references to menstruation. Furthermore, he persistently belittled her intelligence and character publicly. Although minimal distinctions exist between the aforementioned gender stereotype components, there are legal implications for both regarding gender stereotypes and sex discrimination cases that might involve sexual harassment.

Intersectionality Another area receiving increasing attention is intersectionality. The literature describes intersectionality as the mutually constitutive relations among social identities. To situate gender-based stereotyped behaviors, it is essential to consider the context of our social identities that might also be entrenched within such behaviors. Examining

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gendered stereotyped behaviors from that lens allows individuals to begin to connect aspects of power and privilege to certain stereotyped behaviors. Women who belong to more than one group that may be unrepresented or discriminated against can be stereotyped differently than the general category of women. An example would be Black women, who are stereotyped even more negatively than the negative elements of the generic category of women. For example, a group of Black women riding the wine train in Napa in 2015 were essentially thrown off the train for being intoxicated, too loud, and disturbing “other” passengers. These women were likely not the only passengers enjoying themselves on the wine train, however; they were penalized for riding and drinking wine while being Black. In addition, attitudes and behaviors about the sexuality of Black women and other women of color appear to be endorsed by a society that continues to support stereotypes about race and sexuality. The media (film/television/news), which is profoundly owned and produced by majority culture, is replete with examples of the race/ethnicity and sexuality stereotypes. The innocent, good, virginal girl remains the idealized vision of womanhood aligned with White females, but not affiliated with Black or other women of color. Often, women of color are identified in media outlets as sexually promiscuous, amoral, and exotic. These women of color might also be characterized in some instances as asexual matriarchs who are incapable of obtaining adequate employment or stable relationships. When multiple identities are involved, the situation becomes even more complex. Researchers have been called to conduct social justice research that considers intersectionality and examines the intersection of race and gender microaggressions. Further examination of race and gender-based ­ stereotypes would also provide insight into the lives of women of color, which might address their well-being and mental health functioning. Julii M. Green and Margaret L. Signorella See also Exoticization of Women of Color; Feminism: Overview; Gender Bias in Hiring Practices; Gender Role Behavior; Gender Role Conflict; Hegemonic Masculinity; Intersectional Identities; Power-Control and Gender; Race and Gender; Women of Color and Discrimination; Women’s Issues: Overview

Further Readings Bigler, R. S., & Liben, L. S. (2007). Developmental intergroup theory: Explaining and reducing children’s social stereotyping and prejudice. Current Directions in Psychological Science, 16, 162–166. Collins, P. H. (2004). Black sexual politics: African Americans gender and the new racism. New York, NY: Routledge. Eagly, A. H. (1987). Sex differences in social behavior: A social-role interpretation. Hillsdale, NJ: Lawrence Erlbaum. French, B. (2013). More than Jezebels and freaks: Exploring how Black girls navigate sexual coercion and sexual scripts. Journal of African American Studies, 17, 35–50. doi:10.1007/s12111-012-9218-1 Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., & Banaji, M. R. (2009). Understanding and using Implicit Association Test: III. Meta-analysis of predictive validity. Journal of Personality and Social Psychology, 97, 17–41. doi:10.1037/a0015575 Lewis, J. A., Mendenhall, R., Harwood, S. A., & Browne Huntt, M. (2013). Coping with gendered racial microaggressions among Black women college students. Journal of African American Studies, 17, 51–73. doi:10.1007/s12111-012-9219-0 Shields, S. (2008). Gender: An intersectionality perspective. Sex Roles, 59, 301–311. doi:10.1007/s11199-0089501-8 Stephens, D. P., & Phillips, L. D. (2003). Freaks, gold diggers, divas, and dykes: The sociohistorical development of African American women’s sexual scripts. Sexuality & Culture, 7, 3–49. doi:10.1007/ BF03159848 Zell, E., Krizan, Z., & Teeter, S. R. (2015). Evaluating gender similarities and differences using metasynthesis. American Psychologist, 70, 10–20. doi:10.1037/a0038208

Genderqueer Genderqueer is a term that began to circulate within sexual and gender minority communities in the late 1990s and encompasses nonbinary gender expressions and identities. While gender is commonly conceptualized as feminine or masculine, with binary identities of women and men, genderqueer individuals defy and reconstruct these notions of gender and generate nonbinary gender identities and gender expressions. Being an

Genderqueer

umbrella term, genderqueer can take on different meanings for different individuals. For some people, genderqueer means having a shifting gender— sometimes being more aligned with femininity, other times with masculinity. Other individuals may experience their gender as some combination of the more traditional notions of what it means to be a woman or a man, as somewhere on a spectrum between these identities, or as completely outside this spectrum. Some genderqueer individuals also may identify with the term transgender; however, this is not the case for everyone who identifies as genderqueer. In addition, some genderqueer individuals may choose to undergo gender affirming health care, such as hormone replacement therapy or surgical procedures (e.g., chest reconstruction surgery or “top surgery”). In terms of pronouns used by genderqueer individuals, some people may choose to go by gender neutral terms, such as the singular they, or other pronouns, such as ze or hir. Also, while some people use the term genderqueer as a description of their gender expression (e.g., “I am a genderqueer woman”), others use it as their gender identity (e.g., “I am a genderqueer person”). In contrast to genderqueer people, the term cisgender refers to people whose gender identity corresponds with what is typically socially associated with their sex assigned at birth (i.e., someone who is female assigned at birth and identifies as a woman or someone who is male assigned at birth and identifies as a man). The remainder of this entry focuses on research pertaining to genderqueer identities. Research has shown that genderqueer identities may be more common in individuals who were female assigned at birth, likely because people who are male assigned at birth tend to be subjected to a stronger enforcement of gender norms. Genderqueer also is more commonly used by younger generations and has traditionally been viewed as a term more endorsed by White individuals as compared with racial or ethnic minority communities, although identification in these communities has been progressively changing over time. Historically, this term tended to be associated with education, being more common within college settings and among university-based feminists and gender theorists. However, with the greater visibility of gender nonconforming individuals in popular

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media and the spread of information via the Internet, genderqueer identities have become more common in a diverse set of communities. All in all, genderqueer has a wide variety of definitions, and there are myriad ways in which gender is experienced and expressed by individuals who hold this identity. Research has shown that genderqueer individuals experience an awareness of their gender as not being aligned with the gender typically associated with their sex assigned at birth at around the same age as transgender men and women, which typically happens early in life and often before the teenage years. Even though many individuals report an awareness of difference in their gender from early on, claiming a genderqueer identity can be complicated for several reasons. Many people report not having the language to describe their experience early on in life, especially given the framing and reinforcement of binary gender roles in society and the lack of education about nonbinary identities or role models for children. With the social changes in genderqueer visibility and availability of information, however, people are better able to gain exposure to different meanings of gender and learn about various identities. This increased access to information and resources can help them begin to question the societal pressures that have promoted conforming to binary identities. Through this process, people are able to come to an examined understanding of their gender, potentially adopting a genderqueer identity if it suits their experiences. Academic writing on the topic of genderqueer identities and experiences has been extremely limited, even though this identity has become increasingly common within transgender and gender nonconforming circles. This is likely due to the greater research emphasis on transgender men and transgender women, which accompanied research on the diagnosis of gender identity disorder, which the American Psychiatric Association dropped in 2013 from its fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in place of the new diagnosis of gender dysphoria. The latter diagnostic category was developed to position the disorder in response to the emotional distress associated with dysphoria, rather than gender identity. Although there is a great deal of debate about these diagnoses, it is possible that the changes in

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terminology and definitions will be associated with  greater research on nonbinary identified individuals. In much of life, gender operates in binary systems (e.g., when selecting clothing, bathrooms, or identification categories on forms), oftentimes leaving little room for the experiences of genderqueer individuals, who experience themselves somewhere between or outside these binaries. As a result, genderqueer individuals may feel invalidated as they frequently have their identities called into question. For instance, they may be challenged when using a bathroom that is designated for men or women only. Or they may be questioned when needing to produce identification, such as a driver’s license, that may list their sex in a way that does not match people’s gender expectations. Also, they might face social isolation due to the discomfort of others and the stigma of being differently gendered. These social norms may act to delegitimize their identities, generating routine additional stress. These experiences are often referred to as minority stressors, which are daily stressors that minority groups carry—in this case, genderqueer people when compared with cisgender people. Systems that only validate the experiences of cisgender individuals also are at play in research. Many studies do not include genderqueer as an option for how participants can describe their gender. Also, because of the overlap in genderqueer and transgender identities, genderqueer experiences may be researched within the growing body of studies on transgender experiences, but this practice results in minimal knowledge at this point about the specific experiences of genderqueer individuals. What is known thus far in the research literature is that genderqueer individuals experience similar forms of marginalization and stigma as other transgender individuals, such as harassment, victimization, and rejection by others. In the face of this stigma, elevated rates of mental health concerns, such as depression and anxiety, are seen in genderqueer populations. In addition, many people who are genderqueer report feeling that the lack of mainstream awareness or societal understanding of nonbinary identities oftentimes can leave them feeling isolated and distant from others. This often includes being placed in situations in which genderqueer individuals need to explain

their identity to others since it is not a commonly understood identity. Social marginalization can also happen both outside and inside the LGBTQ (lesbian, gay, bisexual, transgender, and queer) community. As a whole, the field of research on genderqueer identities is in the very early stages of development. Researchers have yet to gain a full understanding of the lived experience of being genderqueer, including the ways in which gender is experienced, the ways in which binary societal gender norms influence this identity development, or the ways in which gender may change over time. In addition, more research is needed about the social marginalization experienced by genderqueer individuals, the toll that this has on mental health and wellbeing, as well as how genderqueer individuals cope with those experiences. Last, genderqueer people report great resilience in being able to actualize and affirm their sense of self in the face of the strongly held social norms about gender. Research that investigates not only the social marginalization but also the positive and resilient aspects of genderqueer individuals’ experiences is much needed. Jae A. Puckett and Heidi M. Levitt See also Androgyny; Anti-Trans Bias in the DSM; Bi-Gender; Gender Fluidity; Gender Nonconforming People; Gender Nonconformity and Transgender Issues: Overview; Trans*; Transgender People; Two-Spirited People

Further Readings Beemyn, G., & Rankin, S. (2011). The lives of transgender people. New York, NY: Columbia University Press. Budge, S. L., Rossman, H. K., & Howard, K. S. (2014). Coping and psychological distress among genderqueer individuals: The moderating effect of social support. Journal of LGBT Issues in Counseling, 8(1), 95–117. Erickson-Schroth, L. (2014). Trans bodies, trans selves: A resource for the transgender community. New York, NY: Oxford University Press. Factor, R., & Rothblum, E. (2008). Exploring gender identity and community among three groups of transgender individuals in the United States: MTSs, FTMs, and genderqueers. Health Sociology Review, 17(3), 235–253.

Gilligan’s Moral Development Theory Kuper, L. E., Nussbaum, R., & Mustanski, B. (2012). Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. Journal of Sex Research, 49(2–3), 244–254. Levitt, H. M., & Ippolito, M. R. (2014). Being transgender: Navigating minority stressors and developing authentic self-presentation. Psychology of Women Quarterly, 38(1), 46–64. Naz, D. (2014). Genderqueer: And other gender identities. Los Angeles, CA: Rare Bird Books. Nestle, J., Howell, C., & Wilchins, R. A. (2002). Genderqueer: Voices from beyond the sexual binary. Los Angeles, CA: Alyson Books.

Gilligan’s Moral Development Theory Moral development refers to a person’s developing understanding of the rights and responsibilities between themselves and others. Carol Gilligan is a research psychologist who proposed that instead of only one orientation for solving moral conflicts, there are actually two perspectives that people have used: (1) a justice orientation and (2) a care orientation. In this entry, Gilligan’s background is presented first, followed by that of her mentor, Lawrence Kohlberg. Next, Gilligan’s care orientation moral development theory is defined and contrasted with Kohlberg’s justice orientation moral development theory. The entry concludes with a brief discussion of Gilligan’s model and gender socialization.

Gilligan’s Background Gilligan was born in New York City on November 28, 1936. She attended Swarthmore College, where she focused on literature and graduated summa cum laude in 1958. She then attended Radcliffe University, where she received a master’s degree in clinical psychology in 1960. Gilligan conducted her doctoral work at Harvard University in social psychology, graduating in 1964. She began teaching at Harvard with the famed psychologist Erik Erikson in 1967. By 1970, she had become a research assistant for Kohlberg. Kohlberg is known  for his research on moral development,

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particularly his stage theory of moral development, justice, and rights. However, Gilligan’s primary focus became the moral development of girls and women. Her interest in these dilemmas grew as she interviewed young women who were contemplating abortions; these women were speaking in what Gilligan called a “different” voice about moral conflict and choice than what Kohlberg had described as findings from interviews with men.

Kohlberg’s Background Kohlberg was also born in New York City, on October 25, 1927. He attended the University of Chicago after serving in the merchant marines during World War II. He graduated with a bachelor’s degree in psychology after only 1 year. Kohlberg stayed on at the University of Chicago and wrote his dissertation in 1958. In 1968, he joined the faculty of Harvard University in social psychology. It was there that he worked with Gilligan, who became his research assistant and one of the most vocal critics of his theory. Kohlberg is well known for developing the most widely used method for interviewing people about their moral reasoning. For his dissertation work, he created a hypothetical dilemma focused on “Heinz and the drug,” which he used to ascertain the moral reasoning of 72 White boys of ages 7 to 17 years.

Issues in Moral Development Theory One major issue in social psychology has been whether moral agents reason about moral dilemmas from a justice or a care moral orientation. In addition, a related issue is whether researchers should use a hypothetical or a real-life moral dilemma in research experiments when exploring moral reasoning. For example, the Heinz hypothetical dilemma, made famous by Kohlberg and used by many social psychology researchers, focused on a woman who was deathly ill from a certain form of cancer. The only thing that might save her—according to the doctors—was a radium drug that a pharmacist in her town had discovered. However, the pharmacist raised the price of the drug to 10 times what it cost to make. Heinz, the woman’s husband, could raise only about $1,000 of the $2,000 that was necessary for a small dose. The pharmacist refused to sell the drug to Heinz at

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a lower price, so Heinz thought about stealing it. The question was, should Heinz steal the drug? Kohlberg not just examined whether the interviewees said that Heinz should steal the drug, but he also focused on their moral reasoning, or on how they had arrived at their answer. Fascinated by Jean Piaget’s work in cognitive development, Kohlberg discovered that the boys’ answers fell into what he termed preconventional, conventional, and postconventional levels of moral thinking. For example, those who were the least morally mature based their reasoning on rules put in place by authority figures (e.g., preconventional thinkers think, “It is not right to steal”). More mature reasoners focused on what was acceptable socially (i.e., social conventions), while those who had the most moral maturity also took into consideration the welfare of others. Based on these interviews, Kohlberg developed a moral reasoning model containing six stages (one was later dropped) and three levels. However, Gilligan critiqued Kohlberg’s model on the grounds that he interviewed only boys (as well as only White people). Furthermore, Gilligan’s impact on moral development theory lay in her resolve to highlight the different ways in which girls and women (vs. boys and men) viewed moral conflict and choice. Her original research included interviews across the life span of three groups of women and men: (1) females and males matched at nine age points (ages 6–9, 11, 15, 19, 22, 25–27, 35, 45, and 60 years) and also on intellectual, educational, and socioeconomic levels, (2) 29 women between the ages of 15 and 33 years who decided either to terminate a pregnancy or not, and (3) female and male college students. In each study, Gilligan explored the participants’ descriptions of their own morality as well as “ideal” (e.g., hypothetical) morality. Particular to Gilligan’s work was a focus on the participants’ explorations of their own moral dilemmas rather than the hypothetical, disengaged Heinz dilemma used in Kohlberg’s previous research. In Kohlberg’s interviews using hypothetical dilemmas, deontic judgments were examined; these are judgments about right and wrong, regardless of context, and are based on abstract rules or principles. In contrast, Gilligan used real-life dilemmas to investigate responsibility judgments—those judgments that occur when a person faces an actual, lived moral dilemma and judges what to do

based on how much the person is responsible for the moral decision. Gilligan and colleagues’ interviews started by telling the participants that everybody has had to make a decision when they were not sure what they should do, and then asking them to describe a situation that they had faced in which they experienced a moral conflict and had to make a decision about it. The participants were asked to describe the situation in detail, what the conflict was and why it was a conflict, what they considered before they took action, what action they took, what happened, whether or not it was the “right” thing to do, what was at stake for themselves and others in the conflict, what they had learned from going through this process, and what morality meant to them. Results from Gilligan’s interviews with women demonstrated that the women embodied a “different voice” about moral concerns and what was ultimately morally important to them. For example, this type of moral reasoning was based on wrestling with personal life experiences such as whether or not to terminate a pregnancy. It appeared to Gilligan, that women and girls interpreted moral life as cycling between experiences of attachment and separation, commitment and connection, and as  self-referenced. For these women, “self-in-­ relationship” versus “self-versus-other-selves” served as their progressive understanding of sociomoral reality. In 1982, Gilligan named this moral orientation an ethic of care or care orientation. Gilligan suggested that those using a care orientation appear to experience moral conflict as a conflict in the developing understanding of the rights and responsibilities between self and other. A care orientation requires a type of reasoning that is contextual and narrative rather than abstract and hypothetical. Furthermore, a person with a care orientation as their major moral orientation define moral development not as a response to competing rights and responsibilities, as in Kohlberg’s model, but as responsibility in relationship. In other words, Gilligan posited that care reasoners like to know the particulars of a hypothetical story or dilemma in order to resolve it, rather than pulling back and applying abstract principles to every moral conflict. As Marilyn Friedman as well as Leslee A. Fisher noted, for care reasoners (a) the major moral imperative is not hurting others and avoiding

Government and Gender

selfishness, (b) the concept of duty is expanded to include interpersonal interaction and commitment, (c) the motivating force is reciprocity of response and inclusion of all persons, and (d) the underlying assumption is that all human experiences are interconnected. Female identity development also appears to be inextricably linked to some women’s moral care orientation and, as a result, to some women’s experience of moral development. In comparison, justice reasoners appear to arrive at moral judgments through noncontextual, abstracted, universalized rules and a weighting of competing rights based on principles. For justice reasoners, (a)  the major moral imperative is respect for the rights of others, (b) the concept of duty is limited to reciprocal noninterference, (c) the motivating force is the equal worth of self and other, and (d) the underlying assumption is that persons are highly individuated from one another. Male identity development also appears to be inextricably linked to some men’s justice moral orientation and, as a result, to some men’s experience of moral development.

Gilligan’s Model and Gender Socialization As Fisher noted, one of the great strengths of Gilligan’s model is that it explored the intertwined U.S. moral concepts of femininity, goodness, and interconnectedness and related these to U.S. women’s self-identity development and socialization. In the same way, Gilligan explored the intertwining of U.S. moral concepts such as masculinity, fairness, and noninterference and related these to U.S. men’s self-identity development and socialization. Therefore, Gilligan’s model highlighted the fact that moral development in the United States is situated within a patriarchal and gendered culture and that the genders are moralized in distinct ways. Gilligan’s foundational research and model also led the way for researchers to examine how moral development and moral reasoning are profoundly related to the ways people see themselves; moral identity and gender identity development are dynamically and actively constructed as a result of how people see their social world via role and structural divisions, cultural gender stereotypes, and socialization processes. To be sure, Gilligan’s work pointed out the ways in which (mainly) women’s and girls’ moral and “self” voice (or lack

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thereof) are greatly affected by both constrictions and constructions of cultural femininity. Gilligan’s theory is at base, therefore, a feminist theory. Leslee A. Fisher See also Cognitive Theories of Gender Development; Feminism: Overview; Feminist Identity Development Model; Feminist Psychology; Feminist Therapy; Gender Role Conflict; Gender Role Socialization; Kohlberg’s Stages of Moral Development

Further Readings Brown, L., Argyris, D., Attanucci, J., Bardige, B., Gilligan, C., Johnston, K., . . . Wilcox, D. (1988). A guide to reading narratives of conflict and choice for self and moral voice. Cambridge, MA: Harvard University, Graduate School of Education, Center for the Study of Gender, Education, and Human Development. Fisher, L. A. (2016). “Where are your women?” The challenge to care in the future of sport. Sex Roles, 74(7), 377–387. doi:10.1007/s11199-014-0399-z Friedman, M. (1987). Beyond caring: The de-moralization of gender. In M. Hanen & K. Nielsen (Eds.), Science, morality and feminist theory (pp. 87–110). Calgary, Alberta, Canada: University of Calgary Press. Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press. Haan, N. (1978). Two moralities in actin contexts: Relationships to thought, ego regulation, and development. Journal of Personality and Social Psychology, 36, 286–305. doi:10.1037/0022-3514 .36.3.286

Glass Ceiling See Women and Leadership; Women in Corporate Positions, Experiences of; Workplace Sexual Harassment

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Since the 20th century, the economic policies pursued by governments globally have failed to sustain development, largely because women, a substantial

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portion of the population, have been marginalized. Although in the early 18th century, governments of independent countries began to acknowledge women’s rights and gender equality, it was not until after World War II ended in 1945 that the political situation in a large number of independent countries across Asia, Africa, and Europe afforded the restoration of human rights. The efforts made by national governments since then to facilitate women’s entry into the workforce by providing equal opportunities for education and work have led to positive economic changes, but those changes have not been sustainable due to a host of factors including health care and poverty. Prevalence of gender role stereotypes, prejudices, and attitudinal barriers perpetuated by socialization, particularly among marginalized ethnic minorities and poor populations, continue to affect governmental policies. In 1979, about 100 nations across the globe ratified the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which advocated measures to address discrimination against women and restore their legal, civil, and human rights. Despite the CEDAW, gender parity and substantive equality have not yet been attained. Hence, to ensure sustainable economic development, governments need to target both gender discrimination and poverty by introducing gender sensitive policies for the marginalized and the poor.

Economic Development and Women Sustainable economic development cannot be imagined without empowering the deprived, poor, insecure, and socially marginalized groups. The advocacy for upholding human rights, gender equality, and empowerment of these groups, particularly women, has been an important agenda of many countries. The empowerment of women involves securing their human rights and restoring social justice during peace, at times of war, and in disaster-affected zones. Policies aimed at improving women’s conditions in society have been focused primarily on facilitating women’s entry into the workforce by providing equal opportunities for education and work. Since the formulation of the CEDAW, several significant developments aimed at facilitating women’s entry into the workforce have taken

place. For instance, in 1998, Turkey enacted a family protection law to prevent domestic violence; in 1984, Australia enacted the Sex Discrimination Act; and in 2013, India enacted sexual harassment–related legislation. Consequent to CEDAW, there have been positive changes in societies all over the world according women greater constitutional rights to education, health, work, property, and decision making on matters relating to their family. As a result, since the mid-1990s, more women have enrolled in schools and colleges or joined skilled jobs. However, these changes have been neither significant nor sustainable. Hence, today, the education and empowerment of women remain an important economic agenda of many governments. Research focused on gender issues underpinning development has revealed crucial issues related to gender. Important findings were that men and women as groups are not homogeneous and that gender is not simply a biological characteristic but a socially conditioned, complex self-perception (termed gender role identity). It is important for governments to take into consideration the empowerment of all individuals who may be powerless due to their gender role when devising and implementing policies.

Gender Identity Gender is not about being a biological male or a biological female; rather, it is a person’s perception of psychosocial gender characteristics about their own self and their resulting gender role. Socialization in most cultures prompts people to behave in ways stereotypically appropriate to their biological gender and develop a gender identity of masculinity or femininity. In general, males are expected to be aggressive, dominating, secure, and emotionally strong and nonexpressive, whereas women are supposed to be warm, submissive, caring, and tender. Developing a gender role identity appropriate to one’s own gender is a developmental task considered necessary for one’s adjustment in family and society as well as for one’s well-being, though this varies across cultures. In actuality, not all people conform to the pressures and expectations of society regarding their gender, thereby creating mixed gender role identities such as feminine men and masculine women.

Government and Gender

Gendered Competence During the socialization process, women experience discriminatory social practices that prevent them from developing competence in areas considered bastions of men, particularly in traditional cultures. Women have been found to be better than men on reasoning ability with verbal tasks, whereas boys have been found to do better than girls on nonverbal reasoning and spatial reasoning. With regard to mathematical skills, gender differences are nonexistent in junior classes, but at higher levels, boys have excelled in comparison with girls. Probably due to being confined to the home and their centrality to family relationships, women seem to be far better than men with regard to social skills, including sensitivity and empathy; but in direct assertiveness, women do not do so well. The research relating to gender role differences in achievement reveals that women have goals consistent with the prevailing gender role stereotypes (i.e., the areas of achievement they would choose are supposedly feminine). Trends in the socialization of women indicate that differences in ability found among them could be the product of their cultural reality rather than real biological differences. These gender differences in abilities and competence are mediated by women’s cognitive and self-efficacy beliefs, which are brought about by their gendered social environment. In addition to family, the school environment, textbooks, and teachers’ attitudes can c­ onvey a hidden curriculum that reinforces the gender role expectancy. Media of all kinds also reinforce these gender stereotypes. Realizing the influence of gender practices on economies, governments all over the world have taken steps to intervene at various levels to implement gender fair practices in education and employment.

Government Policies and Gender Equality Gender inequality places a burden on the economies of the world. Of the approximately 1.2 billion poor people in the world, women constitute 70%. This population is engaged mostly in agriculture, domestic work, or other informal activities, which is not counted as productive employment and is considered to have a negative effect on development. In countries where the level of education among women is low and women are unemployed

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or employed in low-wage jobs, per capita income and growth rates have decreased. Data collected from about 140 countries on gender equality and its impact on economies reveal that in the United States in 2015, women’s participation in the economy contributed to one quarter of the U.S. gross domestic product (GDP). Other research estimated that a rise in female employment would improve the global economy, increasing the U.S. GDP by 9%, the Eurozone GDP by 13%, and the Japanese GDP by 16% between 2005 and 2015. In developed economies and in the fast-­ developing economies of East Asia and Southeast Asia, the female labor force participation rates were much higher (69.1% and 58.4%, respectively) compared with those of the Middle East and North Africa (17.2% and 21.2%, respectively), as revealed by data on gender gaps in labor force participation during 1992, 2002, and 2012. To many, this finding seems erroneous because many women were unemployed due to lack of opportunities, not on account of their choice. Globally, the rising awareness at the government level about the deterministic role of women in sustainable development has led to the adoption of inclusive policies toward creating educational and employment opportunities for women. The governments in several countries, particularly in developed countries but also in developing countries, have adopted measures to reduce discrimination toward women in the workplace. Awareness has led not only to the opening up of nontraditional careers for women but also to the creation of measures to help increase women’s participation in the workforce, such as child care leave, day care centers, and women’s hostels (which help women from remote areas stay near their jobs). In addition, many of the governments of developing countries in South Asia and sub-Saharan Africa have taken measures to increase women’s education, including the provision of free primary schooling, books, and uniforms and government loans at low rates for higher education. All of the aforementioned measures have led to minor improvements in girls’ education and more women in the workforce, but the effect on productivity and economic growth in developing countries has been marginal. A large number of women remained out of the workforce or were involved in low-wage jobs despite their education being on par

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with that of men. Thus, the goal of sustainable development has remained out of reach. The recognition and acknowledgment of women’s role in economies has generated attention on the factors that prevent women’s full participation in a country’s development. Research has revealed that poverty is both a cause and an outcome of women being kept out of work. In addition to women’s social status rendering them powerless, women do not have decision-making power over economic and reproductive matters. Their social status is linked to the perception of both males and females about their respective gender roles and their gender identity.

Futuristic Policies The convergence of the goals of feminism and economic development have heightened the concerns of governments for social justice for all people. Women’s empowerment is essential to further sustainable development. Poverty affects not only women but all other socially marginalized, poor, and ethnic minorities. Comparative data in the UNESCO World Atlas of Gender Equality, 2012, reveal a correlation between the overall income level of a country and the total years of schooling for its children. In low-income countries, the likelihood of staying in school is much less compared with middle- and high-income countries; in highincome countries such as Australia, Denmark, and Finland, the number of years children are in school is about 17 to 21, whereas in low-income countries in sub-Saharan Africa and South Asia, the school life of children is only about 4 to 7 years. Within these populations of school-going children, schoolgoing girls are much fewer than school-going boys. Although female enrolment is rising, there are still gaps. For example, in the poor countries of subSaharan Africa, of every 100 children in primary education school, 70 are girls. In 1995, the Fourth United Nations’ Beijing Platform for Action, which set forth strategic objectives and actions to be taken by international governments, the community, nongovernmental organizations, and the private sector by the year 2000 to purge the existing obstacles to women’s advancement, revealed that women’s needs for health care and education are dependent on governments’ spending capacity, as families tend to invest in the

health and education of male members rather than of females. The demand for implementing socially just national policies with regard to wage equality, right to education, health, and work for women could be heard even in countries traditionally closed to the idea of women’s participation in education and work. The research focused on the underperformance of government policies revealed that cultural issues and attitudinal barriers in society (e.g., favoring the male child) are responsible for the failure to leverage the development opportunities created for women. These barriers have a foundation in the gender role relationships in different cultures. Social justice for gender role relationships needs to be informed by understanding gender as a byproduct of socialization rather than as biological. Governments need to take into account different gender roles that bestow differential capabilities while devising national policies for empowerment of women and other marginalized groups in order to restore substantive equity and social justice. This paradigm shift in the process of empowerment would enable understanding of gender equality in a broad sense by implementing policies not only for justice to women and girls but also for all genders in the true sense of justice. Daya Pant See also Gender Bias in Education; Gender Bias in Hiring Practices; Gender Socialization in Women; Gender Stereotypes

Further Readings Daly, K. (2007). Gender inequality, growth and global ageing (Goldman Sachs Global Economics Paper No. 154). Retrieved from http://20-first.com/ wp-content/uploads/2007_Goldman-Sachs_Genderinequality-Growth-and-Global-Aging.pdf Eccles, J. S. (1994). Understanding women’s educational and occupational choice. Applying the Eccles et al. model of achievement related choices. Psychology of Women Quarterly, 18, 585–610. Elliot, A. J., & Dweck, C. S. (2005). Handbook of competence and motivation. New York, NY: Guilford Press. Organisation for Economic Co-operation and Development. (2012). Closing the gender gap: Act now. Paris, France: Author.

Grieving and Gender UN Women. (2014). The world survey on the role of women in development 2014: Gender equality and sustainable development. New York, NY: Author. United Nations Educational, Scientific and Cultural Organization. (1995). The Beijing declaration and platform for action: The 2012 world development report on gender equality and development. Retrieved from http://go.worldbank.org/WT702DRPA0 United Nations Educational, Scientific and Cultural Organization. (2012). World atlas of gender equality in education. Paris, France: Author. United Nations Research Institute for Social Development. (2010). Combating poverty and inequality: Structural change, social policy and politics. Geneva, Switzerland: Author. United Nations Research Institute for Social Development. (2012). Inequalities and the post-2015 development agenda (Research and Policy Brief No. 15). Geneva, Switzerland: Author. World Economic Forum. (2015). The global gender gap report 2015. Geneva, Switzerland: Author.

Grieving

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Grieving is the process of adapting to loss. While traditionally grieving is associated with loss resulting from death, in its broadest sense, the loss can encompass being deprived of something that one once possessed and was attached to. This can include physical loss (e.g., losing an object or some aspect of physical functioning), the loss of relationships, or symbolic loss (e.g., the loss of a dream or faith). The act of grieving has been described as having five components: (1) physical reactions, (2) affective reactions, (3) cognitive reactions, (4)  spiritual reactions, and (5) behavioral reactions. The process of grieving is very individualized. People both experience and express grief differently. There are several variables such as the type of loss, the relationship and attachment to the deceased, the circumstances surrounding the loss, the coping abilities of the bereaved individual, and the levels of social support available, all of which can affect the grieving process. One factor that has been studied more recently is the role of gender in the grieving process. It is speculated that because of socialization into gender roles in Western cultures, men and women demonstrate different grieving patterns. Men in general have been

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observed to have more instrumental grieving patterns. This means that they are more likely to focus on the cognitive aspects of grief, with moderate displays of affects. Instrumental grievers tend to focus on solving the problem of grief and often do not want to share feelings. Those who exhibit instrumental grieving patterns have a desire to master their emotions and overcome them. Women are said to follow intuitive grieving patterns. Intuitive grieving patterns are characterized by intense affects, both experienced and expressed; sharing of the grief experience with others, such as loved ones, bereavement groups, or counselors; and “going with” the grieving experience rather than trying to overcome or master it. However, although instrumental grieving is most typically associated with men and intuitive grieving with women, gender is but one factor that can influence the grieving process. It has been noted by grief counselors that in general the grieving process for women tends to take a longer period of time than that for men, but this could be due to the fact that women are more likely to share their emotions and men tend to be less emotionally demonstrative. There are also social expectations that men should be strong and  overcome the loss quickly, while it is more acceptable for women to express sadness and seek comfort from others. Interestingly, despite the ­ potentially differing patterns of grief, there do not appear to be significant differences in outcome for men and women, with both genders having similar consequences. Grief counselors have postulated that genderrelated coping styles put men and women at risk for different types of complications. Men were believed to be at greater risk for complicated grief, whereas women were supposed to be at greater risk of developing depression and chronic mourning. However, these gender differences can also be affected by culture. In certain cultures, both men and women are encouraged to have strong displays of affect, whereas in other ­cultures, displays of affect following loss are discouraged. These types of cultural factors could affect the expression and consequences for both genders. The research literature suggests that women and men may also differ in the grieving process depending on the type of loss experienced, such as the loss of a spouse, the loss of a child, or the loss

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of a parent. There has been considerable research suggesting that the experience of spousal loss differs significantly for women and for men. Historically, this has been because the roles of married men and women differed in Western culture, with the men providing financial support and the women caring for the family. Thus, it is unclear how, if at all, the changing roles for both women and men within the context of marriage affect the grieving process. Widows report that the grieving process is compounded by feelings of anxiety related to financial instability and management of the household affairs and finances. Widowers report a need to be realistic about the loss and were more likely than females to return to work, begin dating, and remarry. Similar male/female grieving distinctions have been found on the loss of a child, with mothers reporting more significant and intense grief than fathers. Once again, women were more likely than men to share their grief with others and seek outside support, whereas men were more likely to intellectualize their grief, seek solace in work, and suppress their affect. These differential grieving styles were often found to lead to marital strain. Finally, several studies have examined the role of gender in grieving for children who have lost a parent. The few studies that have examined this issue reported that girls were more likely to exhibit symptoms of anxiety and somatic symptoms, whereas boys were more likely to exhibit acting-out behaviors. In addition, girls were found to idealize

the deceased parent more than boys, and girls were more sensitive to changes in the family structure than boys. Similar patterns were found for adult children who lost parents, with women expressing more emotion and men demonstrating more reserve. Overall, it appears that based on socialization, women are more likely to express the affective aspects of grief and seek support from others, whereas men are more likely to suppress affective reactions and keep their feelings to themselves. However, it appears that outcomes for both men and women are similar despite the dissimilar grieving patterns. Elizabeth L. Jeglic See also Cross-Cultural Differences in Gender; Depression and Gender; Gender Expression; Gender Role Socialization; Women’s Friendships

Further Readings Lawrence, E., Jeglic, E. L. Matthews, L. T., & Pepper, C. M. (2005). Gender difference in grief reactions following the death of a parent. OMEGA: Journal of Death and Dying, 52(4), 323–337. doi:10.2190/ 55WN-1VUF-TQ3W-GD53 Martin, T. L., & Doka, K. J. (2000). Men don’t cry . . . women do. Philadelphia, PA: Brunner/Mazel. Stroebe, M. S. (1998). New directions in bereavement research: Exploration of gender differences. Palliative Medicine, 12(1), 5–12. doi:10.1191/ 026921698668142811

H expression are not congruent with the gender assigned to them at birth. Although there is substantial within-group variability in the experiences of LGBTQ people, they are each marginalized by societal heterosexism. Heterosexism is a system of oppression that devalues, renders invisible, or denigrates nonheterosexual, gender nonconforming attractions, behaviors, people, relationships, and communities. Anti-LGBTQ hate crimes are illegal acts that are committed against people because they are perceived to be LGBTQ, and they are motivated by bias or prejudice against LGBTQ people. Notably, hate crimes can encompass a wide array of criminal behaviors, including intimidation, physical assault, sexual assault, murder, human trafficking, robbery, arson, and destruction of property. In 2009, the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act was signed into law, which allows for sentence enhancements when violent crimes are deemed to be antiLGBTQ hate crimes.

Hate Crimes Toward LGBTQ People The U.S. government recently has enacted several policies or legislation that protect the civil liberties of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the areas of marriage and open participation in the armed forces. Such advances correspond with the increasingly more positive, less prejudiced attitudes toward LGBTQ people among the general public. Nonetheless, research continues to show that LGBTQ people are disproportionately victims of bias-motivated crimes based on their sexual orientation, gender identity, or gender expression. Moreover, scholarship in this area suggests that hate crimes, relative to crimes that are not bias motivated, negatively affect the LGBTQ population in unique ways that warrant attention from researchers, clinicians, legislators, and the general public. The present entry defines and describes anti-LGBTQ hate crimes, with emphasis placed on particularly vulnerable populations within the broader LGBTQ community, the characteristics of hate crime perpetrators, and the negative impact of hate crimes on LGBTQ people.

Prevalence of Anti-LGBTQ Hate Crimes According to the U.S. Federal Bureau of Investigation, there were 7,242 victims of hate crime in 2013. Of this, 1,461 (20.2%) were targeted because of sexual orientation bias and 33 (0.5%) were targeted because of gender identity bias. The majority (60.9%) of sexual orientation–related hate crime victims were gay men, followed by mixed groups composed of LGBTQ people (22.5%), lesbian women (13%), and bisexual women and men (1.8%). Of gender identity–related hate crime

Definitions The terms lesbian, gay, bisexual, and queer all denote minority identity labels that are characterized by acknowledgment of some degree of samesex attraction. On the other hand, transgender refers to people whose gender identity and gender 817

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victims, 75.8% were transgender people, whereas 24.2% were gender nonconforming people. These estimates must be interpreted cautiously for several reasons. First, the U.S. Federal Bureau of Investigation generates these estimates based on data provided by local law enforcement agencies, which may not reliably collect or report data on anti-LGBTQ hate crime allegations. Furthermore, LGBTQ people who are victims of hate crimes may not report such crimes because they anticipate that local law enforcement agencies will not take them seriously or may even harass the victims themselves (discussed later in this entry). Thus, it is important to consult other sources of data. Sabra Katz-Wise and Janet Hyde conducted a metaanalysis of 386 studies encompassing 500,000 participants across 18 countries to generate robust estimates of the prevalence of various forms of victimization experiences, some of which fall under the definition of hate crimes. Results indicated that 55% of LGB people had experienced verbal harassment, 40% had been followed, 37% had been threatened, 28% experienced physical assault, 27% experienced sexual assault, 24% experienced destruction of property, and 19% had been robbed. Moreover, when rates of victimization were compared between LGB and heterosexual people, LGB people reported significantly higher rates of victimization for 14 of the 18 forms of victimization examined. Similarly, one study of more than 400 transgender people found that gender identity or gender expression–motivated crimes were relatively common: 56% of the participants had experienced verbal harassment, 29% had been physically assaulted with or without a weapon, 23% had been followed or stalked, 14% had been robbed, and 14% had experienced complete or attempted sexual assault. These estimates suggest that hate crimes motivated by sexual orientation, gender identity, or gender expression are relatively commonplace occurrences among the overall LGBTQ population. However, there also appears to be substantial within-group variability in the experience of victimization. As noted previously, gay, bisexual, or queer men tend to report hate crimes more often than lesbian, bisexual, or queer women. This is consistent with a well-known trend for heterosexist prejudice to be stronger for male rather than for female LGBQ people. Findings regarding sexual

orientation differences are mixed, however, with some studies finding that bisexual people (and men in particular) report higher rates of victimization than gay or lesbian people whereas other studies find no such difference. With regard to gender expression, cisgender (i.e., nontransgender) LGBQ people with more gender nonconforming appearance or behavior (e.g., feminine gay men, masculine lesbian women) appear to be targets of discrimination and hate crimes at greater rates. This is likely because perpetrators of anti-LGBTQ hate crimes associate gender nonconformity with homosexuality and, thus, gender nonconforming people are more identifiable as LGBTQ, regardless of whether or not they are “out.” Sexual orientation, gender identity, and gender expression also intersect with other dimensions of identity, such as race or ethnicity, to affect the likelihood of experiencing the most violent hate crimes. That is, as reported by the National Coalition for Anti-Violence Programs, 55% of ­victims of anti-LGBTQ or anti-HIV homicides in 2014 were of transgender women of color. Thus, multiple systems of oppression, including heterosexism, sexism, and racism, may work in tandem to make certain populations even more susceptible to bias-motivated crimes. It is also important to note that, according to the National Coalition for Anti-Violence Programs, about 46% of LGBTQ or HIV-affected people who experienced a hate crime in 2014 did not report it to the police and 53% of those who did report to the police were met with hostility or indifference. These findings underscore the fact that many victims of anti-LGBTQ hate crimes have no reliable access to legal recourse, despite the presence of federal legislation designed for just that reason, such as the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act.

Characteristics of Hate Crimes and Their Perpetrators Research suggests that anti-LGBTQ hate crimes are distinct from nonbias crimes in several respects. Perhaps most important, anti-LGBTQ hate crimes are more likely to involve violence, such as murder and physical or sexual assault, and they are more likely to result in physical injury of the victim. Anti-LGBTQ homicides are less likely to involve

Hate Crimes Toward LGBTQ People

the use of firearms, which may indicate that these crimes are less likely to be premeditated. Alternatively, as noted by Jeff Gruenewald, the use of deadly force other than gunshots (e.g., slashing, beating) could be a way of prolonging the victim’s suffering or showing an exceptional degree of disdain for the victim. Anti-LGBTQ hate crimes are also disproportionately performed in public spaces, where spectators may witness the acts taking place. Demographically, the perpetrators of antiLGBTQ hate crimes in the United States tend to be young European American or White men. Coupled with the demographic characteristics of victims, these data are consistent with the idea that heterosexual White men in the United States—who are privileged by society with regard to sexual orientation, race or ethnicity, and gender—may be particularly threatened by people who challenge their standing in the social hierarchy. Furthermore, because anti-LGBTQ hate crimes are more likely to involve ostentatious physical force, to be committed in groups, and to be committed publically, scholars have suggested that the perpetrators may be motivated by a desire to “perform” or prove their hegemonic masculinity to others. One notable difference between anti-LGBQ and anti-transgender hate crimes is that while the former tend to be committed by strangers, the latter show no such pattern. Rather, hate crimes committed against transgender people seem as likely to be committed by strangers as by friends, family, or colleagues. This finding may suggest that antitransgender prejudice is particularly pernicious and likely to overcome the supportive bonds associated with close relationships.

Negative Impact of Anti-LGBTQ Hate Crimes A powerful justification for sentence enhancements for bias-motivated crimes, relative to non-bias-motivated crimes, is that the former exert particularly noxious effects on the victims and survivors. Indeed, Ilan Meyer’s minority stress theory posits that social stressors stemming from societal heterosexism, such as discrimination and hate crime victimization, account for poorer mental and physical health outcomes among the LGBTQ population. A large, growing body of research supports many of the tenets of minority stress theory.

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For example, LGBQ people who experienced heterosexist hate crimes within the past 5 years reported higher levels of depression, posttraumatic stress, and anger and lower levels of positive affect than LGBQ people who had experienced nonbias crimes in the same time period. Moreover, hate crime victimization is associated with negative mental health outcomes among LGBQ people even after accounting for the effects of more commonplace but less severe manifestations of heterosexism, such as general discrimination. Although relatively less research has focused specifically ­ on the relations of anti-transgender hate crimes with mental health, the studies that are available demonstrate the same trends. Nonetheless, more research focused specifically on transgender people and their experience of hate crimes needs to be conducted. Beyond the traditional indicators of mental health, research in this area has also examined the effects of hate crimes on the victims’ worldviews. That is, LGBQ people who experience hate crimes are less likely to believe in the benevolence of the world or other people, less likely to feel a sense of control over their own lives, more likely to fear becoming a victim of crime in the future, and more likely to feel vulnerable to future anti-LGBQ hate crimes. These findings speak to the variety and perniciousness of negative outcomes of hate crime victimization. Moreover, they reinforce the rationale underlying hate crime legislation—that is, that hate crimes are actions that are uniquely toxic to the well-being of LGBTQ people and communities as well as society as a whole.

Help for Survivors Given the noxious consequences of anti-LGBTQ hate crimes, it is imperative that local and federal law enforcement agencies continue to enforce existing legislation that calls for reliable collection of hate crime data and appropriate investigation of hate crime allegations. Furthermore, law enforcement agencies must be trained to deliver affirmative, nondiscriminatory services to survivors of anti-LGBTQ hate crimes who report their victimization. Psychologists with training in diversity and social justice issues would be particularly well suited to consult with law enforcement agencies in order to provide LGBTQ-affirmative training

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designed to improve the experiences of hate crime victims seeking justice. Such consultation may also complement the delivery of mental health services that acknowledge the toxic effects that hate crime victimization continue to have on LGBTQ people and communities. Brandon L. Velez See also Gender-Based Violence; Heterosexism; Physical Assault, Transgender Survivors of; Transgender People and Violence; Transphobia

Further Readings Federal Bureau of Investigation, U.S. Department of Justice. (2014). Hate crime statistics, 2013. Washington, DC: Author. Retrieved from https://www .fbi.gov/about-us/cjis/ucr/hate-crime/2013/resourcepages/about-hate-crime/abouthatecrime_final Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Retrieved from http://www .thetaskforce.org/static_html/downloads/reports/ reports/ntds_full.pdf Gruenewald, J. (2012). Are anti-LGBT homicides in the United States unique? Journal of Interpersonal Violence, 27, 3601–3623. doi:10.1177/0886260 512462301 Herek, G. M., Gillis, J. R., & Cogan, J. C. (1999). Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 67, 945–951. doi:0022-006X/99/S3.00 Katz-Wise, S. L., & Hyde, J. S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. Journal of Sex Research, 49, 142–167. doi:10.1080/00224499.2011.637247 Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2001). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42, 89–101. doi:10.1300/ J082v42n01_05 Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. doi:10.1037/0033-2909.129 .5.674 National Coalition of Anti-Violence Programs. (2015). Lesbian, gay, bisexual, transgender, queer, and

HIV-affected hate violence in 2014. New York, NY: Author. Retrieved from http://www.avp.org/storage/ documents/Reports/2014_HV_Report-Final.pdf Stotzer, R. L. (2014). Bias crimes based on sexual orientation and gender identity: Global prevalence, impacts, and causes. In D. Peterson & V. R. Panfil (Eds.), Handbook of LGBT communities, crime, and justice (pp. 45–64). New York, NY: Springer Science+Business Media. doi:10.1007/978-1-4614– 9188-0_3

Health

at

Every Size

Health at Every Size® (HAES®) is a weight-neutral or non-weight-centered approach to health and health care. It is an alternative to the dominant paradigm in Western medicine that views health concerns through the lens of body size. HAES is the trademark registered by the nonprofit organization Association for Size Diversity and Health. The trademark ensures that this term is not used to promote weight loss, something that has occurred with much nondiet language (e.g., “healthy eating”). The term is fair use to promote weight neutrality or the pursuit of health and health care that does not focus on body size or weight loss. After reviewing the origins of the HAES approach, this entry discusses its connection to gender and sexual orientation; the entry concludes by providing the five principles of HAES.

Origins HAES was developed and practiced by physicians, nutritionists, dieticians, and psychologists. After noticing that their patients’ weight loss efforts were largely unsuccessful in the long term, they began to question their focus on weight loss. When they recognized that their patients’ failed attempts at permanent weight change did both physical and psychological damage, they shifted their focus to metabolic health indicators, which change independent of changes in weight. HAES concepts are detailed in a book by Linda Bacon, a nutritionist and researcher at the University of California. Bacon is one of several scientists at the forefront of research showing that nondiet (not restricting food intake) approaches to health have better long-term outcomes than weight-centered

Health at Every Size

approaches. Her book includes a description of a study comparing a traditional-diet group with a nondiet (HAES) group. Her main finding is that real health indicators (heart functioning, metabolic indicators, blood glucose) show sustained improvement in a nondiet model, while diet (weight centered) models only show temporary positive results followed by both weight regain and a return to unhealthy ranges in the areas of concern for patients and physicians.

HAES and Social Justice HAES addresses fat stigma. Much like race, fatness is visible to others and carries stereotypes and stigma that are activated before there is any other exchange. In the same way that people are judged by the color of their skin, fat people are also judged by the size of their body. Many people, from health practitioners to peer groups, make assumptions about individuals based on the physical markers of skin color and body fat. Adopting the HAES paradigm, like adopting antiracist practices, addresses health concerns without focusing on false aesthetic indicators and has more positive results. To address economic inequality, the HAES philosophy promotes food justice and advocates for equal access to both healthy whole foods and health care. The stigma related to body size in Western culture is primarily aimed at women. Western culture promotes conformity to the thin ideal and performance of emphasized femininity. Grounded in women’s liberationist ethics and ideology, HAES has empowered many women. In its acceptance of all bodies, HAES supports people with disabilities as well as gender nonconforming bodies. HAES promotes body acceptance and self-care for everybody. As with gender and race, there are many connections between sexual orientation and HAES. The same arguments that are made to promote heteronormativity are made to promote the thin ideal. Being fat and being queer have both been framed as a choice: If you just tried harder, you could be thin/straight. In both cases, people are trying to change something fundamental and relatively fixed in order to conform to societal norms. Rather than trying to conform in order to avoid societal stigma related to body size, HAES promotes addressing the stigma directly and accepting yourself the way you are. HAES focuses on

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changing a patient’s perspective, not their physical appearance. In treating patients, HAES practitioners liken extreme food restriction to induce weight loss or surgeries aimed at the same goal to reparative therapy. Through this lens, they use the principles of HAES to help clients who are distraught about being fat not change their bodies but to love and accept themselves as they are. HAES practitioners assert that people should not be judged on their health status or their desire to improve their health. HAES stands against healthism (the moral imperative to pursue better health). Their view is that pursuing better health is a personal choice and an individual should not be judged on health status or health behaviors, especially through the lens of weight. While HAES practitioners respect the autonomy of every patient’s health choices, they promote behaviors for their patients that maintain health and longevity rather than focusing on body size, food restriction, and weight loss.

The Five Principles of HAES 1. A Commitment to Loving Your Body

HAES is a commitment to loving and accepting your body exactly the way it is. For health care providers, it is a commitment to health care without pathologizing or idealizing certain body weights. With HAES, weight loss is never a goal, regardless of the person’s size, since there is no evidence that weight loss is ever permanent for most people. Everyone has a set point weight range. Some people are thin, some people are fat, and most are somewhere in between. These variations are natural and should not be adulterated. 2. Enhancing Health for All Body Weights

For the individual, this means approaching one’s health without considering one’s weight. One can pursue better personal health without focusing on weight-centered outcomes. For health care providers, it means treating fat patients in the same way they treat any other patient. If a person has diabetes, focus on blood glucose, not weight. If a person has hypertension, focus on blood pressure, not weight. People can bring their blood glucose and blood pressure down without a weight focus. Small changes in behavior can help with this. In most cases, intentional weight loss results in

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Health Issues and Gender: Overview

weight regain. It is not effective in positive permanent health outcomes and can create new health problems. 3. Respectful Care

For the individual, this means acknowledging the internalization of the negative messages one learns about being fat and how that affects one’s thoughts and feelings about fat bodies. It is a commitment to working toward accepting and respecting all bodies just as they are. For the care provider, it requires recognizing one’s biases, treating all patients with respect, and working to end weight stigma for all people. HAES health care providers understand the intersectionality of body size stigma with the stigma of gender, race, sexual orientation, age, social class, and other identities. HAES acknowledges that health care includes attention to not just physical health but economic, social, spiritual, emotional, and mental health as well. 4. Eating for Health and Pleasure

One should not restrict one’s eating or judge food. It means being flexible in what one chooses to eat or not eat. HAES promotes attention to hunger and satiety signals and respecting those signals (eating when hungry and stopping when satiated), or intuitive eating. Our bodies self-regulate our eating through innate hunger and satiety signals sent to the brain. The signals should not be ignored, as people find that they can be very hard to get back once they are lost. If external cues dictate food intake, it can cause one to eat too much or not enough. This means that one must take control of one’s own eating and not become a “patient” in this regard. Health care professionals should consider the ethics of prescribing weight loss diets that do not work in the long term, or at all, and then blaming the patient for noncompliance. 5. Pleasurable Movement of the Body

Our bodies want to move sometimes and be still sometimes. Everyone has different optimum levels of movement and rest. It can feel so good to stretch and move our bodies, but many people have been forced into weight loss–centered exercise programs that feel more like punishment than pleasure. Movement should be available for life enhancement to people of all sizes and abilities. For providers,

exercise should not be prescribed or used for weight loss but encouraged for health improvement. Movement or exercise should be enjoyed for its lifeenhancing properties, building strength, health, stamina, and mobility. Nathaniel C. Pyle and Michael I. Loewy See also Body Image; Ethics of Self-Care for Psychologists; Fat Shaming; Feminist Psychology; Women’s Health

Further Readings Bacon, L. (2010). Health at every size: The surprising truth about your weight (2nd ed.). Dallas, TX: BenBella Books. Bennett, W., & Gurin, J. (1983). The dieter’s dilemma: Eating less and weighing more. New York, NY: Basic Books. Gaesser, G. A. (2002). Big fat lies: The truth about your weight and your health. Carlsbad, CA: Gurze Books. Rothblum, E., & Solovay, S. (Eds.). (2009). The fat studies reader. New York: New York University Press.

Websites Association for Size Diversity and Health: http://size​ diversityandhealth.org/

Health Issues Overview

and

Gender:

The topic of health, even within the parameter “as it relates to gender,” has tremendous breadth. The sheer number of topics subsumed under the title “health” might well be infinite. Considering both health and gender from a historical perspective further complicates the issue, as the language of health and illness, understanding of the causes of illness and the responses to illness, has transformed over time. Thus, when thinking about health and gender, two ideas emerge: 1. The understanding of health and illness is dynamic and temporal. 2. The role of culture and the social environment is tightly intertwined with the conceptualization and understanding of health, well-being, and illness.

Health Issues and Gender: Overview

This entry explores the definitions of health and gender and considers the interplay of the social and historical contexts as related to biomedical, health, and wellness research. The determinants of health are examined and how these determinants might differ in men, women, and the lesbian, gay, bisexual, transgender, and queer community explored. Stigma related to health and disability, as well as bioethics, and decisions that affect life are also considered.

Defining Health While some may define health as simply the absence of disease, others are much more expansive in their definition and consider health as not merely the absence of disease but also having a sense of well-being, the ability to care for one’s self, and the capacity to respond effectively and cope with changing circumstances. Culture, environment, and societal norms greatly influence how individuals and even populations define health, and perspectives change over time. One example is that in recent years, individuals with limited mobility elected to discard the term disability for what is considered an affirmative term, differently abled, which focuses on their abilities rather than on their impairments. Health, Well-Being, and Disorders in Women: Obesity in Health and Disease

While once a sign of wealth and prosperity, obesity today is classified as a medical disorder and, in many cases, also as a psychological disorder. Descriptions of ascetic nuns between the 1200s and 1500s bear a stunning similarity to descriptions of modern-day people, particularly women, diagnosed with anorexia nervosa. Anorexia nervosa is today a diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; patients with this diagnosis control their eating and lose large and dangerous amounts of weight. These similarities were understood very differently in different time periods. Time, a powerful mediator of advances in knowledge, has led to advances in technology that have furthered the understanding of nutrition, dietary patterns, and the relationship between obesity and disease. Biomedicine and epidemiological research have advanced understanding of the myriad

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medical complications and emotional consequences seen in overweight and obese women. At the other end of the spectrum, anorexia nervosa and bulimia, and other disorders associated with nutritional imbalance and calorie deprivation, are linked to nutritional deficits and present both physical and mental health challenges. On the one hand, it is questionable whether the behaviors of women in two such different time periods, replete with different cultures, values, and social expectations, can be compared. Although parallels exist between the disadvantages and health concerns, the notion of subjugated groups may or may not transcend time. Ascetic nuns of the Middle Ages and college girls of the 21st century may both be considered disadvantaged groups from the standpoint of societal norms and power. The feminine ideal is nuanced with cultural expectations. The health of women is affected when they strive to achieve a feminine ideal that is held in esteem in their distinct time period. Ascetic nuns were seeking to embody a level of holiness and self-sacrifice that is incompatible with sustaining life. Today, young women with anorexia try to achieve a body ideal that is valued by the mainstream culture, even at the risk of serious physical consequences or death. Scholars have speculated on the underlying meanings of these unattainable feminine ideals. Some speculate that it is a matter of social control, for instance; feminine thinness could be a ­metaphor for making sure women take up little space. Others have considered whether there is an unconscious wish to thwart the process of girls becoming women and instead undermine growth and development in favor of women looking like adolescent boys. There are other ideas about what these metaphors might represent that vary according to many factors and are influenced by time period, place, and culture. Complaints and Encounters: Feminine Encounters With Medicine

There are myriad definitions of health, wellness, and well-being; it is interesting who gets to define these culturally nuanced constructs. Complaints and Disorders is an impressive historical undertaking by Barbara Ehrenreich and Deirdre English. In this book, the authors argue that while medicine did not create sexism by disseminating the idea that women are inferior to men, without vigilant attention to implicit cultural and gender issues in

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Health Issues and Gender: Overview

medicine, they are at risk of enacting these biases. Although the relationship between medicine and sexism is not often addressed in the process of training medical practitioners, it should be, because sexism rests on the idea that one sex is dominant over the other; this idea is based on the body. Ehrenreich and English suggested that the body is the playing field for physical, biological, and medical theorizing, and thus intervention. Therefore, the body can be a vehicle for enacting behaviors that promote social control of one gender by another.

Defining Gender Sex or Gender

While sex generally refers to the anatomical differences between men and women, scholar Joan Berzoff states that gender is more about the social expectations for roles and behaviors. Since these social expectations are highly influenced by numerous biological, psychological, social, and spiritual factors, not to mention how these factors are understood across historical time frames, cultures, ethnicities, and economic and political contexts, these definitions are highly complex and multifaceted. However, there are times when this distinction between sex and gender is not so clear. Many question the limitations imposed by the binary system of distinguishing between genders— male and female. Recent societal debate in the United States highlights the challenges of developing social policy that adequately reflects the perceived needs and preferences of the dynamic and diverse American society. Opinions and beliefs stratify along lines that are based on religious beliefs, cultural traditions, generation, lifestyle, and personal preference. It is becoming increasingly necessary to understand that many in American society draw a distinction between sex and gender. There is a need to consider whether the policies that have been created humanely and accurately address the needs of our society based on growing knowledge in this area. It is becoming increasingly necessary to understand the distinction that is commonly made between sex and gender. In scholarly literature, this distinction, while vital, is often contentious. Outside academic circles, this has become a discourse as well. A 2015 article in The New York

Times addresses this question, highlighting the notion of how male and female categories are defined in the arena of track-and-field. Reporting on a pending court decision regarding what constitutes “female” in competitive sports, The New York Times reported on the International Association of Athletics Federation (IAAF) definition of what it means to be male or female. In 2011, the IAAF established guidelines for ­athletes to compete as females. It determined that the issue is one of testosterone levels and whether testosterone levels can affect performance. The guidelines the IAAF conceived were called the Hyperandrogenism Regulations, and they determined that 10 nanomoles per liter, the lower end of the male range of testosterone, was the maximum amount a person could possess and still be eligible to compete as a woman. This issue received attention at the 2011 Olympics in London. Four young women athletes from various rural and developing countries were identified as possessing levels of testosterone that precluded them from competing in the female category. They were asked to either undergo surgery or take hormone-suppressing drugs to limit the amount of testosterone their bodies produced in order to be eligible to participate in the competition as females. Dutee Chand, from India, was the only one who refused to abide by these recommendations on the grounds that she was not ill and that this was something her body produced naturally. This issue went to the global court, the Court of Arbitration for Sport, and the court declared that if the IAAF could not provide satisfactory evidence to prove that testosterone does in fact have an impact on athletic performance, its new regulations would be declared void. Because the IAAF was not able to prove conclusively that her testosterone levels gave Chand an unfair advantage, she won the case. Two years earlier, a similar issue surfaced. Caster Semenya, an 18-year-old South African, middle-distance runner, won a gold medal in the 2009 World Championships for the 800-meter event and was subsequently subjected to gender testing based on a report of unfairness due to what was then deemed “gender factors.” The private affairs of Semenya became a matter of public scrutiny, perhaps resulting in a great deal of stress and humiliation for Semenya.

Health Issues and Gender: Overview

The 2015 outcome was heralded by many as a positive step in addressing gender fluidity. Although categories for athletic events are currently defined using a binary system of male and female, a more fluid system of determining categories for competitive sports may be needed. Medicine: Health and Wellness Research

Similarly, researchers tend to divide people into binary categories of male and female when conducting medical or health research. In the case of medical research, this has been a positive initiative. Recognizing that “women are not small men,” that their signs and symptoms for heart disease are not consistently the same as those of men, undoubtedly has saved lives. However, there are risks involved in this kind of categorization, in particular the risk of overgeneralization. Psychosocial stress is a known risk factor and can have an impact on physical conditions, in terms of both creating and exacerbating the symptoms. Women are more likely to take on a greater percentage of family and household responsibilities, experience more instances of discrimination and harassment, and earn less on the dollar than men in spite of many social advances. Socioeconomic status is a powerful determinant of health and well-being. Economic status affects access to resources, determines the neighborhood one lives in, and influences one’s sense of security and wellbeing. Social status also may have an impact on health risks, affecting one’s self-efficacy, sense of agency, and hopes. Low social status can result in poor health and longevity. There are also stressors and life experiences unique to lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals that can have dire effects on medical health, health care–seeking behaviors, and outcomes. Due to social stigma and discrimination, it may be difficult for members of the LGBTQ community to ask important questions of their medical provider that could promote positive health outcomes. Biases and assumptions about the lifestyles and social behaviors of LGBTQ individuals impede the ability of medical practitioners to determine best medical practices for this community. Thus, the greater inclusion of LGBTQ individuals in biomedical research could help further elucidate issues

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around gender, sex, health, and the needs of this community.

Determinants of Health The determinants of health—that is, those factors that make some people healthy and others unhealthy—involve a range of factors that include personal or individual-level factors, such as genetics, lifestyle, and health behaviors. Other ­ determinants of health act outside the realm of the individual and include social, economic, and environmental factors that significantly influence health risk and health outcome. Commonly called risk factors, the determinants of health may operate independently, but often they interact with each other to increase the risk associated with any single factor. Factors that are recognized as a risk for a particular disease due to genetics could therefore be heightened by environmental factors, such as dietary habits or smoking. For instance, diet and obesity are known risk factors for diabetes mellitus type II, and diabetes mellitus type II is a wellknown factor for cardiovascular disease. Environmental stress exaggerates the risk of both conditions. Social factors act as powerful determinants of health and are reflected in the social and physical environment in which people live. Examples of social factors are neighborhoods that can cause and perpetuate inequalities in health due to violence, the absence of grocery stores, and exposure to lead paint or refinery chemicals. National health policy is another determinant of health that mediates access to health care and can influence health care–seeking behaviors. Perceptions of access to health care, influenced by insurance status, immigration status, or proximity of a health center, can create barriers to health care utilization. Better health outcomes are associated with timely and adequate health care utilization. Many chronic diseases such as cardiovascular disease, hypertension, some cancers, diabetes ­mellitus II, and kidney disease are linked to overweight and obesity. Two or more chronic medical conditions that occur together are referred to as comorbid conditions. Being overweight or obese is considered a modifiable risk factor. Modifiable risk factors are those health risks that individuals have the ability to change or modify through the

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Health Issues and Gender: Overview

adoption of healthier behaviors. However, obesity is also linked to social factors in society such as poverty and the environment. Neighborhood factors such as the absence of grocery stores with fresh fruits and vegetables and the absence of safe places to walk or engage in outdoor sports or activities close by can explain some of the increases in obesity in American society. These are societallevel factors that affect a large proportion of urban neighborhoods in a negative way. These concerns can be addressed through collective social action— that is, large groups of committed individuals working together to problem solve. In addition, future research with greater involvement of ­African Americans, Hispanics/Latinos, and immigrant populations will help elucidate how the determinants of health interact to create health inequalities in these populations. Leading Causes of Death in Adults

According to the Centers for Disease Control and Prevention, in 2016, the leading causes of death in the United States were cardiovascular disease, cancer, chronic lower respiratory disease, accidents (unintentional injuries), stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease (nephritis, nephrotic syndrome, and nephrosis), and intentional self-harm (suicide). Cardiovascular disease is associated with genetic susceptibility; however, there are lifestyle and/or behavioral risk factors that significantly increase the risk for heart disease. Smoking is one such behavior. Improvements in cardiovascular disease outcomes can be achieved through early and ­regular health care, medical intervention, and individual behavior modification. The risk for cardiovascular disease is greater in men than in women. However, after menopause, the risk in women approximates that in men. It must be noted that not all ethnic groups achieve the same benefits from treatments. Furthermore, inherited risk and behavioral risk taking vary across ethnic and cultural groups. Finally, comorbid health condi­ tions, such as obesity, hypertension, and diabetes mellitus II, as well as social risk factors (e.g., smoking) contribute to the differences in cardiovascular disease outcomes. According to the American Cancer Society, in 2016, cancer was the second leading cause of death, with lung cancer being at the top of the list

of cancer causes of death for both men and women. Prostate and colon cancers in men and breast and colon cancers in women follow lung cancer. Disparities in cancer outcomes are seen across race/ ethnicity. For example, African American men have the highest prostate cancer morbidity and mortality rates of all racial and ethnic groups in the United States. Although signs of risk for colorectal cancer can be detected during a screening test, widening disparities are seen when comparing U.S. Whites and African Americans. Some of these inequalities in outcomes are associated with genetic risk factors; however, differences in health care utilization and screening may explain many of the disparities in cancer survival rates when comparing across race/ethnicity. Prostate cancer survival is significantly improved with early detection through screening, timely follow-up of an abnormal screening test, and adequate treatment. Women’s Health

Women’s health and the determinants that influence women’s health outcomes include many of the health risk factors, diseases, and comorbid conditions discussed earlier. From menarche, women’s health is linked to reproductive health care and is focused on family planning, cervical cancer screening, identification and treatment of sexually transmitted infections, immunization, and preventive health. Health education is an integral component of women’s health in the early-tolate adolescent period, and teaching breast selfexamination is included in family planning health care encounters. However, women’s health is not merely reproductive related, and risk factors identified in late adolescence that were potentially modifiable at that time increase a woman’s risk for breast cancer later in life (postmenopausal). These risk factors include weight gain after the age of 18 years and/ or being overweight or obese. Other factors such as delayed parenting, lack of breast-feeding, and use of hormone replacement therapy (combined estrogen and progestin) to relieve the symptoms of menopause also increase a woman’s risk for breast cancer, as do alcohol consumption and lack of regular exercise. Smoking has been associated with increased risk for cancer of the oral cavity, larynx, and lungs; it suppresses the immune system and decreases the ability of the body to fight human

Health Issues and Gender: Overview

papilloma virus (HPV) infection, which is the primary cause of cervical cancer. Breast cancer risk may be increased in long-term smokers who started smoking early, especially before their first pregnancy. As women age, risk behaviors and lifestyle factors are important considerations. Osteoporosis, depression, autoimmune diseases, and unsafe sex are major concerns. Sexual minority women, lesbian women, and women who have sex with women are at high risk for depression and anxiety. Youth who identify as LGBTQ have a higher risk for depression and attempted suicide. Sexual minority women compared with heterosexual women experience greater health care barriers, social stigmatization, alienation, and discrimination. Barriers to health care limit access to health education and health promotion information that could provide the needed interventions to address obesity, social isolation, domestic violence, and risk behaviors that increase health and mental health disparities while comparing LGBTQ women and heterosexual women. Finally, women often do not receive timely health care and neglect their own health because they are the first care providers for their children, parents, partners, and spouses. Therefore, the ­provision of women’s health care must be culturally competent and include advocacy and needed follow-up to ensure that they do not lapse care or delay needed treatments. Men’s Health

As presented earlier, in all racial/ethnic groups, cardiovascular disease, including stroke, is the number one cause of death in men, followed by cancer, unintentional injuries, and chronic lower respiratory disease, also known as emphysema, according to the Centers for Disease Control and Prevention’s statistics for 2016. The important modifiable risk factors for cardiovascular disease, lung cancer, and emphysema are tobacco use and environmental pollution, occupational exposures, an unhealthy diet, obesity and overweight, and lack of physical activity. In adolescent boys, health care is usually acquired through receiving preventive health care, immunizations, camp physicals, and sports team clearance. If they are without symptoms of illness, young men will often lapse care until later in life. Men face key health threats in the fifth and sixth decades of life,

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and health concerns include not only the chronic conditions mentioned earlier but also enlargement of the prostate (benign prostate hypertrophy), prostate cancer, erectile dysfunction, and testosterone levels. Regular medical physical evaluation, which may not have necessarily been part of a man’s adolescent or earlier routine medical visits, becomes important. Screening for prostate cancer is a topic many men find difficult to discuss. While some men achieve the benefits of screening and early detection, others avoid screening, and subsequently, when it becomes symptomatic, they seek medical attention and are diagnosed with late stages of cancer after presenting to a medical provider. While all men face these health risks, men who have sex with men are at an increased risk of contracting HIV, the virus known to cause AIDS, as well as sexually transmitted infections, including HPV, gonorrhea, syphilis, herpes simplex, and chlamydia. Anal cancer due to HPV is a growing concern in gay men. Among men who have sex with men, the risk for anal cancer is significantly greater overall and is increasing. To modify the risk for sexually transmitted infections, men who have sex with men can implement safer sex practices, such as using a condom or other barrier method along with water-based lubricants with each s­ exual encounter. LGBTQ Health

To understand LGBTQ health, one must consider the history of bias and discrimination against sexual minorities in U.S. communities. Social isolation, barriers to health care, assumptions about risk behaviors, and lack of cultural competence contribute to adverse health outcomes in the LGBTQ community. Historically, bars and clubs provided a safe place for LGBTQ individuals to gather, and alcoholism has been an ongoing problem in this community. The limited information available indicates that LGBTQ individuals have high rates of substance abuse, psychiatric disorders, and suicide. Safety and a sense of belonging are important concerns. Furthermore, personal family relationships may be strained, and the lack of acceptance of a person’s sexual orientation may adversely affect their mental health. Violence, including domestic violence and victimization, are also concerns that are prevalent in the LGBTQ community.

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For some transgender individuals, hormones taken to change secondary sexual characteristics, such as hairline, facial hair, and breast development, can increase the risk for cardiovascular disease, and some people may avoid disclosing ­ symptoms for fear that doctors will discontinue the gender affirming procedures. Additional risk occurs when transgender individuals obtain these treatments outside professional medical facilities, as some individuals may place themselves in compromising situations such as sharing needles, which is a risk factor for contracting HIV infection and hepatitis. There is a tremendous need for further research to better document, understand, and promote positive health and health outcomes among LGBTQ persons.

Illness, Disability, and Stigma Illness and disability are often entangled with social stigma, the phenomenon of devaluing people who are not “able-bodied” or of “sound mind.” In two books, Illness as Metaphor and AIDS and Its Metaphors, Susan Sontag suggested that illness is a metaphor for mortality, human frailty, and ­vulnerability—all characteristics seemingly repelled by current social values. Sontag observes that historically increasingly militant metaphors have been developed for how to respond to illness and disease—the disease is seen as an invading army, which will be fought with medication to eradicate it. This is not only a “war” in the medical community, but also professionals and lay people alike join the rank and file in walkathons and campaigns to raise funds for research and increasing awareness on a specific illness. However, such metaphors imply a disdain for and disgust with illness, and such disdain and disgust may by association transfer onto and be internalized by those who are ill. Many cultures hold ill or differently abled individuals responsible for their situation—if not directly, at least for whatever they may have done to anger their Creator enough to have illness or disability brought on them. The impact of this is that those with an illness or disability may internalize the blame and stigma and begin to see themselves as the disease, just as others see them. The journal Schizophrenia Bulletin often runs commentaries by consumers with serious mental illness

and family members of people with serious mental illness. One interesting contribution by the brother of a woman diagnosed with schizophrenia expressed his feeling that when a disease affects the mind, it is difficult to know where the disease ends and the person begins. This statement may provide insight into the phenomenon whereby a person’s diagnosis becomes the person’s identity, rather than just one aspect of a whole human being. Sontag points to another complication regarding fears and ignorance about disease and disability: the common belief that individuals with an illness or disability possess character flaws that predispose them to the illness or disability—for example, “If I weren’t so type A, I would not have colitis” or “If I weren’t so anxious, I would not have developed this disease.” Without negating the impact of stress on the body, it is important to realize that sometimes bad things happen and they are not a person’s fault. Stigma around illness and disability appears to be ingrained in American culture. Language-first advocates want people to consider the implications of referring to a human being with “persons with” language rather than with labels. For instance, referring to a person as a “schizophrenic” invokes stigma, both external and internal, in that it contributes to a person being seen by others and by themselves as nothing more than a disease, whereas a “person with schizophrenia” might be a mother, daughter, sister, friend, leader, writer, student, driver, or reader. An important point with regard to social stigma and illness and disability involves the differentiating between empathy and sympathy. Sympathy, wherein one can feel sad learning of another’s situation and life struggles, can also promote an arbitrary distance, a sense of “us” and “them.” When one feels sympathy, one allows oneself to feel separate and unencumbered by the situation of the other. Empathy is a willingness to make a genuine and concerted effort to understand cognitively and viscerally the experience of another person. Empathy acknowledges the humanity of the other person and the humanness of their struggle. If one allows oneself to feel what another may be feeling, one is recognizing that the other person’s experience is on the same continuum as one’s own. Rather than perceiving another’s experience as unfathomable in one’s own world, empathy validates and communicates one’s understanding of

Health Issues and Gender: Overview

the experience of others. For these reasons, empathy may be the greatest weapon in the arsenal against stigma.

Medical Ethics Informed by Popular Culture Ethical issues in biomedicine and health have been an area of study as far back as the mid-20th century. As technologies (e.g., life support, organ transplant procedures) are developed, challenges to the medical, moral, theological, and individual sense of what is fundamentally right and what is fundamentally wrong arise. The very definition of death has become unclear, thus creating a gray area for determining when efforts should be made to sustain a life. There is much debate about what denotes a life worth living. Consider this scenario in a person who is an athlete. The 2004 film Million Dollar Baby posed the question “Is life worth living when a brain injury renders one quadriplegic?” A 2004 Spanish film The Sea Inside explored the question from multiple angles based on the life of Ramon Sampedro, who fought for almost 30 years for the right to euthanasia after he was rendered quadriplegic following a diving accident. This film asks viewers to consider the following questions: Does a person have a right to death with dignity, and under what circumstances? Many argue that these are decisions better left to the family, while others argue that these decisions are better left to an outside governing body. Conversely, a 2011 French film, Les Intouchables, also based on a true story of a man with quadriplegia, demonstrates the ability of the human spirit to overcome a similar adversity to that experienced by Sampedro and to live a life of purpose, meaning, and hope. Disability advocates argue that a dangerous message is delivered with the legalization of assisted suicide for people with illness or disability, a message that may suggest that certain lives are of less value than others. The question of assisted suicide amplifies the murky ethical territory associated with increasing medical advances. The Handmaid’s Tale, the 1985 novel by ­Margaret Atwood, which was subsequently made into a movie, an opera, and a ballet, raises ­questions about the ethical implications of other modern-day medical advances. This story imagines a world wherein men control women’s bodies and

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lives. An aspect of the story involves the creation of classes of women, which include handmaids, who have been described as reproductive concubines. Atwood’s work challenges readers and viewers to think about the implications of surrogate parenting on women of lesser financial means. These advances create a pathway where power might be abused. Debra Kram-Fernandez and Daramola N. Cabral See also Body Image; Body Image Issues and Men; Body Image Issues and Women; Eating Disorders and Gender; Gay Men and Health; Help-Seeking Behaviors and Men; Help-Seeking Behaviors and Women; Lesbians and Health; Men’s Health; Mental Health Stigma and Gender; Transgender People and Health Disparities; Women’s Health

Further Readings Ait Belkhir, J., & Charlemaine, C. (2014). Introduction: RGC intersectionality, race, gender, class, health, justice issues. Race, Gender & Class, 21(3/4), 3–6. American Cancer Society. (n.d.). Cancer facts and figures 2016. Atlanta, GA: Author. Retrieved from http:// www.cancer.org/research/cancerfactsstatistics/ cancerfactsfigures2016/ Bux, D. A. (1996). The epidemiology of problem drinking in gay men and lesbians: A critical review. Clinical Psychology Review, 16, 277–298. Cabral, D. N., Nápoles-Springer, A. M., Miike, R., McMillan, A., Sison, J. D., Wrensch, M. R., . . . San Francisco Bay Area Lung Cancer Study. (2003). Population- and community-based recruitment of African Americans and Latinos: The San Francisco Bay Area Lung Cancer Study. American Journal of Epidemiology, 158(3), 272–279. Centers for Disease Control and Prevention. (2016). Leading causes of death. Atlanta, GA: Author. Retrieved from http://www.cdc.gov/nchs/fastats/ leading-causes-of-death.htm Connell, R. (2012). Gender, health and theory: Conceptualizing the issue, in local and world perspective. Social Science & Medicine, 74, 1675–1683. doi:10.1016/j.socscimed.2011.06.006 Ehrenreich, B., & English, D. (2011). Complaints and disorders: The sexual politics of sickness. New York, NY: Feminist Press. Fallon, P., Katzman, M., & Wooley, S. (1994). Feminist perspectives on eating disorders. New York, NY: Guilford Press.

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Hankivsky, O. (2012). Women’s health, men’s health, and gender and health: Implications of intersectionality. Social Science & Medicine, 74, 1712–1720. doi:10.1016/j.socscimed.2011.11.029 HealthyPeople.gov. (n.d.). Lesbian, gay, bisexual, and transgender health. Washington, DC: Author. Retrieved from https://www.healthypeople.gov/2020/ topics-objectives/topic/lesbian-gay-bisexual-andtransgender-health Marmot, M. (2006). Harveian oration: Health in an unequal world. Lancet, 368, 2081–2094. Retrieved from http://www.who.int/social_determinants/ publications/health_in_an_unequal_world_marmott_ lancet.pdf Rollero, C., Gattino, S., & De Piccoli, N. (2014). A gender lens on quality of life: The role of sense of community, perceived social support, self-reported health and income. Social Indicators Research, 116, 887–898. Schultz, A. J., & Mullings, L. (2006). Gender, race, class, and health. San Francisco, CA: Jossey-Bass. Sontag, S. (1977). Illness as metaphor. New York, NY: Farrar, Strauss, & Giroux. Sontag, S. (1989). AIDS and its metaphors. New York, NY: Farrar, Strauss, & Giroux. Springer, K., Stellman, J., & Jordan-Young, R. (2012). Beyond a catalogue of differences: A theoretical frame and good practice guidelines for researching sex/ gender in human health. Social Science & Medicine, 74, 1817–1824.

Hegemonic Masculinity Hegemonic masculinity describes the creation and maintenance of a gendered hierarchical structure within a given sociopolitical context. R. W. ­Connell originally conceptualized hegemonic masculinity in the mid- to late 1980s as a sociological construct outlining the cultural, political, institutional, and interpersonal mechanisms underlying the social dominance of men within patriarchal systems. Building from this definition, this entry explains how the core dimensions within hegemonic masculinity influence the gendered aspects of human behavior, social structures, and their interactions.

Dimensions of Hegemonic Masculinity The notion of a hegemonic masculinity implies that competing masculinities exist within a

particular hierarchy, wherein one authoritative and multidimensional masculine gender ideology exists to which all other masculinities are subordinate. Two key defining features of hegemonic masculinity in most Western patriarchal cultures are (1) a binary system of gender (feminine/masculine) and sex (female/male) and (2) heterosexuality as the sole legitimate form of human sexuality. The enforcement of these qualities allows little to no room for ambiguity and diversity in individuals’ experiences and expressions of gender and sexuality. This produces a strict and seemingly unchanging basic social structure on which hegemonic masculinity is able to set and uphold its hierarchy. The social and political hierarchy constructed by hegemonic masculinity is maintained via a strict set of prescribed normative gender roles necessary to uphold that structure. Hegemonic, masculine gender role norms are socially and structurally functional characteristics, attitudes, behaviors, and social practices defined and enforced in ways that uphold the hegemonic masculine hierarchy. They are the idealized masculine gender roles to which groups and individuals are socialized (or encouraged throughout their developmental stages) to endorse, internalize, and aspire toward achieving. Hegemonic masculine gender role norms specifically revolve around achieving and maintaining men’s dominance via the socially sanctioned and enforced subordination, distrust, and devaluation of women and femininity (i.e., anti-femininity). Hegemonic masculine gender role norms such as restricted emotions (apart from anger), aggression, transphobia (particularly in response to male-tofemale transgender individuals), and homophobia (especially in response to men’s homosexuality and bisexuality) uphold the anti-femininity dimension of hegemonic masculinity. Enforcement of hegemonic masculine gender role norms occurs when individuals and groups are socially rewarded for successfully adhering to these norms and punished for either failing or refusing to abide by the norms defined within hegemonic masculine contexts. For instance, men who do not present themselves as tough and self-reliant (or independent), both of which are common hegemonic masculine norms, may be socially punished by being labeled as weak, feminine, and/or homosexual. Similarly, women who are perceived as large or muscular and who do not present themselves as docile and passive, each of which are common expectations for women in hegemonic masculine contexts, are often

Hegemonic Masculinity

socially punished by being labeled as ugly, monstrous, or sexually promiscuous. Importantly, these social punishments not only serve to harm the individuals who threaten or violate the hegemonic masculine hierarchy but also function to reinforce the basis for that hierarchy by stigmatizing certain identities (e.g., homosexual men and strong women).

Individual and Social Impacts of Hegemonic Masculinity Endorsing and adhering to hegemonic masculinity means adhering to a strict set of prescribed beliefs and behaviors that often have negative individual and social consequences. Gender role stress describes the individual experiences and the physical, psychological, and social consequences of strict adherence to a narrow set of prescribed gender norms, such as those enforced under hegemonic masculinity. Situations eliciting gender role stress are considered gender relevant or gendered because they are contexts that either explicitly or implicitly invoke adherence to prescribed gender roles (e.g., gender-segregated sports). Hegemonic masculine gender role stress is especially salient in gender-relevant situations that specifically threaten the socially dominant (i.e., hegemonic) status that accompanies identification with or attempted achievement of hegemonic masculine gender roles. Research has demonstrated that tactics for reaffirming a hegemonic masculine status in response to experiences of gender role stress tend to be maladaptive in nature, with several negative health and behavioral outcomes. Such outcomes include unhealthy lifestyle behaviors (e.g., excessive risk taking and substance abuse) and increased anger, anxiety, and aggression toward self and others.

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with violence. Psychological research to date has demonstrated considerable evidence linking individuals’ experiences of hegemonic masculine gender role stress to heterosexual men’s perpetration of intimate partner and sexual violence. One theoretical explanation for this phenomenon posits that when a person perceives their intimate partner as posing a threat to their dominance, the immediate response is violence toward the source of that threat (i.e., the intimate partner) to reestablish a dominant status. Hegemonic Masculinity and Marginalized Identities

The internalization of a culturally defined normative standard for the dominant group within a given sociopolitical context is not necessarily restricted to a person’s assigned sex or gender identity. Members of systematically marginalized groups may internalize and adhere to the same cultural norms that function as tools for oppression. For example, sexual minority women (i.e., lesbian, gay, bisexual, or pansexual women) who identify with masculinity may internalize the gender role norms associated with hegemonic masculinity. Sexual minority women’s experiences with their own masculinities may in turn mirror this culturally established idealized masculinity. In this way, hegemonic masculinity is less about defining and enforcing a form of maleness than it is a gender ideology that works to enforce the identities, behaviors, and social practices of all members of a society in order to perpetuate its own hierarchy. Rachel M. Smith See also Cross-Cultural Differences in Gender; Gender Identity; Gender Role Stress; Machismo; Masculinities; Violence and Gender: Overview

Hegemonic Masculinity and Violence

Further Readings

The consequences of hegemonic masculine gender role stress extend beyond individuals to interpersonal, institutional, and structural issues. This is especially evident in research examining the impact of gender roles associated with hegemonic masculinity on individuals’ and groups’ perpetration of violence. For instance, a fundamental aspect of the socialization and enforcement processes of hegemonic masculine gender role norms involves encouraging boys and men to respond to perceived threats to their masculinity and dominant status

Beasley, C. (2008). Rethinking hegemonic masculinity in a globalizing world. Men and Masculinities, 11, 86–103. doi:10.1177/1097184X08315102 Carrigan, T., Connell, B., & Lee, J. (1985). Toward a new sociology of masculinity. Theory and Society, 14, 551–604. doi:10.1007/BF00160017 Moore, T., Stuart, G., McNulty, J., Addis, M., Cordova, J., & Temple, J. R. (2010). Domains of masculine gender role stress and intimate partner violence in a clinical sample of violent men. Psychology of Violence, 1, 68–75. doi:10.1037/2152-0828.1.S.68

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Smith, R., Parrott, D., Swartout, K., & Tharpe, A. (2015). Deconstructing hegemonic masculinity: The roles of antifemininity, subordination to women, and sexual dominance in men’s perpetration of sexual aggression. Psychology of Men & Masculinity, 16, 160–169. doi:10.1037/a0035956

Help-Seeking Behaviors and Men This entry provides an overview of help-seeking behavior in men. The entry begins with an exploration of how social scientists conceptualize masculinity, as well as an examination of predominant beliefs regarding masculinity in cultures where masculinity research is most commonly conducted. The entry then discusses patterns in how men seek help from both within and outside their social support network, with a particular focus on family, friends, medical professionals, and mental health care providers. Finally, the entry addresses the factors that discourage men from seeking help and the implications for men’s physical and mental health.

Masculinity Contemporary social science research characterizes masculinity as a set of values, beliefs, and attitudes regarding what it means to be male. Individuals learn, both implicitly and explicitly, what it means to be male or female through interactions with caregivers, peers, and the social institutions that directly and indirectly influence their lives. Masculinity is therefore understood to be a social construct—a body of ideas that is embedded in a cultural context, sensitive to cultural shifts and possibly changing over time—rather than an immutable quality that individuals possess. It is therefore important to acknowledge the distinction between masculinity and biological indicators of the male sex when discussing matters related to men and masculinity. While research suggests that individuals may not hold a rigid understanding of masculinity, and may entertain several, often competing, ideas of what it means to be a man, many social scientists who study men in contemporary Western cultures have focused on hegemonic masculinity. Hegemonic

masculinity is defined by dominant beliefs and norms surrounding what it means to be a man in a given culture or context. Historically, being a traditional man in a Western cultural context has been characterized by adherence to a particular set of physical, social, emotional, and behavioral traits. Wide shoulders that taper to a thinner waist, coupled with a high degree of muscularity, have emerged as the idealized body type for men in many contemporary Western cultures. Men in these cultures are also expected to perform certain roles in society, with many experiencing pressure to provide most or all of the income for their families and pursue leadership positions in the organizations in which they hold membership. These societies often discourage the expression of emotions in men, with anger being a notable exception to this trend. Finally, masculinity in contemporary Western cultures is associated with certain patterns of behavior including striving for physical fitness, aggressive or violent reactions to perceived threats, risk taking, negative attitudes toward women and homosexual men, and exhibiting less concern about physical and mental health. Social scientists generally evaluate an individual’s masculinity in one of two ways: (1) the number of traits regarded by society as masculine that an individual possesses and (2) an individual’s masculinity ideology—the extent to which an individual values masculine gender norms as appropriate guidelines for male behavior. A large body of research points to masculinity ideology as an important influence on a variety of attitudes and behaviors in men, including men’s relative willingness to seek emotional and practical support.

Cultural Differences Each culture defines masculinity differently and has its own set of predominant beliefs, attitudes, and norms surrounding gender and masculinity. While research suggests that overlap between different cultures’ conceptualizations of masculinity is growing as a result of globalization, there is abundant evidence supporting the claim that men from different cultures assess masculinity with different sets of criteria. Much of the research mentioned in this entry on the relationship between hegemonic masculinity and help-seeking behaviors in men has been conducted in Western contexts

Help-Seeking Behaviors and Men

with participants who identify as heterosexual and White. For the purposes of this entry, men and masculinity refer largely to heterosexual Western men and hegemonic masculinity in contemporary Western cultures, respectively. More work needs to be done to explore the relationship between masculinity and help-seeking behaviors in individuals with non-Western cultural backgrounds, bicultural identities, and/or sexual minority status.

Seeking Help From Family and Friends Research on gender differences in help-seeking behavior shows that men are less likely than women to seek help from friends, family, and other close relationships. Furthermore, this pattern appears to continue late into the life span. Research on married heterosexual individuals’ social support networks shows that married men tend to have smaller social networks than married women later in life and that these men appear to seek support primarily from their spouses. In contrast, married women receive emotional support from a larger network of friends and family well into old age. Whereas women appear to utilize their support networks for assistance with a wide variety of issues, including emotional and practical matters, men seem to approach their family and friends for help regarding a much smaller range of concerns. Research has identified emotional and psychological distress as problems that men most consistently avoid seeking help with. Men are less likely to disclose private and emotionally charged information to others and tend to have fewer confidants— that is, friends or family members who serve as outlets for this type of disclosure. Although men tend to seek help from individuals in their social support network relatively less often than women, there is a notable exception to this tendency. Men are more likely to seek help from others when they perceive opportunities to reciprocate in a similar fashion in the foreseeable future. For instance, men in communities affected by large-scale disasters are more likely to request practical assistance, as it is likely that they will have the chance to provide similar help to other members of the community. This tendency may be due to a predominant view of masculinity as a limited resource, which is diminished by perceived nonmasculine behaviors like accepting help and

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bolstered by traditionally masculine behaviors like providing help to others.

Seeking Medical and Mental Health Care A large body of research suggests that men are significantly less likely than women to utilize medical and mental health services. This reluctance to seek medical and mental health care is evident at the onset of symptoms, when men are more likely to ignore physical symptoms of illness and signs of psychological distress. Men are especially likely to ignore symptoms that are perceived as insufficiently severe or normative. Even when men acknowledge the need for medical or mental health care, they tend to delay seeking professional medical and mental health care for longer after the onset of symptoms than women. Research on men’s motivation for seeking medical help shows that men are more likely to seek assistance from a medical professional if the presenting concern is one that threatens their masculinity. Such concerns include conditions that pose an immediate threat to a man’s sexual potential (e.g., erectile dysfunction), observable male sex characteristics (e.g., testicular cancer), or ability to care for family members. These exceptions to men’s reluctance to utilize medical health services suggest that the need to preserve or restore masculinity when it is threatened can be a powerful motivator for men in deciding to seek help from others. Men are also more likely to consult medical professionals as they advance in age. This may be due to a tendency for men to conceptualize masculinity more flexibly later in life. Another explanation for this pattern is that younger men are less likely to experience serious health issues that require immediate medical attention. As men progress through the life span, threats to their physical health become more frequent and severe. Consequently, self-preservation emerges as an increasingly salient motivator as individuals approach the end of the life span, encouraging men who would not normally seek help from medical professionals to do so in the face of existential threat.

Barriers to Help Seeking Research suggests that men avoid seeking help from family members, friends, and health

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professionals because they perceive help-seeking behavior to be incompatible with the societal norms surrounding masculinity that they have internalized. Male reluctance to seek help can therefore be understood as a product of male gender role conflict—when rigid socialized beliefs about masculinity restrict or otherwise negatively influence male behavior, resulting in negative outcomes. Components of hegemonic masculinity identified as obstacles to help-seeking behavior in men include the following: (a) the valuing of ­independence and self-reliance, (b) restriction of emotional expression, and (c) misogyny and homophobia. Peer disapproval of help-seeking behavior also suppresses male willingness to seek help. Perhaps the most easily discernable origin of the stigma against help-seeking behavior in men is the prevailing belief that men should not seek help. When men are asked why they hesitate to seek medical help, they frequently respond by saying that seeking help is not a behavior characteristic of “traditional” men, who men often characterize as independent and self-reliant. Men’s reluctance to seek emotional support appears to be related to another predominant belief about masculinity: the belief that men should restrict or suppress their emotions. Acknowledging emotional distress may represent a failure to conform to a model of masculinity that emphasizes stoicism, while the act of seeking help to address that distress may violate predominant social norms discouraging emotional expression. This element of masculine ideology can be particularly problematic when the provider of emotional support is male, as many contemporary Western societies are especially discouraging of affectionate and emotionally charged interactions between men. Male reluctance to seek support from friends, family, medical professionals, and mental health services may be motivated not only by the desire to preserve or enhance their masculine characteristics but also by the desire to avoid being perceived as feminine or homosexual. Support for traditional male gender roles is associated with homophobia and misogyny in many contemporary Western c­ultures, and men may view helpseeking behavior, commonly regarded as feminine or characteristic of gay men, as a potential threat to their masculinity.

Peer dynamics may also play a role in discouraging men from engaging in help-seeking behavior. Fear of social rejection and ridicule can keep men from seeking medical attention, especially if they perceive their male peers as disapproving of helpseeking behavior. The inhibitory effect of male peers on help-seeking behavior is exacerbated when men identify with and highly value their peers.

Implications Research suggests that men’s relative unwillingness to seek interpersonal, medical, and mental health support may contribute to negative health outcomes for men in the developed world. Some researchers posit that men’s negative attitudes toward seeking medical help may contribute to the higher chronic illness prevalence, increased mortality rates, and lower life expectancy among men in the United States. Despite a lower rate of diagnosis in men for common mental health issues, such as eating disorders, depression, and posttraumatic stress disorder, negative outcomes for men dealing with these issues may be more severe without the buffering influence of social support. Men have been shown to be more likely than women to engage in substance abuse and complete suicide, patterns that many researchers attribute to men’s reluctance to seek interpersonal and professional mental health support. Men’s reluctance to reach out to family, friends, and professionals for help may have a particularly profound impact on men without life partners, due to the observed tendency for men to seek emotional support primarily from a spouse. This may result in a higher degree of vulnerability to physical and mental health issues for men without life partners, especially toward the end of the life span. Jaime Lam and Stephanie Budge See also Gender Role Conflict; Masculinities; Masculinity Gender Norms; Masculinity Ideology and Norms; Masculinity Threats; Men’s Health; Mental Health Stigma and Gender

Further Readings Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American

Help-Seeking Behaviors and Women Psychologist, 58(1), 5–14. Retrieved from doi:10.1037/0003-066X.58.1.5 Antonucci, T. C., & Akiyama, H. (1987). An examination of sex differences in social support among older men and women. Sex Roles, 17(11–12), 737–749. Retrieved from http://doi.org/10.1007/BF00287685 de Visser, R. O., & McDonnell, E. J. (2013). “Man points”: Masculine capital and young men’s health. Health Psychology, 32(1), 5–14. Mishkind, M. E., Rodin, J., Silberstein, L. R., & StriegelMoore, R. H. (1986). The embodiment of masculinity: Cultural, psychological, and behavioral dimensions. The American Behavioral Scientist (1986–1994), 29(5), 545. Möller-Leimkühler, A. M. (2003). The gender gap in suicide and premature death or: Why are men so vulnerable? European Archives of Psychiatry & Clinical Neuroscience, 253(1), 1–8. O’Brien, R., Hunt, K., & Hart, G. (2005). “It’s caveman stuff, but that is to a certain extent how guys still operate”: Men’s accounts of masculinity and help seeking. Social Science & Medicine, 61(3), 503–516. Shumaker, S. A., & Hill, D. R. (1991). Gender differences in social support and physical health. Health Psychology, 10(2), 102–111.

Help-Seeking Behaviors and Women Women are generally more likely than men to seek help for a multitude of physical and mental health concerns. However, they are also more likely to attribute ill feelings, both physical and mental, to stress and life challenges, which can affect the type of help they seek. Help seeking is noted as a ­protective factor for many diseases in women, especially depression and symptoms of suicidality. Help seeking can be in the form of formal or professional support, such as from doctors, therapists, or counselors, or in the form of informal support, such as from friends, clergy members, or family. Social support, or informal help seeking, is a protective factor for women. Social support can decrease symptoms of anxiety and depression, as well as act as a positive coping mechanism for women with both mental and physical health concerns. Seeking formal supports can decrease the progression of illness in women and improve the odds for successful treatment.

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Defining Help Seeking There has not yet been widespread agreement on one definition for help-seeking behavior. There are multitudes of measurement tools utilized to study these behaviors, which lead to a multitude of definitions. Most studies focus on either informal or formal types of help-seeking behaviors. Formal help-seeking behaviors are generally considered to be visits to professionals in the physical or mental health fields, while informal help-seeking behaviors generally refer to discussions with family or friends, or support groups. Increasingly, informal supports are shifting to online communities, linking women nationally and internationally. Studies and conceptual pieces in the literature that examine the definitions of help-seeking behaviors suggest the importance of the following in more clearly defining help seeking: (a) the type of help seeking (from whom), (b) the time involved in the help-seeking activity, and (c) clarity about the type of illness, condition, or concern for which help is being sought.

Formal Help Seeking Women are more likely than men to seek help from doctors for most medical conditions. Although for some problems, such as sexual dysfunction, they are generally less likely to seek help, for issues related to sexually transmitted diseases, they are more likely to seek help sooner, despite the taboo nature of this particular issue. Women often delay formal help seeking for colorectal issues, due to the embarrassing nature of these problems and the stigma associated with discussing one’s bowel issues. Women are likely to attribute embarrassing medical concerns and symptoms, such as colorectal issues, to stress and often normalize their symptoms for these conditions at first, rather than immediately seeking professional care. They will, however, reach out to friends or others in their social support networks to gather information. Seeking help for an alcohol- or substancerelated disorder is also an area of embarrassment for women, also possibly due to the stigma associated with it. Women who are married and have children are less likely to seek formal treatment options, and whether or not they believe that they have a problem affects whether or not they seek professional or formal help.

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Informal Help Seeking and Social Support Women are much more likely than men to seek help in informal ways as well, through social support networks for numbers of concerns and issues related to stress, mental health, and physical health and illness. Women learn and process information more readily through relationships. Studies have also found that help-seeking behaviors in women can be reciprocal, which means that women can benefit from giving social support as well as from receiving it. The buffering hypothesis suggests that women’s feelings of stress during a crisis situation are reduced if they have more social support. Social support can also decrease physical health symptoms, as women learn from one another, developing positive coping strategies and ways to manage illness. Informal help seeking and social support have gone increasingly to the Internet. Online support communities for chronic illness, information gathering, and mental health issues have become more common in recent years. Women can connect with one another across the globe by utilizing online support resources. There are numbers of support sites specifically for women seeking help and support with health and mental health issues. Studies show that interventions for women that are either online or through telephonic communication are successful at providing access to help and support for chronic illness. These interventions have been demonstrated to reduce isolation and improve access to health information and support, especially in rural communities, where seeking help is more difficult due to distance and travel limitations.

Interpersonal Violence and Help Seeking in Women Interpersonal violence (IPV) and help seeking is a topic that has received more attention in women’s health literature since the early 2000s. Despite the growing attention to IPV as a widespread public health concern, it remains a taboo topic, holding a stigma for many women and families. Women are often embarrassed to admit that they have this type of problem in their home. The literature demonstrates that formal help seeking often follows an incident of physical abuse that was reported to the

police. There are studies that show that women are more likely to seek professional or formal help following an incident of this type. Women seek help from mental health counselors, social workers, psychologists, and specialized domestic violence hotlines and shelters for assistance with IPVrelated issues. Women also look to informal supports, which can be helpful depending on the source and their understanding of IPV dynamics. Friends and relatives are less helpful in referring to outside sources of help unless they have had experience with IPV, although women are more likely to seek help from friends and family before seeking professional help. The literature demonstrates that women do seek help from clergy and religious personnel for advice with IPV. Experiences with clergy are mixed. There are limited studies on this particular topic of help seeking, but those available show that clergy want to help women in this kind of situation but often do not know how to help or the correct strategies to advise. For example, clergy might suggest marital or couples counseling, although this is a controversial piece of advice, due to safety concerns. Another example is a clergy person who might recommend separation if an abusive act happens again rather than addressing the immediate safety issue. There are studies suggesting that the type of support or advice/reaction a woman receives from any source of support or help determines her next steps and whether or not she will seek help in the future. Thus, it is important for providers and community members to understand the level of importance these interactions may hold.

Cultural Factors and Help Seeking in Women Culture and sociocultural issues play a large role in the ways in which women seek help and the types of help that they seek. Women of color are less likely than White women to seek help, both professionally and through informal supports. Stigma in communities of color is high with regard to mental health and related illnesses, so women of color are often hesitant to seek professional care. They are also embarrassed to discuss these issues with friends and family for fear of being labeled “crazy” or “sick.” Furthermore, Latina women delay help

Help-Seeking Behaviors and Women

seeking due to language barriers and fear of deportation. The literature indicates clear health disparities with regard to mental and physical health conditions in women of color. Mortality rates from health problems related to heart conditions, diabetes, and asthma are higher among women of color. Studies show that hesitance to seek care and lack of trust in the medical community, as well as lack of access to health information, contribute to these disparities. The digital divide contributes to this as well. The digital divide refers to the concept that people of color and of lower socioeconomic status tend to have less access to the Internet, computers, and online information, in general. Women of color are more likely to rely on spirituality and their connection to religion and a higher power to help them heal, as well as seeking advice from clergy. The literature demonstrates that this relationship is especially strong in African American and Caribbean American women. The literature on help seeking in Asian and South Asian women is sparse, but the topic has been studied more in recent years. The available literature demonstrates serious stigmas associated with help seeking in Asian women, particularly for IPV and for mental health issues. Also, Asian families often choose to seek help from nontraditional sources and rely less on Western medicine. This is sometimes interpreted as mistrust for the health care system, but may represent a different framework for treating illness. That being said, there still remains stigma within this community around help seeking, and widespread embarrassment exists if a family member exhibits symptoms of mental illness or inability to manage stress.

Barriers to Help Seeking There are numbers of things that can stop women from seeking help in situations of crisis or need. Stigma associated with mental health issues, such as depression, anxiety, mood disorders, or psychosis, sometimes keep women from seeking professional help. Stigmas can also keep women from discussing their symptoms or concerns with friends and family, for fear of being ostracized or labeled. Research shows that it is becoming more and more important as time goes on to educate communities and families about mental health and its associated

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symptoms and the consequences of untreated mental illness. This may reduce stigma and therefore improve women’s confidence in seeking the help that they need. Poor health literacy or knowledge about health and mental health issues that might be troubling has also been a long-time barrier. The more recent surge of health knowledge on the Internet has greatly increased women’s access to health information, and studies show that women are more likely to seek out information on the Internet. However, there is a wide range of information available from sources of varied reliability.

Future Directions Further research needs to be conducted to develop validated measurement tools for help-seeking behaviors. Once clear definitions are developed, more defined studies can be done to provide clarity around women’s help-seeking behaviors. By using different definitions of help seeking, it is difficult to compare findings across studies. Consistency in this area will be of great value. Also, while it is clear that women do seek help more often than men and are less hesitant about seeking help from a variety of sources, stigmas still exist, particularly around sexual health, colorectal health, and ­mental health. There also remains a lack of information about the process of help seeking and motivating factors. Learning about these topics can assist health care providers in developing interventions to reach more women and reduce stigmas and ­barriers to help seeking. Amanda Sisselman-Borgia See also Health Issues and Gender: Overview; HelpSeeking Behaviors and Men; Mental Health Stigma and Gender; Sexual Dysfunction

Further Readings Anker, A. E., Reinhart, A. M., & Feeley, T. H. (2011). Health information seeking: A review of measures and methods. Patient Education and Counseling, 82(3), 346–354. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., . . . Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of

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quantitative and qualitative studies. Psychological Medicine, 45(01), 11–27. Cornally, N., & McCarthy, G. (2011). Help-seeking behaviour: A concept analysis. International Journal of Nursing Practice, 17(3), 280–288. Currie, D., & Wiesenberg, S. (2003). Promoting women’s health-seeking behavior: Research and the empowerment of women. Health Care for Women International, 24(10), 880–899. Evans, M. A., & Feder, G. S. (2014). Help-seeking amongst women survivors of domestic violence: A qualitative study of pathways towards formal and informal support. Health Expectations, 19(1), 62–73. Oliver, M. I., Pearson, N., Coe, N., & Gunnell, D. (2005). Help-seeking behaviour in men and women with common mental health problems: Cross-sectional study. British Journal of Psychiatry, 186(4), 297–301. Percheski, C., & Hargittai, E. (2011). Health informationseeking in the digital age. Journal of American College Health, 59(5), 379–386. Rizo, C. F., & Macy, R. J. (2011). Help seeking and barriers of Hispanic partner violence survivors: A systematic review of the literature. Aggression and Violent Behavior, 16(3), 250–264. Wu, L. T., & Ringwalt, C. L. (2014). Alcohol dependence and use of treatment services among women in the community. American Journal of Psychiatry, 161(10), 1790–1797.

Heteronormative Bias in Research Heteronormative bias is the preconceived opinion that heterosexuality is the only normal and natural form of sexuality. Historically, heteronormative bias has been particularly prevalent in research on sexual minorities. As the European medical community became interested in human sexuality in the 18th century, homosexuality and other forms of nonprocreative sex were written about as deviations from “normal” sexuality. These writings ­continued well into the 19th century, until homosexuality and all other types of nonprocreative sexuality were specifically labeled as pathological in nature. Akin to insanity, homosexuality was considered to be a mark of a deeply disturbed individual. Perceptions of nonheterosexual behavior as

pathological persisted into early psychoanalytic writings in the 20th century. For example, Sigmund Freud considered homosexuality as a less mature form of identity, and this assumption continued in psychoanalytic writings throughout the mid- and late 20th century. In addition to addressing heteronormative bias in early research, this entry discusses the sources of such bias in current research.

Heteronormative Bias in Early Empirical Research The first set of empirical research on homosexuality began in the late 1950s and continued into the 1960s and early 1970s. Much of the research from this era contained the bias that heterosexuality was the norm and that deviations from heterosexuality were pathological. Indeed, a content analysis of 139 research studies from the late 1960s to the early 1970s showed that 88% of the research assumed the psychopathology of homosexuality. As such, research focused on developing methodologies for diagnosing homosexuality and discerning the causes of homosexuality, and on attempts to confirm the psychopathology of homosexuality. Research attempting to find a methodology for diagnosing homosexuality stems from the assumption that homosexuality is a disease that must be diagnosed in order to be cured. Likewise, investigations on the causes of homosexuality were primarily conducted to prevent its development or to find a treatment for it. Research attempting to find evidence supporting the psychopathology of homosexuality arises from the assumption of psychopathology. These research studies, by and large, were unsuccessful: Not only did they fail to find a “cure” for homosexuality, but also attempts to find empirical evidence supporting the psychopathology of homosexuality were unsuccessful. To the contrary, even though the initial trickle of research confirming the lack of mental health concerns in participants who were homosexual compared with those who were heterosexual was largely ignored, by the late 1970s the volume of research refuting the psychopathology theory had snowballed and could no longer be ignored. This culminated in the removal of homosexuality from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Heteronormative Bias in Research

Persistence of Heteronormative Bias in Current Research Much of the early work investigating homosexuality provides examples of overt bias. While current research no longer equates homosexuality with psychopathology, many biases still remain. Common themes in research that demonstrate continuing heteronormative bias include assumption of the heterosexuality of participants, the assumption that psychological processes are identical for heterosexual and nonheterosexual participants, perpetuation of the disease model of homosexuality, the use of inaccurate comparison groups and biased sampling, and the use of biased measurements. Assumption of Heterosexuality

A common source of heteronormative bias found in psychology research is the assumption of heterosexuality for all participants. This occurs when researchers overlook or deny the presence of participants who are lesbian, gay, or bisexual (LGB). For example, research investigating the psychological processes of sexuality might discuss sex solely as vaginal intercourse, or romantic attraction as exclusively heterosexual. In either case, when LGB participants are not identified in the research, the researcher risks using a research design that is not appropriate for all of the participants involved. Considering that most adult ­samples will contain some participants who are LGB, the assumption of heterosexuality can be particularly problematic for the validity of the data. Defining sex as intercourse can result in lower rates of reported sexual activity and more restricted types of sexual activity than those existing in reality, calling into question the validity of the findings. Assumption of Identical Psychological Processes

Heteronormative bias can also occur when the psychological processes under study are assumed to identically affect heterosexual and LGB individuals. Looking at the previous example, it may not be the case that the psychological processes involved in sexuality and romantic attraction are identical between LGB and heterosexual participants. Thus, even if heterosexuality is not assumed,

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assuming a lack of variability in psychological processes can result in incorrect theory formation and lack of data validity. On the other hand, research that examines the possibility of differences across LGB and heterosexual participants could broaden the overall understanding on topics of interest and help identify linkages between sexual orientation and other psychological phenomena. Recognition of difference is also critical to research on topics that may be of particular interest to sexual minorities, such as the experience of stress due to being a member of a stigmatized sexual minority group. Focus on the Disease Model of Homosexuality

As mentioned previously, the assumption of psychopathology in participants who are LGB has been a major source of bias in psychological research. Even though attempts to find cures or treatments for nonheterosexual identities have been largely discredited and the practice of conversion therapy declared unethical, research on or about sexual minority status can still be subtly framed within the disease model. For example, researchers can imply the psychopathology of homosexuality when nonheterosexual identities are assumed to be associated with poor adjustment. Much of the current research on sexual minority status tends to focus on the negative impact of sexual minority status on psychological and physical well-being. Of course, these studies are not suggesting that nonheterosexual identities, in and of themselves, are harmful or unhealthy. Rather, they are usually investigating the harm caused by negative stereotypes and stigma on stress and health. And, indeed, some studies have found a connection between sexual minority stigma and increased symptoms of stress. However, focusing of research on adverse effects, rather than on positive impact, can carry a subtle message that ties LGB identities with mental distress and signal ill-being and lack of adjustment. On the other hand, an approach that considers perseverance and other positive effects alongside research into ill effects could serve to avoid such biases. Indeed, research looking at the overall health and well-being of sexual minorities has suggested that while social stigma exists, members of sexual minority groups have

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the ability to manage the potentially negative effects that their sexual minority status may have both for mental health and for relationship quality between partners. Factors such as family support, internalized homophobia, and self-esteem can all mediate the relationship between discrimination and life outcomes. Similarly, early research investigating the coping mechanisms of participants who are LGB tended to perpetuate the disease model of homosexuality by emphasizing the relationship between sexual orientation and the tendency to use negative coping mechanisms. This type of research often ignored the situational factors that could be affecting the data. Research looking at rates of alcoholism in sexual minority populations typifies this type of bias; not only was the emphasis on the negative behavioral coping mechanism of using alcohol, but the research also often ignored situational factors that could have better explained the relationship, such as participant recruitment from a bar. It was only relatively recently that work began to look equally at positive coping mechanisms for sexual minorities, such as crisis competence, and negative ones.

recent work has demonstrated that probability sampling methodology, such as random digit dialing, is a viable method for conducting research with members of sexual minority groups. Thus, while this type of participant recruitment methodology might not fit all types of research, it does offer a possible method for ensuring that the participant sample is reflective of the population at large. Finding comparison groups for research on sexual minority populations in a way that avoids heteronormative bias can also pose a particular challenge for researchers. Effort must be made to ensure that the comparison reflects the variable of interest. For example, when attempting to compare participants who are lesbians, a comparison sample of married women would not be appropriate. Instead of having sexual orientation as the sole demographic variable of contrast, the research is confounded by marital status. In addition, this comparison is further problematized by the presence of participants in the lesbian group who are in committed relationships, as well as participants in the married group who may be nonheterosexual women who are married to men.

Additional Methodological Sources of Heteronormative Bias

Measurement Validity as a Potential Source of Bias

Participant Recruitment as a Potential Source of Bias Another way in which heteronormative bias can creep into research is in the recruitment of potential research participants. Because of the concealable nature of sexual orientation and the potential impact of internalized heterosexism, the population of those who volunteer for research may not be representative of the sexual minority population as a whole. This can result in two different concerns. First, the existence of stigma against members of sexual minority groups means that random sampling from the general population may not be possible, due to potential participants’ unwillingness to disclose their sexual orientation status. Second, the resulting reliance on convenience samples can result in biased sampling. For example, recruiting participants from LGB organizations, entertainment locations where potential participants who are LGB might gather, or urban centers where the stigma surrounding sexual orientation might be less strident can result in biased outcomes. However,

The measures used in research can also introduce potential bias in the research. Wording that is either noninclusive of sexual minorities or pathologizes nonheterosexual identities may perpetuate heteronormative bias in the research. While there are many instances in which noninclusive language may be used, some common examples include equating sexuality and sex with heterosexuality and heterosexual sex, respectively, and unnecessary gender labeling of the participant’s romantic or sexual partners. Oftentimes, this problem is most relevant in research specifically looking at one gender. For example, the Female Sexual Function Index ignores the possible presence of sexual minorities in the sample by defining sexual activity as heterosexual-specific sex activities.

Final Thoughts Heteronormative bias in research, while not as pervasive as it has been in the past, can still be an area of concern. Researchers need to carefully

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consider the ways in which the research is framed and question the assumptions that are being made in developing the research question. By avoiding heteronormative bias, researchers can also avoid misapplication of theory, the existence of possible confounding variables, and questions about the validity of the resulting data. Dean Manning and Chu Kim-Prieto See also Ethics in Gender Research; Gender Bias in Research; Gender-Biased Language in Research; Heteronormativity; Research Methodology and Gender

Further Readings Braun, V. (2000). Heterosexism in focus group research: Collusion and challenge. Feminism & Psychology, 10(1), 133–140. Herek, G. M., Kimmel, D. C., Amaro, H., & Melton, G. B. (1991). Avoiding heterosexist bias in psychological research. American Psychologist, 44(9), 957–963. Hooker, E. (1958). Male homosexuality in the Rorschach. Journal of Projective Techniques, 22(1), 33–54. Martin, J. I., & Knox, J. (2000). Methodological and ethical issues in research on lesbians and gay men. Social Work Research, 24(1), 51–57. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. Moradi, B., Mohr, J. J., Worthington, R. L., & Fassigner, R. E. (2009). Counseling psychology research on sexual (orientation) minority issues: Conceptual and methodological challenges and opportunities. Journal of Counseling Psychology, 56(1), 5–22. Morin, S. F. (1977). Heterosexual bias in psychological research on lesbianism and male homosexuality. American Psychologist, 32(8), 629–637.

Heteronormativity Heteronormativity is the notion that heterosexuality is the only “normal” sexual orientation and that romantic relationships exist only between the opposite sexes. It is also the belief that people fall distinctly into two genders, male or female, and that their dress and behaviors reflect their

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biological sex assigned at birth. Similarly, a heteronormative orientation typically means that a person believes that one’s biological sex, gender, and gender expression should align and that one’s sexual orientation should be heterosexual. This creates a system of expectations, demands, and constraints on persons who deviate outside traditional gender, gender roles, or sexual orientations. As such, heteronormativity is linked to heterosexism and homophobia, discussed elsewhere in this encyclopedia. The term heteronormativity was popularized by the queer theorist Michael Warner in 1991, in his article “Introduction: Fear of a Queer Planet.” Other queer theorists, including Gayle Rubin, Adrienne Rich, and Samuel A. Chambers, have provided grounding for the concept. Although based in queer and lesbian, gay, and bisexual (LGB) studies, it has since been adopted into both gender and transgender movements. It is crucial for clinicians, educators, and other practitioners to understand the concept of heteronormativity so that they do not replicate the systems of oppression, discrimination, or prejudice with clients they may serve. As such, the following sections introduce readers to different aspects of heteronormativity and how it can manifest through research, law, and policy. The entry ends with a psychological, cultural, and clinical exploration of the impact of heteronormativity.

Demographics As of April 2015, the population of the United States was estimated to be 321,160,000. Of the total population, approximately 51% are female, 49% male. Early theorists have suggested that approximately 10% of the U.S. population identified as being somewhere on the lesbian, gay, bisexual, transsexual, queer, and intersex (LGBTQI) spectrum; however, more recent statistics estimate that 5.6% of the U.S. population identify as LGBTQI. A variety of factors have influenced the accurate reporting of the true LGBTQI population, leading to considerable debate as to the actual number and percentage. Heteronormativity itself has affected this debate because some people choose to avoid any label that presupposes “normalcy.” Thus, reporting methods, stigma, religious views, and other

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societal views pertaining to the LGBTQI population may cause some individuals who belong to this group to avoid self-identification. The notion of being considered “normal” has a profound impact on human beings. For instance, in large metropolitan areas, such as Boston, Atlanta, and San Francisco, acceptance of the LGBTQI population seems to be more prevalent; in these metropolitan areas, the percentage of people who identify as LGBTQI is much higher than the national statistics. Within Boston, for instance, it is estimated that 12.3% of the metropolitan population identify as LGBTQI; estimates in Atlanta and San Francisco are 12.8% and 15.4%, respectively. Thus, despite a national reported average of 5.6%, one should question the overall demographic of this population, due to the variety of factors that may inhibit self-report.

Legal and Policy Considerations The history of law and policy in the United States has generally favored heterosexual people, fueling the concept of heteronormativity. Going back as far as the ratification of the U.S. Constitution in 1787, heteronormativity was a staple in U.S. law and policy. Although the early laws may have not specifically addressed LGBTQI concerns, they provide a framework for looking at other social issues that have precluded the LGBTQI population from full participation in a heteronormative society. Until the Stonewall Riots of 1969, most of the LGBTQI population were “underground” for fear of retaliation from employers, public servants (the police), and American society in general. Perhaps the greatest policy issues that have historically favored heterosexuals in the United States include employment, military service, and marriage. Employment

In the 1970s, singer and beauty pageant contestant Anita Bryant hosted a campaign against the LGBTQI population. Her “gay scare” tactics suggested that U.S. public school students were being taught by members of the LGBTQI population, which led many states to enact laws prohibiting such individuals from teaching in public schools. As late as 2014, there were nine states that banned “gay propaganda,” or public display or support of

LGBTQI people. Such states can and do freely fire openly LGBTQI teachers in public schools. Heteronormativity provides a rationale for such discrimination in employment, particularly in areas where the LGBTQI population have little or no voice. Military Service

Until 1993, all branches of the U.S. military banned members of the LGBTQI population from service, despite the fact that many members of this population were serving their country. The policy against LGBTQI military service stemmed from heteronormative values and scare tactics; two of the reasons most cited for this ban included the perceived fear of heterosexual service members and perceived fear of blackmail of LGBTQI service members (especially during the Cold War). In 1993, President Bill Clinton signed what is commonly known as “Don’t Ask Don’t Tell” (DADT), whereby LGB (but not transgender) people could serve in active-duty military positions as long as they did not disclose or act on their sexual orientation. This law ultimately had negative ramifications for the LGB population, as the number of military discharges for violating DADT outnumbered the discharges based on sexual orientation prior to its enactment. Ultimately, in 2011, President Barack Obama repealed DADT, and currently, LGB people may openly serve in the U.S. military. However, there is no such provision for transgender people. Marriage

It can be argued that legal marriage is the most intimate relationship in which two people can be engaged. Marriage is typically viewed from both legal and spiritual/religious perspectives. Some would argue that traditional marriage is the most heteronormative system both in the United States and across the world. From a purely legal sense, marriage is a contract between two people. Entering into this contract provides the parties specific rights, such as being insurance beneficiaries, health care visitation, inheritance rights, tax advantages, and other innumerable contractual “rights” between the parties. Unmarried people, whether heterosexual or members of the LGBTQI population, are denied such benefits, making marriage an

Heteronormativity

appealing option for couples, both to publically declare their love for each other as well as to financially and legally protect their spouse. Prior to 2003, it was illegal for same-sex couples to marry in the United States. Despite this limitation, a variety of policies enacted during the 1980s created civil unions and domestic partnerships. Some states recognized such partnerships as similar to the binding contract just described. In addition, many U.S. corporations extended health care benefits to domestic partners. However, this work-around faced some controversy and disappointment among LGBTQI advocates, as shared benefits in domestic or civil partnership arrangements are subject to taxes, whereas marriage benefits typically are not. One entity that never recognized such partnerships was the U.S. government. As such, persons in domestic partnerships were not afforded the tax benefits and, in some cases, inheritance benefits afforded to heterosexual married couples. In addition, one’s domestic partnership was not “portable” between states. Thus, what was recognized as a legal partnership in one state was not necessarily recognized in other states. In 1996, Congress passed the Defense of Marriage Act (DOMA), which defined marriage on a federal level as “between a man and a woman.” This heteronormative act of Congress essentially allowed states to refuse same-sex marriage and refused federal protections and benefits to those in same-sex domestic partnerships. It also had a secondary impact on same-sex couples who wished to adopt children, making the process much more difficult. In a historic 2003 decision, the Massachusetts Supreme Court made marriage between people of the same sex legal; this marked the first time in history that heteronormative “rules” were not required for legal marriage. Over the next 10 years, several states followed suit, legalizing so-called gay marriage or marriage equality. National sentiment and public opinion seemed to be shifting toward acceptance of same-sex marriage. By June 2013, the U.S. Supreme Court struck down DOMA as unconstitutional because it denied federal benefits to legally married samesex couples in the United States. After the U.S. Supreme Court struck down DOMA, numerous LGBTQI couples sued in their

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home states, arguing that prohibition of same-sex marriage was unconstitutional under both the Fifth and the Fourteenth Amendments to the U.S. Constitution. Numerous cases made their way through the federal court system, leading to a disagreement among federal circuit courts of appeal. When such disagreements exist among the circuit courts, the U.S. Supreme Court will often agree to hear the case to settle the difference and create a national law or standard that all states must follow. In a landmark ruling handed down on June 26, 2015, the U.S. Supreme Court, in the case of Obergefell v. Hodges, ruled that marriage is a constitutional right for same-sex couples. Although 36 of the 50 states had already legalized same-sex marriage, this case had the effect of legalizing same-sex marriage in the United States as a whole and further recognized the duty of one state to recognize a legal marriage performed in another state.

Impact and Consequences Heteronormativity, and the frequently concomitant heterosexism, can have an impact on both individuals and the culture more broadly. Combined, these also are known to have societal implications. Research has associated heteronormativity with oppression, discrimination, and role constraint. Furthermore, these consequences are institutionalized through the antiheteronormative stereotyping evident within the legal system and other biased and discriminatory organizational policies, practices, and structures. From an individual perspective, heteronormativity and its correlates affect development. These developmental implications include, but are not limited to, the interrelated aspects of identity formation, internalized homonegativity, and psychological well-being. As heteronormativity has been shown to extend into educational and vocational career choice, the personal developmental ramifications for individuals can be far-reaching. The Gay, Lesbian, and Straight Education Network (GLSEN) conducts a biennial national survey with secondary students that has repeatedly documented high levels of verbal and physical harassment taking place in U.S. schools based on the heteronormative perception of affectual identity and gender expression. Adding to this, students

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who are at the receiving end of this harassment report that not only do school personnel frequently fail to intervene but also these adults whose role it is to protect students sometimes initiate the heteronormative and antigay discourse. Culturally, heteronormativity has been implicated in maintaining and reifying a patriarchal gender binary, negatively affecting all persons. As heteronormativity has been explored across and within many aspects of culture, including national, racial, socioeconomic, religious, political, legal, and educational domains, it is easy to see how the multidimensional facets of heteronormativity can underpin and permeate all aspects of familial and social interaction, relational discourses, and the symbols and enactments of culture quite broadly. One way to positively reframe the ubiquitous nature of heteronormativity is through recognition of the multitude of ways in which allies and social justice advocates can intervene to address and change heteronormativity. Building off the individual and cultural implications of heteronormativity, educators, counselors, and other human service professionals need to also consider the clinical implications. There are welldocumented higher risks for suicidal ideation and self-harming behaviors including alcohol and other drug abuse, as well as higher reported rates of anxiety, depression, and interpersonal conflicts for LGBTQI persons. In addition, the family, friends, and allies of LGBTQI persons may also be at higher risk for person-environment challenges when part of a heterosexist and heteronormative culture. As the relationship between these clinical manifestations and heteronormativity may not be fully recognized or explored by clients, clinicians need to have competency in broaching this subject with clients and further working with them to address this issue within the treatment setting. Cultural relational theory and other constructivist approaches may offer a framework through which clinicians can address heteronormativity and its impact on clients and the cultural systems of which we are all a part. Kristopher M. Goodrich, Melissa Luke, and Steven Kassirer See also Heteronormative Bias in Research; Heterosexism; Heterosexist Bias in the DSM; Homophobia; Microaggressions; Minority Stress

Further Readings Herz, M., & Johansson, T. (2015). The normativity of the concept of heteronormativity. Journal of Homosexuality, 62(8), 1009–1020. De Jong, D. (2015). “He wears pink leggings almost every day, and a pink sweatshirt . . . ”: How school social workers understand and respond to gender variance. Child & Adolescent Social Work Journal, 32(3), 247–255. Kelso, T. (2015). Still trapped in the U.S. media’s closet: Representations of gender variant, pre-adolescent children. Journal of Homosexuality, 62(8), 1058–1097. Matthews, C., & Adams, E. (2009). Using a social justice approach to prevent the mental health consequences of heterosexism. Journal of Primary Prevention, 30, 11–26. Morandini, J. S., Blaszczynski, A., Ross, M. W., Costa, D. S. J., & Dar-Nimrod, I. (2015). Essentialist beliefs, sexual identity uncertainty, internalized homonegativity and psychological wellbeing in gay men. Journal of Counseling Psychology, 62(3), 413–424. doi:10.1037/cou0000072 Ward, J., & Schneider, B. (2009). The reaches of heteronormativity: An introduction. Gender & Society, 23(4), 433–439. Warner, M. (1991). Introduction: Fear of a queer planet. Social Text, 9(4), 3–17. Woodruffe-Burton, H., & Bairstow, S. (2013). Countering heteronormativity: Exploring the negotiation of butch lesbian identity in the organisational setting. Gender in Management: An International Journal, 28(6), 359–374.

Heterosexism Heterosexism is most succinctly defined as prejudice toward a person who is not heterosexual or any act or idea that is not heterosexual. It may be overt or covert, as well as intentional or unintentional. It may be intrapersonal, interpersonal, or institutional in belief or action. Heterosexism may be as subtle as a glance or as violent as murder, while manifesting the full spectrum in between. The presumption of heterosexism is that heterosexuality is normal, is the rightfully privileged affectual identity, and appears to be rooted at the core of most dominant contemporary cultures. It is taught and learned from birth by heterosexuals

Heterosexism

and members of the lesbian, gay, and bisexual (LGB) populations. Concepts such as “deviant,” “unnatural,” and “morally wrong” are used to reinforce heterosexism against those who do not identify as heterosexual, even though they are unsupported by scientific evidence or fact. Heterosexism is nearly ubiquitous in its expression and becomes automatic and unconscious on the part of most individuals. From a social justice point of view, like racism and sexism, heterosexism relates to power and maintaining control. It is about privilege for those who are heterosexual, which is seen as normal, natural, and superior. Members of the LGB populations are denigrated and stigmatized systemically and systematically. All things not heterosexual are minimized, disenfranchised, and marginalized toward subordination and invisibility. Bias, discrimination, and oppression maintain dominance and privilege in civil rights and social benefits, the privilege to feel at home in the world, unencumbered by questioning of oneself or others within one’s group, and without concern for those who are different. Such privilege most often lacks awareness. In most settings, heterosexism has supplanted the older term homophobia. Multiple reasons for this change have been put forward. Homophobia comes from a time when homosexuality was legally and medically pathologized, and thus for many, it continues to carry that sense. Phobia implies an irrational fear or anxiety response in an individual. The connection to mental illness remains, whether applied to those who are homosexual or those with strong responses. Heterosexism, by contrast, encompasses a wider meaning, taking the negative response toward LGB persons from an individual to a societal level. While not dismissing the intra­ personal or interpersonal, it introduces the institutional realm. Heterosexism acknowledges how civil rights and social benefits are denied to those who do not fit the established norm. It recognizes the systematic oppression of these minorities, not unlike oppression due to racism and sexism.

Institutional Heterosexism Heterosexism occurs on an institutional level as society-wide practices or those common to farreaching groups or organizations. Heterosexism

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appears to be the norm within the governmental/ legal system at all levels, educational systems at all levels, major religious organizations, health care systems, and the family. Heterosexuality is assumed and is the preferred standard. These institutions not only teach what they believe to be appropriate behavior but also reward conforming beliefs or behavior with privilege. Collusion between the institutions ensures the marginalization, discrimination, and oppression of persons not identifying as heterosexual, while mitigating the fear of change or loss of prestige among members of the dominant group. Hegemonic gender roles with strict norms and expectations are a means of oppression. Nonconformity is punished swiftly and decisively. Generalizations and stereotypes about gay males and ­lesbians, the former as effeminate and the latter as masculine, are used to perpetuate concepts of members of these groups as deviant or unnatural. Similarly, biphobic responses challenging bisexual individuals as “being confused” or “not able to pick” between genders similarly perpetuate heterosexism by pathologizing and stereotyping bisexuality as a lesser identity. This extends to language use, as gay is used as one of the most condemning of adjectives by heterosexuals, especially adolescent males. While such name-calling seldom is meant literally, the damage is done by stigmatizing members of the LGB populations. Heterosexism is taught in the home by parents and other family members, by peers, in schools, at religious institutions, at places of work, and throughout the media. Even if not more viciously expressed, jokes and comments propagate the message that LGB persons are not normal or welcome. Members of these groups are described in pejorative terms that seldom conform to reality. Legislative groups from the community to the federal level validate and sanction discrimination and exclusion, as well as sustain the dominance of heterosexuality in the legal realm. There have been noteworthy changes, however, including the 2010 repeal of the U.S. military’s “Don’t Ask, Don’t Tell” policy prohibiting openly gay and lesbian members from joining the Armed Forces, the 2013 U.S. Supreme Court decision striking down a portion of the Defense of Marriage Act that forbade recognizing same-sex marriages for the purpose of federal programs even when the marriages were legal in

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the states of residence, and the 2015 U.S. Supreme Court ruling on same-sex marriage creating marriage equality across the nation. The federal Hate Crimes Prevention Act of 2009 included sexual orientation, but only a minority of states have the complementary laws needed to prosecute many such crimes. Laws protecting LGB persons from discrimination in housing and jobs, similar to those based on race, religion, and sex, exist in fewer than half of the U.S. states. Politicians continue to campaign on promises of revisiting and trying to change the current status of Don’t Ask, Don’t Tell, the Defense of Marriage Act, and marriage equality. State and local officials are using existing or passing new so-called religious freedom laws in support of legalized discrimination in retail establishments and restaurants. The message to LGB individuals is still quite clear, especially in much of the United States: Even those civil rights that have been afforded are opposed by many and may be at risk.

Interpersonal Heterosexism Heterosexism occurs on the interpersonal level when involving exchanges between two or more persons. This would include a major part of what most people think of when considering heterosexism (or homophobia). Interpersonal heterosexism cannot easily be separated from institutional heterosexism, which teaches the underlying beliefs and continues to support—or at least not interfere with—interpersonal expressions of heterosexism. Whether direct or indirect, verbal or physical, subtle or violent, intentional or unintentional, these actions intimidate and denigrate members of the LGB populations. Simply witnessing heterosexist language used to insult others, as described earlier, is demeaning and perpetuates the message that LGB persons are not normal and certainly not wanted. More direct interpersonal heterosexism may take the form of LGB persons being stared at, laughed at, or targeted with rude and demeaning language or name-calling. Seemingly more benign treatment, but no less harmful, may consist of being ignored or not included in activities. Due to the depth and pervasiveness of heterosexism, even those who believe themselves to be supportive of LGB persons may perpetuate heterosexism out of ignorance and lack of understanding. Interpersonal heterosexism often escalates to physical expressions ranging from threatening

postures to physical contact, including assault and battery, and in some cases murder. For LGB adolescents, already facing the usual challenging changes of that stage of life, bullying is especially common. Lack of support from school officials or even from their families results often in lower academic ­performance, quitting school, running away, homelessness, or even suicide, sometimes referred to as bullycide. Adults too may be met with abuse in college, at work, or in other social or legal situations. Personal and property damage and other hate crimes may be attributed to heterosexist beliefs. Much of the subtle heterosexism faced daily by members of LGB populations may not even be within their awareness. Microaggressions are so frequent and common that they go unnoticed consciously by both perpetrator and victim. Members of LGB populations received the same indoctrination growing up as did heterosexual children and adolescents. They too believe heterosexism to be normal. This is often described as internalized ­heterosexism. Heterosexist microaggressions may include seemingly innocent questions such as ­asking whether an adolescent has a girlfriend or boyfriend (using the term that would indicate ­heterosexuality) or inquiring whether an adult is married (which even in the new age of marriage equality most often means to a person of the ­opposite sex). These heteronormative assumptions perpetuate the sense that nonheterosexual relationships are unnatural. Interpersonal heterosexism along with institutionalized heterosexism contributes to stigma and stress among LGB persons, whether open or secretive about their orientation status. Coming out or disclosing their sexual orientation status is less likely among persons who experience or witness heterosexism. Disclosure to others has been seen to reduce antigay prejudice as people are able to put aside the propagated myths and come to know the LGB persons in their lives. An openly LGB person, however, faces higher levels of heterosexism, including discrimination, rejection, and violence. An unfortunate cycle of continued heterosexist behavior and continued secrecy is thus perpetuated.

Intrapersonal Heterosexism Heterosexism occurs intrapersonally when it is within an individual. Just as members of racial/ ethnic minorities can grow up to have internalized

Heterosexism

racist thoughts or identity, members of the LGB populations often grow up holding beliefs that are disparaging or stereotypical of their own LGB identity or behavior or that of others. The commonly used terms include internalized heterosexism, internalized homophobia, and internalized oppression. As stated earlier, children who grow up to be LGB individuals are taught the same heterosexism as other children. From birth, institutional and interpersonal heterosexism reinforces the stigma, as any behavior on the part of these children that may indicate nonconformity is quickly discouraged. The message is clear to the child and the adolescent that something is wrong with them. Heterosexism perpetuates this concept of pathology of the individual as opposed to a societal problem in dealing with those who are different. Unlike members of other oppressed groups, the situation is further complicated for LGB children because they almost always grow up in families with no other members sharing their status. Intrapersonal heterosexism, along with the stress associated with belonging to a marginalized group, results in reduced self-esteem and selfworth, which contributes to lowered academic performance, sexual risk taking, drug and alcohol use, self-harm, and suicide. Intrapersonal heterosexism is independent of the disclosure of affectual orientation, with even those who are passing as heterosexual subject to this internal conflict and struggle. Ironically, intrapersonal heterosexism may result in the individual manifesting strong externalized heterosexism interpersonally and in support of institutional heterosexism. Members of the LGB populations are disproportionately represented among those persons who seek mental health services. This fact has been used to insinuate that the pathologizing has some basis. Considered differently, psychological distress is an understandable response to minority stress and heterosexism on the institutional, interpersonal, and intrapersonal levels.

Intersectional Identities Individuals have multiple identities, including affectual orientation and racial/ethnic affiliation. The intersectionality of identities affects how individuals see themselves (intrapersonally), how others view them (interpersonally), and how society may treat them (institutionally). Minority cultural

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beliefs and expectations around gender roles and behaviors (e.g., machismo and marianismo in Hispanic culture) may create additional challenges for LGB persons. Likewise, institutional heterosexism may be greater within some cultural groups (e.g., African American, Hispanic, Asian American), corresponding to stronger familial and religious connections. Identity development on these various fronts may be more difficult, resulting in intrapersonal heterosexism and intrapersonal racism, not to mention intrapersonal sexism. Within the current empirical literature on LGB populations, there appears to be a White bias. Of course, members of any race or ethnicity may hold an LGB identity, but White dominance and privilege carry over to LGB populations just as in society as a whole, including academia. Additional research exploring LGB persons of color and their experiences is needed. At the very least, the intersectionality of multiple minority statuses presents LGB individuals with challenges on multiple fronts. This compounds the experiences already faced by LGB or racial/ethnic minority members. Messages promoting the standards of the dominant racial/ethnic culture added to the dominance of heterosexuality complicate the experiences of LGB persons of color.

Modern Heterosexism Popular support for and acceptance of LGB persons are much higher than in previous decades, with rejection of the old style of hostility by many. Many celebrated the 2015 U.S. Supreme Court decision regarding marriage equality. While polls varied, it was estimated that about 50% of Americans were in support of the decision. The same decision, however, brought forth vitriolic rhetoric from some politicians and religious leaders, in itself perpetuating oppression but also calling for retreating to previous levels of civil rights. As has been seen in the realm of race, much of heterosexism has taken a modern approach in which it is expressed less brutally but nonetheless destructively. This new heterosexism often avoids physical violence, which may bring sympathy for LGB populations, in favor of approaches such as promoting the idea that heterosexist oppression has come to an end. The lack of recognition of the more far-reaching aspects of prejudice and

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discrimination merely demonstrates the depth of heterosexism within society. Calls for patience or denials that heterosexism still exists, no matter how supportive the intention, perpetuate the power of the dominant group.

Clinical Applications Given the prevalence of heterosexism across institutional, interpersonal, and intrapersonal domains, internalized homonegativity and sexual identity distress are common. It is therefore understandable that both LGB and heterosexual clients may present in psychotherapy with a need to explore and address the impacts of heterosexism. Interventions focused on heterosexism at the institutional, interpersonal, and intrapersonal levels are suggested for clinicians’ consideration. To address heterosexism at the institutional level, clinicians can support clients in reflecting on the ways institutions of which they are a part may be contributing to and reifying institutionalized heterosexism. Accordingly, clinicians may introduce the concepts of an organizational assessment/ audit and organizational transformation. Clinicians can facilitate clients’ gathering of information about how the policies and practices of various organizations (e.g., school, work, avocational clubs or associations) may perpetuate heterosexist beliefs, as well as how such organizations may acknowledge, respond to, or advocate to combat heterosexism. Successively, clinicians can then support clients in identifying, developing, and implementing efforts directed at organizational transformation, with a primary goal of illuminating and eradicating the insidiousness of heterosexism. Given the nature of group work, group ­counselors have a unique opportunity to address heterosexism at the interpersonal level. As such, clinicians are advised to consider group activities and interventions that are designed to formally address heterosexism, as well as look for less formal opportunities to identify and address heterosexism when it is occurring within groups. Group therapists may use immediacy in these instances, helping clients process their respective experiences and potentially redress them in the moment. Individual therapists can also address interpersonal experiences of heterosexism and microaggressions with their clients. Psychotherapists may wish to

employ psychoeducation with clients, aimed at developing a greater understanding of the physical and psychological effects of heterosexist stressors, including interpersonal experiences of heterosexism. In tandem, counselors can work to develop positive coping skills and resiliency-building strategies with individual clients, designed to ameliorate the negative effects of heterosexism. At the intrapersonal level, both LGB and heterosexual clients may present with a range of thoughts, feelings, behaviors, and relationship patterns related to the impacts of internalized heterosexism. Psychotherapists may wish to intentionally select and utilize cognitive and narrative interventions focused on clients’ thoughts, affective and e­ motionfocused interventions focused on clients’ feelings, behavioral and experiential interventions focused on clients’ behaviors, and systemic i­nterventions that address cultural, familial, and relational dynamics. Last, whether clinicians are working with clients to examine and address ­heterosexism at the institutional, interpersonal, or intrapersonal level, attention to preventive measures is also warranted. Relational cultural theory may be useful in providing clinicians with direction toward these efforts. Kristopher M. Goodrich, Gene Crofts, and Melissa Luke See also Heteronormativity; Homophobia; Internalized Heterosexism; Microaggressions; Minority Stress

Further Readings Herek, G. M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research and Social Policy, 1(2), 6–24. doi:10.1525/srsp.2004.1.2.6 Kashubeck-West, S., & Szymanski, D. (2008). Risky sexual behavior in gay and bisexual men: Internalized heterosexism, sensation seeking, and substance use. The Counseling Psychologist, 36(4), 595–614. doi:10.1177/0011000007309633 Matthews, C., & Adams, E. (2009). Using a social justice approach to prevent the mental health consequences of heterosexism. Journal of Primary Prevention, 30, 11–26. doi:10.1007/s10935-008-0166-4 Morandini, J. S., Blaszczynski, A., Ross, M. W., Costa, D. S., & Dar-Nimrod, I. (2015). Essentialist beliefs, sexual identity uncertainty, internalized

Heterosexist Bias in the DSM homonegativity, and psychological wellbeing in gay men. Journal of Counseling Psychology, 62(3), 413–424. doi:10.1037/cou0000072 Nadal, K. L., Issa, M., Leon, J., Meterko, V., Wideman, M., & Wong, Y. (2011). Sexual orientation microaggressions: “Death by a thousand cuts” for lesbian, gay, and bisexual youth. Journal of LGBT Youth, 8(3), 234–259. doi:10.1080/19361653.2011 .584204 Swim, J. K., Johnston, K., & Pearson, N. B. (2009). Daily experiences with heterosexism: Relations between heterosexist hassles and psychological well-being. Journal of Social & Clinical Psychology, 28(5), 597–629. doi:10.1521/jscp.2009.28.5.597 Walls, N. E. (2008). Toward a multidimensional understanding of heterosexism: The changing nature of prejudice. Journal of Homosexuality, 55(1), 20–70. doi:10.1080/00918360802129287

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in the

DSM

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition as of 2013, describes the origins, etiology, and treatment of mental disorders. Today, the DSM is used by a variety of mental health professionals including psychiatrists, psychologists, social workers, and counselors in the United States as a guide for treating patients with mental disorders. Earlier versions of the DSM received criticism over its heterosexist bias, which refers to the favoring of heterosexuality over all other forms of sexuality, particularly as it relates to its classification of homosexuality as a mental disorder.

Homosexuality as a Mental Disorder The earliest example of heterosexist bias in the DSM was seen in the original version of the manual published in 1952 that classified homosexuality as a mental disorder in the section on sexual deviations. Homosexuality was categorized as a sociopathic personality disturbance because it was believed that it stemmed from a traumatic parentchild relationship manifested from a supposed pathological hidden fear of the opposite sex. The predominant view of homosexuality as pathology

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was initially challenged in 1957 by psychologist Evelyn Hooker who found no significant differences between the overall psychological adjustment of 30 homosexual men and 30 heterosexual men in the United States. This study was important because it included both homosexual and heterosexual men who were functioning normally in society and were recruited from community-based organizations. In other words, these were men who were not psychiatric patients or receiving mental health treatment of any kind. To avoid any potential experimenter bias in knowing the sexual orientation of the participants, Hooker had independent experts blindly score three projective tests (the Rorschach, Thematic Appreciation Test, and Make-A-Picture-Story Test) that were completed by participants. The two independent groups (homosexual men and heterosexual men) were matched according to age, education, and level of intelligence. The experts were unable to distinguish the sexual orientation of participants when asked by Hooker which tests were completed by each group. Equal numbers of heterosexual and homosexual men (2/3 per group) were categorized by the experts to be in the three highest categories of psychological adjustment. Based on her findings, Hooker concluded that homosexuality is not a psychiatric disorder. Other researchers have confirmed these results through replication studies. For example, in 1971, psychologist Mark Freedman used the same methodological design as Hooker to compare ­ homosexual women with heterosexual women. However, instead of using the same projective tests as Hooker, he used personality tests. Similar to Hooker, he did not find any significant differences between the two groups of women. Despite these encouraging findings for the gay and lesbian community, it surprised some individuals in the medical profession who questioned these and other similar study’s findings. Thus, homosexuality remained in the DSM as a psychiatric disorder until 1974. In 1970, the American Psychiatric Association’s annual convention was held in San Francisco, ­California, where gay rights activists and others protested the continued inclusion of homosexuality as a mental disorder in the DSM. These individuals argued that homosexuality is a normal part of human sexuality and not a pathological deviation

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of normal sexual development as many psychiatrists and others had believed at the time. Proponents of this view indicated that the declassification and removal of homosexuality from the DSM was warranted because it was scientifically unfounded, encouraged an adversarial relationship between psychiatry and the gay and lesbian community, and was misused by some individuals inside and outside psychiatry to deny civil rights to sexual minorities. On the other side of the debate, however, were people who viewed homosexuality as a pathological disturbance in sexual development and believed that to remove it from the DSM would officially endorse a form of sexual deviance, that it would be a cowardly act of succumbing to the pressure of a small but vocal group of gay rights activists trying to prove that they and other homosexuals were not mentally ill, and that it would discourage gay and lesbian persons from seeking much-needed psychiatric treatment. Although there has been some past research that has claimed to support the notion that homosexuality is a mental disorder, many of these studies have been critiqued for being methodologically flawed. Unlike Hooker’s participants, these researchers used samples comprising psychiatric patients or incarcerated individuals, for example. Therefore, generalizability of the findings from these studies to the population at large would be difficult. Investigator bias was also a major weakness of many of these studies because the ­ researchers and evaluators were not blinded to the identity of the participants. For instance, overall psychological well-being might be assessed by a participant’s psychoanalyst, who was treating the participant for homosexuality at the same time. In addition, some clinical researchers would interpret any differences in childhood experiences or family relationships between heterosexuals and homosexuals as evidence for psychopathology among the homosexual participants, even when there were no statistical differences in social or psychological functioning between the two groups. It should be noted that heterosexism may evoke for some individuals persistent and marked distress regarding their sexual orientation. Similarly, for those not yet aware of their homosexuality, heterosexism may manifest unrelenting and severe anxiety about their sexual differentness. Highly closeted individuals or persons not publically open about their sexual orientation may experience

symptoms that are consistent with a variety of mental disorders. Yet when these individuals come out or reveal their true sexual orientation, the symptoms or other problems they had been experiencing dissipate. Sociocultural influences on a diagnosed mental disorder have not always been identified or considered as part of the treatment process. In the past, a variety of psychiatric problems have been associated with homosexuality including borderline personality disorder, dysthymia, hypomania, homosexual panic, and homosexual erotomania. However, it is important to point out that many of these mental disorders may have resulted from the experience of heterosexism by sexual minorities. During the early 1970s, gay rights activists interrupted conference proceedings by challenging psychiatrists and other mental health professionals for maintaining their stance that homosexuality was a psychiatric condition that needed to be treated and cured. It was not until the seventh printing of the second edition of the DSM ­(DSM-II) in 1974 that homosexuality was declassified and removed as a mental disorder. This was based, in part, on data presented by a number of researchers including Hooker and Alfred Kinsey who showed that homosexuality was not a pathological deviation from normal sexual development. Even though homosexuality was declassified and removed as a psychiatric disorder from the DSM, it was replaced with another condition called sexual orientation disturbance.

Sexual Orientation Disturbance Sexual orientation disturbance was the mental disorder that replaced homosexuality in the revised version of the DSM in 1974. It was created for persons who were disturbed by, in conflict with, or wished to change their sexual orientation from homosexual to heterosexual. It was supposed to be distinguished from the earlier diagnosis of homosexuality, which by this version of the manual no longer constituted a psychiatric illness by itself. Homosexuality was now viewed as one form of sexual behavior and like other forms of sexual behavior was no longer considered to be a psychiatric problem. However, the code number used for sexual orientation disturbance was the same as the one used for homosexuality in the International Statistical Classification of Diseases and Related

Heterosexist Bias in the DSM

Health Problems (ICD) published by the World Health Organization. Later, the diagnosis of ­egodystonic homosexuality would replace sexual orientation disturbance in the third version of the manual in 1980.

Egodystonic Homosexuality Egodystonic homosexuality refers to a mental ­disorder in which an individual’s sexual orientation or physical and emotional attraction to the same-sex conflicts with that person’s idealized image of themselves. Some psychiatrists and other mental health professionals argued that the disagreement between one’s realized self and one’s idealized self produces anxiety and a desire to change one’s sexual orientation from homosexual to heterosexual. Specifically, in this version of the manual, egodystonic homosexuality was indicated by two features: (1) a persistent lack of heterosexual arousal, which the patient experiences as interfering with initiation or maintenance of wanted heterosexual relationships and (2) persistent distress from a sustained pattern of unwanted homosexual arousal. Critiques of this new diagnostic category claimed that it was a political compromise to appease those psychiatrists and other mental health professionals, mostly psychoanalysts, who still considered homosexuality to be a mental disorder. Some clinicians also questioned the clinical utility of having a separate diagnosis that focused on an individual’s dysphoria as opposed to subsuming it under other general diagnostic categories. In addition, gay rights activists proclaimed that the use of egodystonic homosexuality perpetuated antigay and -lesbian sentiment. Some members of the American Psychiatric Association also supported the notion that for some gay and lesbian persons their sexual orientation could be considered to be ego dystonic or incompatible with or unacceptable to the ego due to the widespread prejudice against homosexuality in the United States and around the world. They argued that the development and maintenance of a positive selfimage for sexual minorities can be daunting given that fears and misunderstandings about homosexuality are pervasive. In 1987, with the publication of the American Psychiatric Association’s DSM-III-R, egodystonic homosexuality was removed as a psychiatric condition. However, the World Health Organization’s

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ICD-10 includes a version of this called ­egodystonic sexual orientation, which is considered to be a disorder of sexual development and orientation. For a diagnosis of egodystonic sexual orientation, according to the ICD-10, the individual must have a mental disorder that makes him or her want to change his or her sexual orientation. However, sexual orientation in and of itself does not constitute a psychiatric problem, according to the ICD10 by this point. Several national organizations have been opposed to the use of egodystonic sexual orientation, such as the American Psychological Association, since the late 1980s.

Sexual Disorder Not Otherwise Specified With the declassification and removal of egodystonic homosexuality from the DSM-III-R in 1987, sexual disorder not otherwise specified was added in its place. According to this version of the manual, sexual disorder not otherwise specified shared the same diagnostic criteria as egodystonic homosexuality, which includes a persistent and marked distress about one’s sexual orientation. This has remained unchanged through multiple revisions of the manual including the DSM-IV in 1994, the DSM-IV-TR in 2000, and the DSM-5 in 2013. Some critics have argued that the maintenance of sexual disorder not otherwise specified as a diagnosis in the DSM allows mental health professionals the flexibility in continuing to pathologize homosexuality as a mental disorder. Indeed, this diagnosis has been used by some clinicians to rationalize the use of conversion or reparative therapy, which is a form of treatment that aims to alter one’s sexual orientation from gay, lesbian, or bisexual to heterosexual. Such treatments are ineffective and result in long-lasting trauma, which is why the American Psychiatric Association, the American Psychological Association, and all other mental health organizations have viewed such treatment as unethical.

Conclusion Although homosexuality has been declassified and removed from the DSM as a mental disorder since the early 1970s, some have argued that heterosexist bias continues to influence the writing and usage of the manual today. Over the past four decades, different diagnostic categories were

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developed and then subsequently replaced to account for the removal of homosexuality including sexual orientation disturbance in DSM-II, egodystonic homosexuality in the DSM-III, and ­ sexual disorder not otherwise specified in the DSM-III-R. Each of these newly formed diagnostic categories has been criticized for perpetuating antigay and -lesbian sentiment. Moreover, some ­ clinicians have suggested that for most sexual minorities their sexual orientation could be considered egodystonic due to the widespread prejudice against homosexuality in the United States and around the world. Jacob J. van den Berg See also Anti-Trans Bias in the DSM; Gender Bias in the DSM; Gender Role Socialization; Heteronormativity; Heterosexism; Patriarchy

ways in which sexuality and gender are entangled in our heteropatriarchal society. For the purpose of clarification, it is important to note that the terms sexual orientation and sexual identity are distinct constructs despite the fact that they have historically been used interchangeably. First, sexual orientation is narrower and refers specifically to an individual’s attraction and/ or behavioral inclinations toward one or more sexes. Second, sexual identity is broader and can be defined as the recognition, acceptance, and expression of various aspects of an individual’s sexuality, which includes sexual values, behaviors, and desire, as well as sexual orientation. This entry reviews several identity development models and discusses the need for future models and empirical research.

Marginalized Identity Development Models Further Readings Freedman, M. (1971). Homosexuality and psychological functioning. Belmont, CA: Brooks/Cole. Herek, G. M., Chopp, R., & Strohl, D. (2007). Sexual stigma: Putting sexual minority health issues in context. In I. H. Meyer & M. W. Northridge (Eds.), The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual, and transgender populations (pp. 171–208). New York, NY: Springer Science+Business Media. Spitzer, R. L. (1981). The diagnostic status of homosexuality in DSM-III: A reformulation of the issues. American Journal of Psychiatry, 138, 210–215.

Heterosexual Male Identity Development The concept of heterosexual identity development has only recently begun to gain attention in the field of psychology. This serves as an important advancement for the profession because it disrupts the common societal assumption that the identity category of heterosexuality is uniform and “natural.” Furthermore, placing the lens on heterosexual male identity development is particularly relevant to psychology and gender because of the powerful

Since the mid-1980s, scholarship that focused on the identity development process for individuals with marginalized social identities has served as a cornerstone of multicultural psychology. Early stage models were primarily focused on the identity development process for individuals of color, but during this time period, scholars were also introducing identity development models focused on sexual minority individuals’ sexual orientation and, in particular, the “coming out process.” Similar to the racial/ethnic identity development paradigm, these models theorized a linear process of development, starting from a place of identity confusion and gradually moving toward a greater level of self-acceptance and identity congruence. One of the most widely cited models of lesbian/gay identity development is Vivian Cass’s six-stage process of integrating a lesbian/gay identity into one’s self-concept. The historical significance of these early lesbian/gay identity models cannot be denied. However, contemporary research has demonstrated that sexual identity development is often not a linear process and is a less stable phenomenon than previously proposed. Other important critiques of the early sexual identity development models are that they failed to capture the vast intragroup variability among sexual minority individuals and also did not recognize the differences and similarities

Heterosexual Male Identity Development

between those who identify as gay/lesbian and those who identify as heterosexual.

Heterosexual Identity Development Models To better understand the processes making up the sexual identity development of heterosexual identifying individuals, Roger Worthington and colleagues proposed a multidimensional model that expanded beyond sexual orientation identity and encompassed the dynamic construct of sexual identity at the individual and biopsychosocial ­levels. At the individual level, their construct of sexual identity includes (a) identification and awareness of one’s sexual needs, (b) the adoption of personal sexual values, (c) an awareness of preferred sexual activities, (d) an awareness of ­ preferred modes of sexual expression, and (e) recognition of, and identification with, sexual orientation. Among the strengths of the model are that it addresses the fluidity of sexuality and acknowledges various biopsychosocial influences, such as the biological aspects of development and maturation, gender norms, gender role socialization, culture, religion, systemic heterosexism, and sexual prejudice and privilege. The first proposed status, diffusion, is characterized by the absence of both active exploration and commitment. People in this status are likely to have identity confusion in other domains and a general lack of self-awareness. These individuals may also reject social conformity or may be experiencing a period of crisis. In any case, it is clear from the authors’ description that this is a particularly maladaptive status. The next status, unexplored commitment, characterizes persons who are lodged in compulsory heterosexuality and who accept and adhere to societal heterosexist assumptions. The authors suggest that this is the starting point for the majority of persons due to the all-encompassing nature of heteronormativity and the myriad other ways in which society prescribes specific and rigid mandates on appropriate sexual behavior. The third identity status in the model is active exploration. This status is characterized by an intentional process of exploration and assessment of one’s sexual desires, values, and orientation and/ or inclinations for different experiences, partner qualities, or modes of sexual expression.

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The final two statuses in Worthington and colleagues’ model are deepening and commitment and synthesis. The former is characterized by movement toward a greater level of commitment to one’s sexual identity; however, individuals in this status may experience either passive deepening (due to engaging in a passive exploration process) and commitment or active deepening (gained from a deliberate exploration process) and commitment. The final status, synthesis, is akin to reaching a state of actualization. Individuals in this status are thought to be highly adaptive and mature because they have reached a high level of congruence between their individual and social sexual identity domains through a conscious and deliberate process. The authors theorize that individuals reflecting the status of synthesis are likely to have a more positive disposition toward sexual minorities. Worthington and colleagues’ model is a valuable contribution to the discussion of the process of deconstructing heterosexism. They suggest that one’s disposition toward sexual minorities is intertwined with one’s own heterosexual identity. Their model also highlights that greater self-awareness of heterosexuals’ privilege is necessary for deconstructing heterosexism. Another model of heterosexual identity development that has had a significant impact on the psychology field was published by Jonathan Mohr. Mohr’s model is complex, recursive, and particularly attractive to the fields of counseling psychology and related mental health services, because it focuses directly on explaining the differences among therapists and counselors in their work with queer clients, as well as differences in counseling psychology training. Mohr articulates the two primary assumptions of his model thus: (1) heterosexuals develop beliefs and judgments about their own sexual orientation and express their sexuality in a manner that fosters a positive and coherent sense of self and (2) heterosexual therapists’ work with sexual minorities is, in part, a reflection of how they negotiate their own heterosexual identity. Mohr constructs his theory on two pillars, two theoretical concepts that together influence how one perceives one’s own heterosexual identity: (1) working models of sexual orientation and (2) core motivations. Working models consist of the cumulative phenomena of experiencing, anticipating, interpreting, and responding to sexuality,

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including social information and social responses to sexual orientation. These working models are then fused to the self, but they may be revised and updated as one has new experiences. Mohr proposes that, as individuals are exposed to divergent phenomena regarding sexual orientation, they have access to multiple working models of sexual orientation, although one particular model will be favored by the self and adopted given a particular time and context. The favored working model then becomes the dominant working model. Mohr then suggests four dominant working models currently functioning in society that allow heterosexuals to make sense of their heterosexual identity. The first is democratic heterosexuality. Mohr suggests that heterosexuals who adopt this model view all people as essentially the same, regardless of sexual orientation. Differences regarding sexual orientation become minimized within this working model, while common denominators of human experience are emphasized. Those who operate within the democratic heterosexuality model maintain that moving one’s focus away from differences is a gesture of goodwill, but they are unaware that this may lead to risks such as (a) assuming that all persons are heterosexual, (b) missing out on the benefits of exploration and self-reflection, and (c) being more vulnerable to common queer stereotypes. Working within the democratic model also fosters further abeyance and/or minimization of the awareness of one’s heterosexual privilege. Mohr’s second working model is compulsory heterosexuality. In this dominant working model, heterosexuals understand straight sexuality as the only morally and socially acceptable orientation, while viewing queer ways of being as a threat to both society and individuals. Psychologists ­operating from this model would be engaging in intentional and overt heterosexism and would be working in violation of their ethical obligations. Mohr’s third working model is politicized heterosexuality. Heterosexuals working from this model place great emphasis on the sociopolitical oppression of sexual minorities and maintain a heightened awareness of their own heterosexual privilege. It is difficult for individuals working from the politicized model to imagine that there are facets of queer ways of being that lie outside the political domain. Strong emotions of anger and guilt are present, as well as limited patience or empathy for those who reject nonheterosexual ways of being. A significant component of this

working model is the presence of dualistic, all-ornothing thinking. Mohr’s fourth and final working model is integrative heterosexuality. Heterosexuals within this working model are theorized to connect deeply with queer oppression, while at the same time understanding that all persons on the sexual spectrum suffer from and reproduce heteronormative oppression and that no one is all good or all bad with respect to her or his views on sexual orientation issues. Diversity within the queer community is acknowledged and celebrated. Sexual orientation is understood as complex and multidimensional. Sexuality across the spectrum is not viewed as fundamentally different, while at the same time there is an understanding that heterosexual privilege imposes significant differences on sexual experiences. The second pillar of Mohr’s theory of heterosexual identity development is the concept of core motivations. Core motivations are an individual’s general identity needs in relation to the self and others. These include one’s need to fit into a social group— how one may adjust one’s thoughts, feelings, and behaviors to be a member of the group—as well as the need to have a cohesive and consistent sense of self. Conflict with one’s sense of self—threats to the coherence of one’s identity—is understood to trigger dissonance, internal discomfort, general anxiety, and even more severe forms of mental illness and emotional breakdown. Mohr argues that one’s core identity motivations may not be directly connected to one’s heterosexual identity but that an outcome of seeking to meet one’s identity needs is to favor one of the dominant working modes. These two models of heterosexual identity development are significant contributions to the field. They have both helped fill a large gap in the literature base on sexual identity, which has historically been overwhelmingly focused on the ­identity development process of gay and lesbian identifying individuals. The primary limitation of both models is that they lack empirical support.

Heteronormativity, Patriarchy, and Male Identity Despite the growing attention to heterosexual identity development, sexual minority identities have received much more scholarly attention within the field of psychology. This imbalance is curious because impaired identity development among a majority of heterosexuals informs the construction

Heterosexual Male Relationships

of a heteronormative culture that oppresses and marginalizes sexual minorities. This imbalance also reinforces the implicit, colonizing message that heterosexual identity is “normal” or “natural” whereas LGB identities merit more attention because they are the Other, an exotic specimen that needs to be labeled, categorized, and examined. In other words, the inequitable attention on LGB identity development over heterosexual identity development reproduces heterosexuality as the unmarked, silent, default identity, further reifying heteronormativity. Within a patriarchal society, heteronormativity is a particularly powerful force in the shaping of male heterosexual identity. For men in the United States, strict adherence to compulsory heterosexuality is socially mandated. Because masculinity is premised on heterosexuality, more specifically the domination, objectification, and subordination of women, rigid masculine gender roles are defined and sustained through heterosexual expression. Conversely, any vacillation regarding heteronormativity or exploration of alternative sexualities is considered a violation of male gender norms and is met with fierce social sanctions. Men who violate heteropatriarchal gender norms are policed heavily. At the individual level, boys and men who are marked as less masculine face increased risk for harassment and physical violence. At the institutional and societal levels, men who are perceived as diverging from heternormative gender roles often risk a loss of social capital and influence in the male-dominated, patriarchal society. The field of psychology would benefit from developing heterosexual identity development models that tease apart the traditional cisgender male from female heterosexual identity. A small but growing body of research suggests that male heterosexuals exhibit a greater degree of heterosexism than female heterosexuals, tend to be less questioning of their sexual orientation compared with women, and are more likely to describe their sexuality as innate. Yet despite these concerning empirical findings, there is an absence of empirical literature that specifically addresses male heterosexual identity development. Indeed, this is yet another example of male privilege.

Future Directions The growing body of scholarship focused on heterosexual identity development represents a progressive step forward in the psychology field. At this

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point, the literature is heavy on theory and models but light on empirical support. Both heterosexual identity development models reviewed in this entry are theoretically robust and sophisticated, but there is a need for quantitative and qualitative research testing the validity of the models. There is also a clear need for empirical research that captures the complex intersection of gender and sexual orientation in relation to the sexual identity development of male heterosexual identifying individuals. Richard Q. Shin and Lance C. Smith See also Heteronormativity; Intersectional Identities; Patriarchy

Further Readings Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of Homosexuality, 4, 219–235. doi:10.1300/J082v04n03_01 Mohr, J. J. (2002). Heterosexual identity and the heterosexual therapist: An identity perspective on sexual orientation dynamics in psychotherapy. The Counseling Psychologist, 30, 532–566. doi:10.1177/00100002030004003 Morgan, E. M. (2012). Not always a straight path: College students’ narratives of heterosexual identity development. Sex Roles, 66, 79–93. doi:10.1007/ s11199-011-0068-4 Smith, L. C., & Shin, R. (2014). Queer blindfolding: Difference “blindness” towards persons who identify as lesbian, gay, bisexual and transgender. Journal of Homosexuality, 61, 940–961. doi:10.1080/00918369 .2014.870846 Worthington, R. L., & Reynolds, A. L. (2009).Withingroup differences in sexual orientation and identity. Journal of Counseling Psychology, 56, 44–55. doi:10.1037/a0013498 Worthington, R. L., Savoy, H. B., Dillon, F. R., & Vernaglia, E. R. (2002). Heterosexual identity development: A multidimensional model of individual and social identity. The Counseling Psychologist, 30, 496–531. doi:10.1177/00100002030004002

Heterosexual Male Relationships The relationships that men have with each other have historically been written about as a close intimate bond with a deeply supportive connection.

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Until the 1950s, male friendships were still commonly described as emotionally close, particularly among men in uniform and other predominantly homosocial or same-sex environments. During childhood, male friendships are typically homosocial. This can be driven by gender role expectations of what and how boys and girls should play and by early gender messages that enforce homosocial environments, like “cooties” or teaching that boys and girls are drastically different. As children grow into late adolescence, heterosexual males start to seek out more cross-gender friendships with peers because of their potential to turn into romantic relationships. Research shows that men often expect that once they hit late adolescence/early adulthood they will be emotionally closer to their female friends, building up to what they perceive as their most intimate friendship, the relationship they have with their future wife.

Gender Differences The empirical studies that provide information about male relationships typically come from research on gender differences. Friendships were studied in the early 1900s but using only men as their research sample and generalizing the results to women; this was a standard practice in early psychology. As female participants started to be used more often in studies from 1950 onward, a trend in psychological research emerged in which both male and female relationships were studied, but often only to find the differences between them. Research in the early 2000s has continued to find these differences despite similar studies showing that gender differences in other realms are not as large as previously thought. Shared Activities

Psychological research on male relationships has shown that they involve shared activities, often involving rules of conduct that guide behavior, sports being one of the most common. The emphasis in research with men has been that men “do” things together. This is in contrast to how men typically see their friendships with women, in which a greater level of communication and spending time with each other without any shared activity occurs. Psychological research has shown that a strong contribution to this may be gender role expectations

that men are to conceal emotional responses. Research throughout the 1990s and early 2000s has shown a multitude of ways in which men defy expectations and use sports and shared activities as venues to discuss emotions, even if it is uncommon behavior or atypical of gender role. Emotional Intimacy and Support

While many men become emotionally close and intimate with a male friend, and find support through male relationships, most adult men researched have indicated that their best friend is their wife. Men sometimes, but not typically, list a male friend as being their best friend and biggest support. This is in contrast to women, who regularly respond with a female friend’s name as well as that of their spouse. Psychological research since the 1960s has consistently shown that both men and women feel safer sharing emotional intimacy with women. Heterosexual men as a group identify that their friendships with women are more emotionally nurturing and supportive than their relationships with other men.

Possible Causes of Gender Difference In heterosexual male relationships, the demands of masculinity and gender role socialization contribute heavily to relationship behaviors. The traditional male gender role is taught as being stoic, noncommunicative, and unemotional. This could guide expectations that friendships with women should be more emotional and friendships with men should involve shared activities, which then guide the formation of friendships and beliefs about their purpose. Research in the 2000s and 2010s has shown that men may share emotional intimacy with their male friends but it is likely to take an atypical format and emotional experiences are less likely to be talked about or displayed for others. Studies show that a sizeable portion of men feel emotionally close with their male friends and have even cuddled on occasion but were hesitant to tell anyone about how close they were due to the expectations of masculinity. Homophobia and Heterosexism

In psychological research on heterosexual male relationships, there are always portions of the

Heterosexual Men and Dating

sample that display atypical behavior. In thinking about why more men do not challenge masculine norms, psychologists from the 1970s onward have identified homophobia and heterosexism to be the major culprits. Homophobia is the fear that one is homosexual or that others will perceive one to be homosexual and treat oneself poorly as a result regardless of actual sexual orientation, whereas heterosexism is a social system that values heterosexual and opposite-sex attractions and relationships. Prior to the 1960s, it was common for boys to insult other boys who did not conform to gender roles by implying that they were immature and needed to “man up.” Psychologists have shown that this discourse has been replaced by one of homophobia and heterosexism. Now boys are not labeled as immature for not conforming to masculinity; instead, they are labeled as gay. This has contributed to a culture in which fear of being seen as gay underlies a lot of the behavioral differences in men’s friendships with other men compared to those with women.

Childhood as a Place of Gender Nonconformity Research in the late 1990s and into the 2000s and 2010s has shown some remarkable challenges to traditional thinking about heterosexual male relationships. Particularly, work with younger boys has shown a great deal of emotional intimacy and bonding between same-sex friends that boys are willing to speak about openly. In late adolescence, more cross-gender relationships form for boys, and the demands of masculine gender role become stronger. Most of the heterosexual male relationship behaviors discussed in this passage do not emerge until late adolescence. Hunter N. Kincaid See also Gender Role Behavior; Gender Role Socialization; Heterosexism; Heterosexual Male Identity Development; Homophobia; Masculinities; Masculinity in Adolescence; Men’s Studies

Further Readings Reisman, J. M. (1990). Intimacy in same-sex friendships. Sex Roles, 23(1–2), 65–82. Rubin, L. B. (1986). On men and friendship. Psychoanalytic Review, 73(2), 165–181.

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Way, N. (2013). Boys’ friendships during adolescence: Intimacy, desire, and loss. Journal of Research on Adolescence, 23(2), 201–213.

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Dating

Traditionally, dating has been defined as a relationship between two people based on mutual attraction. Dating usually begins during puberty as a way to explore social and sexual relationships. The frequency of dating differs across age-groups, with the highest number of daters being in high school and college. However, given that people are living longer, there has been an increase in the number of older adults in dating relationships. Across the life span, being in a dating relationship has been associated with better health outcomes and more satisfying social connections. In addition to the increased likelihood of dating in older adults, the Internet has influenced how people meet as well as how they interact with one another. To date, there are numerous online dating websites and several dating apps available for computers and mobile phones that make it easier to find and meet people in today’s culture. This entry focuses specifically on the dating patterns of heterosexual men.

Hooking Up Since the mid-1990s, hooking up has become more common. There are several different behaviors included in hooking up, ranging from “making out” to sexual intercourse. Hooking up is typically defined as engaging in sexual behavior with another person in the absence of a committed relationship. Approximately 60% to 80% of college students have participated in a hookup. In addition, men are twice as likely as women to have sexual intercourse during a hook up and are more comfortable than women with having sexual intercourse when they hook up. College students frequently overestimate how often their peers are hooking up; that is, they believe that their peers are hooking up more often than they are in reality. College men also believe that women are more comfortable with sexual activity when they hook up than they actually are. Furthermore, while both heterosexual men and gay men report high rates of hooking up, earlier research found that gay men

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were more likely than heterosexual men to meet sexual partners in public or anonymous spaces. However, with the increase in dating applications, anonymous hookups appear to be increasing for men of all sexual orientation identities.

Expectations for Dating With these changes in dating, there have also been overall changes in expectations for dating relationships, as well as differences between heterosexual men and women with respect to these expectations. These gender differences start as early as the first date. Men expect more sexual intimacy on a first date than women, whether it is kissing or additional sexual activity. This is true regardless of how well the man knows the woman before the date. For both men and women, alcohol use also is a common expectation for a first date. Men expect to be less anxious and more comfortable talking to their date if they drink alcohol. In addition, men expect more sexual intimacy on a first date if there is alcohol use. Even today, for a first date, men and women expect the man to pick up his date and drive her home. Differences in the expectations of heterosexual men and heterosexual women extend past the first date. Among college students, there are expectations for more dating and hooking-up experiences. Men who think that their close friends are hooking up are more likely to engage in sexual intercourse on a date and to have “friends with benefits” hookups. In addition, drinking has been the norm for dating and hooking up for men and women, and overall, there is an expectation for greater alcohol consumption within the college culture. Across all ages, men are typically expected to be and are the initiators of sexual activity in dating and hooking-up situations. Culturally, it is expected that men will have more sexual partners than women. It is also expected that men seek sexual activity as a source of pleasure on its own and override the woman’s resistance in a dating or hooking-up situation. Perhaps the acceptance of men’s sexual promiscuity as a source of sexual pleasure explains previous research findings that gay men engage in more open, nonmonogamous relationships than heterosexual men.

Sexual Aggression Differences in dating expectations can lead to problems with consent and sexual experiences. For

example, if a man believes that a woman’s resistance is not genuine, he is more likely to engage in sexually aggressive behavior. Sexual aggression is frequently defined as sexual activity without consent, which includes rape (i.e., sex as a result of the use of physical force or threats, or the consumption of alcohol or drugs) and sexual coercion (i.e., sexual acts as a result of verbal pressure or manipulation). Approximately, 10% to 15% of men have engaged in sexual aggression, with college-age men being more likely to engage in sexually aggressive behaviors. In addition, men are more likely to be sexually aggressive toward a partner or ex-partner than toward an acquaintance or a stranger. Research has identified several factors that influence men’s sexually aggressive behavior. These include positive attitudes about sexually aggressive behavior, acceptance of rape myths, positive perceptions of sexual harassment, hostile sexism (i.e., negative attitudes and behaviors toward nontraditional women), acceptance of violence against women, and previous sexually aggressive behavior. In addition, there are aspects of social situations that influence men’s sexually aggressive behavior, such as alcohol use and being in a bar or party setting. Men who believe that their friends support sexually aggressive behavior are also more likely to engage in it. If there is an expectation of punishment (criminal or social) for sexual aggression, men are slightly less likely to aggress. Several programs have been developed that focus on reducing men’s sexually aggressive behavior. While they have been able to change some of men’s attitudes about rape, these programs have been largely unsuccessful in changing men’s sexually aggressive behavior. Although the majority of sexual aggressive behavior is male initiated, men also experience female-initiated sexual aggression. Approximately 10% to 15% of men have experienced sexually aggressive behavior from a woman. Men are more likely to experience verbal pressure and alcoholrelated sexual aggression than physical force from a woman. They are also more likely to experience sexual aggression from a partner or ex-partner than from an acquaintance or a stranger. There has been limited research looking at men’s experiences of sexual aggression, due to the higher rates of victimization among women and cultural expectations that men are the likely aggressors and that men cannot be victimized. In addition, men are less likely to report experiencing sexual aggression and

Heterosexual Men and Feminism

are less likely to use supportive resources such as counseling. This topic merits further attention, specifically regarding changes in dating patterns related to longer life span and technology facilitating dating, how expectations for dating influence dating behaviors, and the likelihood of men perpetrating and experiencing sexual aggression in dating situations. Kari A. Leiting, Gabriela Lopez, Ryan S. Ross, and Elizabeth A. Yeater See also Benevolent Sexism; Gender Roles: Overview; Heterosexual Romantic Relationships; Heterosexual Women and Dating; Marriage; Masculinity Gender Norms; Rape Culture

Further Readings Berntson, M. A., Hoffman, K. L., & Luff, T. L. (2014). College as context: Influences on interpersonal sexual scripts. Sexuality & Culture, 19, 149–165. Garcia, J. R., Reiber, C., Massey, S. G., & Merriwether, A. M. (2012). Sexual hookup culture: A review. Review of General Psychology, 16(2), 161–176. Hoyt, T., & Yeater, E. A. (2011). Individual and situational influences on men’s responses to dating and social situations. Journal of Interpersonal Violence, 26(9), 1723–1740. Malamuth, N. M., Linz, D., Heavey, C. L., Barnes, G., & Acker, M. (1995). Using the confluence model of sexual aggression to predict men’s conflict with women: A 10-year follow-up study. Journal of Personality and Social Psychology, 69(2), 353–369. Prospero, M., & Fawson, P. (2010). Sexual coercion and mental health symptoms among heterosexual men: The pressure to say “yes.” American Journal of Men’s Health, 4, 98–103. Tharp, A. T., DeGue, S., Valle, L. A., Brookmeyer, K. A., Massetti, G. M., & Matjasko, J. L. (2013). A systematic qualitative review of risk and protective factors for sexual violence perpetration. Trauma, Violence, & Abuse, 14, 133–167.

Heterosexual Men

and

Feminism

Feminists have been advocating and working for the rights of girls and women for several centuries. For example, Mary Wollstonecraft (1759–1797) wrote A Vindication of the Rights of Women,

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c­onsidered by many historians to be one of the first unambiguously feminist writings. Since ­Wollstonecraft’s time, men have joined women in advocating for gender egalitarianism and other feminist goals. This entry provides a brief overview of men and feminism, a description of some of the organizations started by men that promote feminism, and a discussion of both the willingness and sometimes reluctance of men to adopt a ­feminist label. The focus of this information is on feminist men in Western countries, such as the United States and the countries in western Europe.

Historical and Contemporary Overview French philosopher and utopian socialist François Marie Charles Fourier (1772–1837), who believed that the expansion of women’s rights was important to social progress, has been credited with coining the term feminisme in 1837. However, even before the early 19th century, men were active in promoting equal rights for girls and women. Thomas Paine, writing in 1775, commented on the mistreatment of women by men worldwide. In Alcuin: A Dialogue, published in 1798, American novelist Charles Brockden Brown wrote about the injustices that women were forced to endure, comparing them to slaves. This slave analogy was prescient; in 1840, abolitionists George Bradburn and Wendell Phillips spoke about the importance of including women in antislavery organizations. Also, feminist leaders such as Susan B. Anthony and Elizabeth Cady Stanton drew inspiration from the antislavery movement when advocating for the rights of women. In 1869, the British philosopher John Stuart Mill published The Subjection of Women, in which he argued about the importance of education for women, along with other rights, and—reminiscent of Fourier’s comments—that the oppression of women hindered societal progress. During the mid-18th to mid-19th centuries, men continued to advocate for women’s rights regarding access to education, the workplace, marriage, sexuality, and political life. The Declaration of Sentiments, written primarily by Elizabeth Cady Stanton and presented at the Seneca Falls Convention in 1848, outlined arguments for why women in the United States should have suffrage. It was signed by 100 people, including 32 men. Among those men were the famous antislavery and women’s rights activists Frederick Douglass and James Mott. In 1917, the American novelist and

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magazine editor Floyd Dell wrote an article titled “Feminism for Men,” in which he argued that women’s emancipation would also make men free. However, it is well to remember that some of the most idealistic and progressive men of the past were hypocritical in their personal relationships with women. For example, Leo Tolstoy wrote sensitively about female characters (e.g., in Anna ­Karenina), but he was apparently callous regarding the hardship his wife endured bearing his 13 children. The latter half of the 20th century witnessed many social changes, including what social historians refer to as the second wave of the women’s movement. As in previous centuries, men were active in writing about and speaking out for gender egalitarianism in personal relationships, education, politics, the workplace, reproductive rights, and sexuality. These men included musician John Lennon, actors Ed Asner and Alan Alda, Reverend Jesse Jackson, and Supreme Court Justice Harry Blackmun. In concert with the burgeoning women’s studies courses and programs during the late 1960s and early 1970s, men’s studies programs and courses were being developed. These men’s studies courses used feminist perspectives and theories to understand men and masculinities. Men’s feminist activism continued into the late 20th century and is still evident today in the early 21st century. These activists include writers and scholars such as Jackson Katz, John Stoltenberg, Chris Kilmartin, and Michael Kimmel. Also, men were organizing explicitly feminist and antisexist groups in the late 20th and early 21st centuries; some of these groups are discussed in the next section.

Men’s Feminist and Antisexist Organizations Most antisexist and feminist men’s organizations are not only involved in advocating for girls’ and women’s rights, but they are also active in ­redefining what masculinity should look like. Furthermore, they emphasize and educate about the benefits of gender egalitarianism and feminism for boys and men as well as for girls and women. The National Organization for Men Against Sexism (NOMAS) started as a loosely organized group in the 1970s in the United States. It changed its name to NOMAS in 1990. According to its website, this group is “pro-feminist, gay-­affirmative, [and] anti-racist.” Men Can Stop Rape, another

U.S.-based organization, began in 1997. It has developed programs as well as public awareness campaigns to educate youth and college men about sexual violence. The White Ribbon Campaign, an organization that began in Canada in 1991, was a response to the murder of 14 women and the injuring of 14 other people by an avowedly anti-feminist man at Montreal’s École Polytechnique in 1989. This organization is now global and advocates against gender-based violence and for gender equity and a healthy masculinity. MenEngage is another global alliance and is active in securing reproductive rights, advocating for sexual and gender minorities, and reducing gender-based violence.

Calling One’s Self a Feminist Some feminist activists have argued that men cannot or should not call themselves feminists but instead they should use the label “pro-feminist.” Part of the reasoning behind this is that feminists can only be women because they are the ones who have primarily been oppressed by sexism. The profeminist label has also been adopted by some men who actively support feminist goals but who do not want to be perceived as being a member of the feminist movement. Regardless of whether men call themselves feminist or pro-feminist, there has been reluctance among many men to adopt these labels. This reluctance may be due to the fear of being perceived as feminine or of having their sexuality questioned. However, there is evidence that men who call themselves feminists are more likely to be active in working toward gender egalitarianism than men who do not adopt the label. Veanne N. Anderson See also Feminism: Overview; Feminism and Men; Gay Men and Feminism; Gender Equality; Masculinities; Men’s Studies

Further Readings Kimmel, M. S., & Mosmiller, T. E. (Eds.). (1992). Against the tide: Pro-feminist men in the United States 1776–1990, A documentary history. Boston, MA: Beacon Press. Tarrant, S. (Ed.). (2008). Men speak out: Views on gender, sex, and power. New York, NY: Routledge. Tarrant, S. (2009). Men and feminism. Berkeley, CA: Seal Press.

Heterosexual Privilege

Websites National Organization for Men Against Sexism: http:// nomas.org/

Heterosexual Privilege Heterosexual privilege refers to the structural differentiations within our heteronormative society wherein heterosexuals are conferred societal entitlements and advantages that are denied to sexual minorities. Conceptually, heterosexual privilege is theoretically similar to other forms of “epistemic privilege” that accompany membership within dominant or ruling social groups, such as male privilege, White privilege, class privilege, and cisgender privilege. Like all of these forms of societal privilege, heterosexual privilege is not earned, not acquired by merit, and not conferred on heterosexuals because of anything they have done or failed to do. Heterosexuals acquire this privilege simply by being born into a heterosexual sexual orientation.

The Theoretical Inception of Heterosexual Privilege In 1955, Simone de Beauvoir wrote Privileges, a collection of reflective essays on the privileges associated with class, education, sex, and nationality and how those with privilege should negotiate their unmerited social advantages. For Beauvoir, social privilege is not only about unmerited social advantages but also about the systemic denial of such advantages. Beauvoir held that our social systems are designed to obfuscate, rationalize, and deny the dominant groups’ privileged status. For heterosexuals, the relative ease of remaining unaware of their own privilege (i.e., the luxury of obliviousness) has been downloaded into our society’s heteronormative operating system and is an integral aspect of heterosexual privilege itself. Influenced by Beauvior, Peggy McIntosh in 1989 applied the construct of privilege to racial identity. In her essay “White Privilege: Unpacking the Invisible Knapsack,” McIntosh defined privilege as an invisible package of unearned assets that White people can count on cashing in each day but about which they are “meant” to remain oblivious. This essay is credited with catapulting the political

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theory of epistemic privilege into greater social and academic awareness. McIntosh suggests that privilege comes in two types: unearned entitlements and conferred dominance.

Unearned Entitlements Unearned entitlements are valuable forms of social capital that everyone should have. For example, everyone should have the freedom to hold their lover’s hand in public without fear of harassment or physical threat, the right to employment without fear of getting fired because of their sexual orientation, or for their child the opportunity to find a picture book in the school library that depicts a parental unit similar to their own. Heterosexuals have these unearned entitlements. Sexual minorities do not. When an unearned entitlement is restricted to certain dominant groups such as heterosexuals, it becomes a form of privilege that is called an unearned advantage.

Conferred Dominance Conferred dominance is the form of privilege that gives one group social power over another. Social dominance naturally follows from unearned advantages. Within a heteronormative society, this results in heterosexuals having an unequal share of social power and control. Conferred dominance is readily identified by paying attention to which group is highly visible if not always present and which group is silenced and/or absent in social spaces. For example, when the latest blockbuster romantic comedy is released in theaters, it is virtually guaranteed to be about a heterosexual couple. Or when waiting in the office of a family dental practice, the pictures that adorn the walls will in all likelihood depict heterosexual family units. More conspicuously, in very few electoral districts and states are potential sexual minority candidates considered electable. There is a dearth of openly LGBT senior executives within corporate culture, and until very recently, there were no openly gay or lesbian CEOs of Fortune 500 companies. Conferred dominance is also evident when nondominant groups are exoticized or objectified by society. For example, when gay or lesbian characters are written into film and television, they are often stereotypical caricatures. Finally, conferred dominance is demonstrated when

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heterosexuals feel entitled to appropriate queer cultural experiences.

•• Heterosexuals are never mocked, by their own friends or others, for being too straight.

Lance C. Smith

Heterosexual Privilege in Everyday Life Numerous scholars and theorists have adapted McIntosh’s groundbreaking knapsack of White privilege to convey the privileges that come with heterosexual status. Just a few of the many heterosexual privileges that have been identified are listed below: •• Heterosexuals do not experience their colleagues getting defensive or uncomfortable when they talk about their significant other. •• Heterosexuals can hold hands with their significant other in public without worrying about the possibility of being harassed or beaten. •• No one questions heterosexuals’ right to raise children. •• Heterosexuals’ sexual orientation is never considered to be the single most important characteristic that defines who they are. •• Heterosexuals can be rest assured that whether they are hired, promoted, or fired from a job, it will have nothing to do with their sexual orientation. •• Heterosexuals can turn on the television or go to the movies and be assured of seeing characters, news reports, and stories that reflect the reality of their lives. •• Heterosexuals can feel confident that their child’s school will have picture books, coloring books, games, and toy figures that are representative of their parental unit and family structure. •• No one paternalistically “affirms” their heterosexual identity. •• Heterosexuals can participate in any religious community they wish, without worry of being ostracized or marginalized. •• Heterosexuals never have to decide how, when, or whether to inform their family, friends and coworkers about their sexuality. •• Heterosexuals know who their potential love interests are and that they are likely to live in close proximity. •• Heterosexuals are never accused of promoting their “heterosexual agenda” when they seek to promote a more just and equitable society for people like themselves.

See also Heteronormativity; Heterosexism; Male Privilege

Further Readings Beauvoir, S. D. (1955). Privileges. Paris, France: Gallimard. Johnson, A. G. (2006). Privilege, power and difference. New York, NY: McGraw-Hill. Kruks, S. (2005). Simone de Beauvior and the politics of privilege. Hypatia, 20, 178–205. McIntosh, P. (2000). White privilege: Unpacking the invisible knapsack. In J. Noel (Ed.), Notable selections in multicultural education (pp. 115–120). Guilford, CT: Dushkin/McGraw-Hill. Smith, L. C. (2014). Queering multicultural competence in counseling. In R. Goodman & P. Gorski (Eds.), Decolonizing “multicultural” counseling and psychology: Visions for social justice theory and practice (pp. 24–40). New York, NY: Springer. Tollefson, K. (2010). Straight privilege: Unpacking the (still) invisible knapsack. Retrieved from http://eric .ed.gov/?id=ED509465

Heterosexual Romantic Relationships Human beings have a fundamental need to belong, which is satisfied in part by romantic relationships. Romantic relationships are defined by interdependence, intimacy, and sexual attraction. This entry focuses on factors related to the development and maintenance of romantic relationships between heterosexual men and women and provides an overview of both evolutionary and social learning explanations for heterosexual men’s and women’s attitudes toward and behavior in romantic relationships. For the purposes of this entry, heterosexual men are defined as those who are biologically male, psychologically identify as male, and express sexual interest in women, and heterosexual women are defined as those who are biologically female, psychologically identify as female, and express sexual interest in men.

Heterosexual Romantic Relationships

Relationship Development: Partner Selection and Relationship Types Heterosexual Men

The type of partner preferred by heterosexual men depends, in part, on the type of relationship desired. Men pursue both short-term, casual sexual relationships and long-term, committed relationships. Physical attractiveness is a key predictor of attraction in both types of relationships. Heterosexual men report being most attracted to women who display signs of physical health and youthfulness, including a waist-to-hip ratio of approximately 0.7, large breasts, healthy skin, childlike facial structures (wide-set, large eyes; small nose; prominent cheekbones), and shiny hair. Men also report greater physical attraction to younger women and to women who are ovulating. When selecting partners for long-term relationships, heterosexual men desire characteristics indicative of warmth, trustworthiness, and status (in addition to physical attractiveness). In general, physical attractiveness tends to be valued more by men than by women, and valued by men more than other characteristics such as status or personality when selecting a partner for a short-term sexual relationship. Compared with women, heterosexual men en­­ dorse more unrestricted sociosexual attitudes and behaviors. They express greater interest in shortterm sexual relationships and sexual variety and are more likely to accept offers of casual sex and consent to sex after knowing someone for a short period of time. It is important to note, however, that on average there is greater variability in sociosexual attitudes and behaviors within men and women, respectively, than between men and women. Heterosexual Women

Heterosexual women pursue both short-term and long-term mating strategies, but on average they endorse more restricted sociosexual orientations than do heterosexual men. Compared with men, women are older when they first have sex, have fewer sexual partners, are less interested in sexual variety, and focus more on long-term mating strategies. A woman’s relational goals influence what characteristics she finds attractive. Physical

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attractiveness is a key predictor of attraction for both short- and long-term relationships. Heterosexual women are attracted to men with angular facial structures and broad jaws, combined with baby-faced features such as an expressive smile. They prefer tall men with broad shoulders and symmetrical bodies. Such features are likely to indicate health, fertility, and dominance. In addition to physical attractiveness, women are sensitive to cues of warmth/trustworthiness and status/resources. When selecting mates for a long-term relationship, heterosexual women identify intelligence, warmth, and trustworthiness as most important, followed closely by physical attractiveness and status/resources. Compared with men, heterosexual women give greater importance to cues of status and resources (or the ability to acquire resources). Heterosexual women are also more likely than men to consider less physically attractive partners if they possess other qualities such as intelligence and status.

Relationship Maintenance: Jealousy and Conflict Jealousy

Jealousy is an emotional response to threats to one’s romantic relationship. It can be motivated by real or perceived rivals and also by real or perceived threats of sexual and emotional infidelity. Sexual infidelity occurs when one partner has sexual relations outside the primary relationship, while emotional infidelity occurs when one partner develops an emotional attachment outside the relationship. Heterosexual men’s jealousy is driven by a desire to protect their egos more than their relationships. For example, they are threatened more by a potential rival who is exceptional on dimensions relevant to their own self than by one who possesses traits that are attractive to their partner. Heterosexual women’s jealousy is driven by a desire to protect their relationships. For example, they are most threatened by rivals who possess characteristics important to their partners. Sex differences in responses to infidelity have been controversial. In response to forced-choice hypothetical scenarios, heterosexual men anticipate experiencing greater distress in response to sexual infidelity than to emotional infidelity, whereas

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heterosexual women anticipate experiencing greater distress in response to emotional infidelity than to sexual infidelity. However, for women who have experienced actual infidelity, emotional and sexual infidelity are equally distressing. Jealousy in response to sexual infidelity (actual or perceived) is a common trigger of relationship violence committed by men against women. H ­ owever, numerous studies with greater ecological validity than scenario studies have found that men experience jealousy equally in response to both emotional and sexual infidelity. Responses to infidelity continue to be a source of research and debate. Conflict

In romantic relationships, partners will inevitably have conflicting goals. Constructively ­navigating conflict can benefit a relationship, but destructive conflict behaviors (e.g., criticism, hostility) cause greater distress and reduce relationship satisfaction. A common conflict communication pattern in heterosexual relationships is the demand-withdraw pattern. Demand occurs when one partner who desires change in the relationship nags, criticizes, and demands that the other partner bring about this change, while withdraw occurs when the other partner becomes unresponsive or avoids discussion of the problem. Typically, women take on the role of demanding, and men take on the role of ­withdrawing. This may reflect gender differences in communication (men are less emotionally and verbally expressive than women), but demand­ withdraw roles are also determined by situational factors, including which partner desires change and which partner needs to change (women more often than men express the change they would like to see in the relationship). Although the demand-­withdraw pattern of communication is destructive to relationships, it is one of the most common communication patterns in heterosexual relationships and the most likely to escalate into conflict.

Explanations for Heterosexual Men’s and Women’s Attitudes Toward and Behavior in Romantic Relationships Evolutionary Explanations

Evolutionary theory argues that adaptive traits (i.e., those that help individuals survive and reproduce in the environment) are, over time, passed onto

successive generations. The attitudes and behaviors of heterosexual men and women in romantic relationships as observed in modern humans may reflect evolutionary adaptations related to parental investment and reproductive certainty. Parental investment theory argues that women invest far more in offspring than men. Because women gestate their offspring, they have to make substantially greater investments of time, energy, and resources in them than men do. For women, casual sexual relationships come with potentially greater costs. Accordingly, they seek long-term commitments and attend to cues of a partner’s status and his ability to provide resources. However, for men, reproduction requires only that they impregnate a fertile sexual partner. Thus, the characteristics they value in potential short- and long-term mates are those that indicate fertility (e.g., health, youth). In addition, men and women face different challenges related to paternal uncertainty. Men can never be certain of their genetic relation to offspring and thus risk investing time and resources in raising a competitor’s child. The risk of investing in a different man’s offspring may lead men to be more distressed by sexual infidelity than emotional infidelity. Moreover, men’s lack of paternal certainty motivates them to pursue multiple sexual partners and short-term relationships in order to increase the chances that they produce genetically related offspring. Both paternal uncertainty and parental investment explain women’s reactions to emotional infidelity. Because fertilization occurs in the woman’s body, she is certain that any offspring she bears is genetically related to her. Thus, sexual infidelity is not as threatening to women as it is to men. However, because women are required to make substantial investments in their offspring, emotional infidelity is threatening because it signals that their partner may divert resources to another woman. Social Learning Explanations

In contrast to evolutionary theories, social learning explanations argue that heterosexual men’s and women’s attitudes and behaviors concerning romantic relationships are socialized. Specifically, scripts associated with the roles of being “heterosexual” and a “man” and being “heterosexual” and a “woman” define how heterosexual men and women, respectively, should think, feel,

Heterosexual Women and Dating

and behave in romantic relationships. Socialization occurs by observing others (e.g., parents, peers, the media) and by being reinforced for gender-typed behavior. For example, college students report that men are expected to pursue short-term sexual relationships, to value physical intimacy more than emotional intimacy, and to be dominant in their relationships, whereas women are expected to pursue long-term sexual relationships, to value emotional intimacy more than physical intimacy, and to be submissive in their relationships. Thus, the attitudes and behavior of heterosexual men and women in romantic relationships may reflect socialization and reinforcement rather than evolutionary adaptations. Sara E. Branch See also Attraction; Evolutionary Sex Differences; Gender Socialization in Men; Gender Socialization in Women; Heterosexual Male Identity Development; Heterosexual Men and Dating; Heterosexual Women and Dating; Romantic Relationships in Adulthood

Further Readings Carpenter, C. J. (2012). Meta-analyses of sex differences in responses to sexual versus emotional infidelity: Men and women are more similar than different. Psychology of Women Quarterly, 36, 25–37. doi:10.1177/0361684311414537 Finkel, E. J., & Baumeister, R. F. (2010). Attraction and rejection. In R. F. Baumeister & E. J. Finkel (Eds.), Advanced social psychology: The state of the science (pp. 419–461). New York, NY: Oxford University Press. Fletcher, G., & Overall, N. C. (2010). Intimate relationships. In R. F. Baumeister & E. J. Finkel (Eds.), Advanced social psychology: The state of the science (pp. 461–494). New York, NY: Oxford University Press. Fletcher, G., Simpson, J. A., Campbell, L., & Overall, N. C. (2013). The science of intimate relationships. Oxford, England: Wiley-Blackwell.

Heterosexual Women

and

Dating

Dating is defined as a relationship between two people based on mutual attraction. Dating begins during puberty and is used as a way to explore social

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and sexual relationships with others. While dating takes place throughout the lifetime, most dating occurs during high school or college. Maintaining these social and sexual relationships with others during adolescence marks an important developmental milestone. Since the early 2000s, the Internet has significantly changed the “landscape” of dating, making it easier for people to meet others through online dating websites. This entry discusses heterosexual women’s dating patterns and behaviors.

Hooking Up Hookups, which have become more common since the mid-1990s, include different behaviors such as kissing, intimate touching, oral sex, and sexual intercourse, but hooking up is broadly defined as participating in sexual behavior with another person without being in a committed relationship with that individual. Approximately 35% to 55% of women have engaged in a hookup. Compared with men, women are less comfortable and less likely to have sexual intercourse during a hookup. Women often believe that their peers are hooking up more than they actually are in real life. In addition, women are more likely than men to report a desire to start a serious relationship as a reason for hooking up. Furthermore, while there appear to be some differences in hookup culture between gay men and heterosexual men, there do not appear to be differences between heterosexual women and lesbian or bisexual women.

Expectations for Dating Women have expectations for dating that are different from those of men, and these expectations are present as early as the first date. Typically a woman is expected to behave passively during a first date, including having the man pick her up, drop her off or walk her home, and pay for activities on the date. However, one contemporary cultural change is that women now ask men out on dates. With this change, there has also been a shift in women’s expectations. Both men and women expect to use alcohol on a first date; however, this expectation is stronger in female-initiated first dates. Women expect less sexual intimacy (kissing or more than kissing) on a first date than men, whereas men expect more sexual activity, especially on female-initiated first dates.

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Women also have expectations for dating in general. These expectations include more dating and hookup situations during college, as well as for alcohol use to be a part of these experiences. Across all ages, women are expected to be more passive sexually than men when dating and hooking up. That is, women are expected to be the “gatekeepers” of sexual activity and determine how far sexual behavior will go, but they are not expected to initiate sexual activity. Women, typically, do not seek out sexual activity for pleasure only, and women who have several sexual partners often are viewed more negatively than men who have the same number of partners. Because of these cultural expectations, women may feel pressured to behave in passive ways sexually, which men may unjustifiably and illegitimately perceive as consent.

Dating Violence Because of societal sexism and men’s misogynistic dating expectations, women are at higher risk for sexual violence than men. Sexual assault, often defined as experiencing sexual activity or contact without consent, includes rape (i.e., sex resulting from the use of physical force or threats, or occurring while intoxicated), sexual coercion (i.e., sexual acts as a result of verbal pressure), and unwanted sexual touching. Approximately 50% of college women have experienced some type of sexual assault, with 25% experiencing an actual rape. Most sexual assaults involve a partner or acquaintance; stranger sexual assaults make up approximately 10% of all assaults. In addition, women who have experienced a sexual assault during adolescence or early childhood are twice as likely as other women to experience another sexual assault, an event called sexual revictimization. Currently, there are no effective prevention programs for reducing men’s sexual aggression. Programs for women that focus on helping them learn effective responses to risky sexual situations show some promise. Because interventions with men have been ineffective, research with women has focused on identifying factors that increase women’s victimization risk—such as difficulties with risk perception; problems responding assertively to high-risk situations; alcohol use, especially binge drinking; beliefs about what typically happens during a sexual assault; and positive attitudes

toward casual sex. Despite this, there are traditional, heteronormative aspects of dating and social situations that influence women’s risk for sexual assault. For example, when a man asks a woman out on a date, drives the woman to the date, and pays for all of the expenses, there is a greater likeliness that the woman will be sexually assaulted. Although the majority of dating violence is experienced by women, men also experience female-initiated dating violence. Approximately 4% to 8% of women have engaged in sexually aggressive behavior. Women are more likely to use seduction, manipulation, and alcohol than physical force to coerce a man into sexual activity. Although there has been limited research examining these events, research has found that a woman’s negative attitude toward men increases the woman’s ­likelihood of sexual aggression. If a woman is in a situation in which her peers encourage sexually aggressive behaviors, she is more likely to behave aggressively. Furthermore, while the research on lesbian or bisexual women and dating violence is scarce, emerging research finds that heterosexual women are less likely than lesbian women to feel scared or unsafe on a date or with a partner and less likely than bisexual women to experience sexual assault on a date or with a partner. The topic of heterosexual women and dating merits further attention, specifically regarding ­dating patterns and the influence of technology, changes in dating expectations and dating behaviors as women initiate more dating and hookup situations, and the likelihood of women experiencing sexual assault and perpetrating coercive behaviors in dating situations. Gabriela Lopez, Kari A. Leiting, Ryan S. Ross, and Elizabeth A. Yeater See also Benevolent Sexism; Gender Role Socialization; Gender Roles: Overview; Heterosexual Men and Dating; Heterosexual Romantic Relationships; Marriage; Rape Culture

Further Readings Martin-Storey, A., & Fromme, K. (2016). Trajectories of dating violence: Differences by sexual minority status and gender. Journal of Adolescence, 49, 28–37. Yeater, E. A., McFall, R. M., & Viken, R. J. (2011). The relationship between women’s response effectiveness

Heterosexuality and a history of sexual victimization. Journal of Interpersonal Violence, 26, 462–478. Yeater, E. A., Treat, T., Viken, R. J., & McFall, R. M. (2010). Cognitive processes underlying women’s risk judgments: Associations with sexual victimization history and rape myth acceptance. Journal of Consulting and Clinical Psychology, 78, 375–386. Yeater, E. A., & Viken, R. J. (2010). Factors affecting women’s response choice to dating and social situations. Journal of Interpersonal Violence, 25, 1411–1428.

Heterosexuality Heterosexuality is commonly described as sexual or romantic feelings toward the “opposite” sex or gender: For women, heterosexuality dictates a sexual and romantic desire for men, and for men, a desire for women. In this way, people either fit or do not fit into discrete categories of sexual orientation; people are thought to be heterosexual and oriented to the other sex or gender, homosexual and oriented to the same sex or gender, or bisexual and oriented toward both the same sex and the other sex or gender. This fixed trait version of heterosexuality is frequently understood as biologically determined and, therefore, the normal and essential sexuality for people. Although not disconnected from biology, psychologists and other social scientists have come to understand heterosexuality (and all sexualities) as much more ­complicated. This entry outlines some of this complexity by describing the need to understand heterosexuality as an individual sexual orientation and sexual identity, as connected to gender, as an institution that is inseparable from power and privilege, and as connected to history and scientific measurement. Thus, this entry discusses the ways in which heterosexuality can be understood as an institution that structures social relations and as a cultural product that is shaped by politics and history.

Heterosexuality as an Identity and Orientation It is important to distinguish between heterosexuality as a sexual orientation and as a sexual identity. These are related but distinct concepts that are

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often conflated. Sexual orientation can be understood as a type of compass pointing to the gender(s) one is oriented to in terms of sexual/ erotic or romantic attraction. Sexual identity is a broader term that includes recognition of and identification with aspects of one’s sexual orientation. Sexual identity invokes people’s understandings of themselves as sexual beings, describing how they understand the most salient characteristics of their sexuality, including their sexual orientation, sexual behaviors, biological sex, and beliefs about gender roles (e.g., how one understands being a man or a woman, often expressed in terms of masculinity or femininity) and gender identity (how one identifies, understands, and expresses one’s gender). Thus, while often thought of as a monolithic or fixed category of sexual orientation, heterosexual identity is a multidimensional and ­ complex concept. For example, identifying as ­heterosexual does not mean that one has not had same-sex attractions or sexual experiences. Sexual orientations are thought to represent fairly stable, deeply rooted attractions or predispositions, whereas sexual identities are something that people adopt and develop throughout their lives and are a product of biology, environment, and culture. Identity labels are socially constructed and context specific, and can change over time and place, varying with age, social location (e.g., class), racial/ethnic group, and/or culture. Despite the relatively fixed nature of sexual orientations, identities may take a variety of trajectories, rather than reflecting a single innate tendency: Currently, identifying as heterosexual does not mean that in the past that person identified as such or that the person will continue to do so in the future. While there is a body of research on homosexual sexual identity development, researchers have only recently begun examining heterosexual sexual identity development. Heterosexual identity development has been theorized as influenced by biological factors, environmental contexts, gender norms and socialization, culture, religion, and sexual prejudice. In most cultures, heterosexuality is the norm, and many heterosexually identified individuals may automatically adopt a heterosexual identity without questioning or exploring its meaning or appropriateness. Moreover, because heterosexuality affords certain rights and privileges, it may be easier to adopt a heterosexual identity than an identity that is stigmatized.

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Heterosexuality

Heterosexuality and the Gender Binary Heterosexuality is commonly understood as ­opposite-sex romantic and sexual attractions, feelings, and behaviors. “Opposite sex” conflates sex and gender and makes the mistake of assuming that there are only two sexes (i.e., male and female) and two genders that correspond to biological sex (man/masculine and woman/feminine). Researchers understand sex and gender to be distinct concepts that are not dichotomous, which has ­ implications for more encompassing definitions of heterosexuality. Biological sex—measured through chromosomes, gonads, internal reproductive organs, and external genitalia—is typically dichotomized as male or female, ignoring the variation that exists within such indicators of sex and the 1.7% to 4.0% of people who are intersex and have uncommon combinations of these biological markers. Gender refers to the set of cultural identities, expressions, behaviors, expectations, performances, and roles, often thought of as feminine or masculine, that are socially prescribed to people based on their (perceived or actual) biological sex. Thus, people perform “being” a man or woman everyday: while making decisions about what to wear, how to express emotions, what jobs or activities are appropriate, and even who to date or marry. Heterosexuality is constructed through a dichotomization of bodies that relies on the conflation of sex, gender, and sexuality. This conflation serves to create fixed and unchanging categories of gender, which then become the only socially intelligible categorizations. In this model, there is no room for intersex people or any genders that exist outside the binary. Men and women are seen as discrete categories, as distinctly opposite, and as only available to be attracted to persons of the opposite sex. People whose gender identities do not map onto their biological sex (e.g., transgender or genderqueer individuals) or who have desires that are outside of opposite-sex attractions (e.g., lesbian/ gay people) may face stigma or other social sanctions. However, these marginalized identities are necessary to hold up heterosexuality as the idealized, socially valued orientation. While people can take on a variety of gender identities that are not linked to their biological sex (e.g., people who are transgender, genderqueer, or gender nonconforming), heterosexuality relies on

the assumption that there are fundamental sex and gender differences between men and women. Heterosexuality dictates conventions of masculinity for men (e.g., how men should look and act) and femininity for women (e.g., how women should look and act). Hegemonic masculinity perpetuates men’s dominant status in society through expectations that men assert sexual and physical dominance over women. Conventions of femininity, on the other hand, expect women to be sexually passive but also desirable to heterosexual men. This performance of gender (e.g., idealized femininities and masculinities) is associated with negative relational experiences (e.g., women’s experiences with sexism and violent relationships) as well as negative economic consequences (e.g., the wage gap between men and women).

Heterosexuality as Systems of Power Heterosexuality is often thought of as only an individual identity; however, it also operates at the relational, social, and institutional levels. Social, economic, legal, and political institutions are often fundamentally heterosexual or heterosexually oriented. As a result, not all sexual orientations and identities are equally valued in Western society. Heterosexuality is generally perceived as an unquestionably natural and systemic privilege. Heteronormativity refers to the relational, social, and political practices that normalize and naturalize heterosexuality. It involves the (re)production of heterosexuality not as a visible choice but as the invisible standard, and in all aspects of life and culture (e.g., the law, nationality, economics, education), not simply intimate (e.g., sexual or romantic) practices. First described by Adrienne Rich as a way to understand women’s experiences within patriarchy, compulsory heterosexuality describes how the institution of heterosexuality is enforced and reproduces hierarchies of sexuality and gender by affording social, legal, and economic benefits to men over women while also rendering heterosexuality as the only available option. Women of color scholars have additionally noted that these gendered relations of power and privilege are shaped by the intersectionality of race and class. Compulsory heterosexuality works not only to reproduce heterosexuality but also to produce an ideal version of middle-class Whiteness. Thus, beyond

Heterosexuality

constructing differences between men and women, heterosexuality creates hierarchies of privilege that map onto material, social, and political inequalities for all people who occupy marginalized social locations (e.g., on the basis of race, gender identity, age, geography). Representations of heterosexual standards regulate both those who fall within and those who fall outside its boundaries. In most countries, heterosexuality is the only sexual orientation or identity that is fully recognized in terms of social and legal privileges. In the United States, there is a long history of laws that prohibit nonvaginal sex (e.g., sodomy laws) and nonheterosexual unions. The sociopolitical climate has slowly been changing in the United States since the 1990s: In February 2015, only 37 states and the District of Columbia allowed same-sex marriage; however, the Supreme Court ruling on June 26, 2015, declared that state bans against marriage are unconstitutional. Despite the progression of gay marriage between 1999 and 2015, the LGBTQ political fight for equality continues, including other legal rights such as ­ employment, access to education, and housing. For example, it is still legal in a majority of states to terminate someone’s employment for being ­transgender or gender nonconforming. There is a body of interdisciplinary research—with roots in ­psychology—that has found that there are negative psychological implications, in addition to the possible economic implications, for same-sex couples living in U.S. states without legal protections for LGBTQ people. Yet even within heterosexual relationships, there are hierarchies of privilege: Social and legal rights and privileges are afforded to those who engage in the “good” or idealized forms of heterosexual behavior, such as marriage and child rearing. Gayle Rubin theorized that within heterosexual sexual practices, only married sex for procreation (e.g., conceiving children) falls within “a charmed circle” of socially sanctioned acceptable behaviors. Other sexual behaviors—including nonheterosexual behavior and unmarried or nonmonogamous heterosexual sexual behaviors—are cast outside and considered deviant and immoral. However, this model also reveals the historical and social nature of sexual norms and values because what is considered good or bad sexual practices can shift over time.

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History and Measurement A historical look at its social and scientific past reveals that heterosexuality is not an essential, universal category of sexuality but, rather, is contextually and historically bound, with meanings that have varied across time and place. In fact, heterosexuality as a concept and as a term is relatively novel; its common usage in Western countries did not begin until the 20th century. The term was coined in Richard von Krafft-Ebing’s Psychopathia Sexualis in 1889 (translated into English in 1892). This book was part of the early sexology studies, studying human sexual behavior, that largely defined any nonprocreative sexuality (including homosexuality) as perverse. Michel Foucault’s genealogy The History of Sexuality traces how categories of sexuality (e.g., heterosexuality) were socially constructed, such that sexual behaviors (e.g., sex between a man and a woman) came to constitute a category of person (e.g., a heterosexual person). Since the turn of the 20th century, in the United States, heterosexuality has been constructed as normal and moral, whereas homosexuality has been constructed as deviant. For example, homosexuality was considered a mental illness and was not removed from the American Psychological Association’s standard for diagnosing mental illness, the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973. Knowledge of heterosexuality also depends on how it is measured. Sexual orientation is commonly measured by asking participants to select self-reported identity labels (e.g., “I am heterosexual” or “I am straight”). This use of forced selflabels often fails to reflect the complicated ways in which people define their sexuality. There are a variety of ways in which people identify their sexual orientation, other than homosexual/gay/­lesbian or heterosexual/straight, including the increasingly popular “mostly heterosexual/mostly homosexual” labels, as well as ways that challenge the dichotomy of gender (e.g., pansexual, queer). Moreover, while most people identify as heterosexual (estimates range between 93% and 96.6%), estimates suggest that between 16% and 21% of the population experience same-sex attractions and about 8% report that they have engaged in same-sex sexual activity. Methodologically, only using sexual orientation labels (as opposed to

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behavioral measures) does not capture the experiences of those who identify as heterosexual but who also have had romantic relationships or sexual experiences with, or felt attracted to, persons of the same sex.

Conclusion Marginalized sexualities serve to maintain the normalness, value, and invisibility of heterosexuality. A function of its privileged status, it is often easier to define what heterosexuality is not rather than what it is. This entry complicates notions of heterosexuality by providing a definition more nuanced than is commonly understood. Heterosexuality is an identity and an institution that plays out in cultural, social, and political practices that affect all people’s experiences of gender and sexuality; it is an institution and cultural product shaped by politics and history that structures social relations and regulates heterosexual and nonheterosexual behaviors and identities. Kimberly Belmonte, Jennifer Chmielewski, and Brett G. Stoudt See also Gender Identity; Hegemonic Masculinity; Heteronormativity; Heterosexual Privilege; Masculinities; Sexual Identity; Sexual Orientation: Overview

Further Readings Butler, J. (1990). Gender trouble. New York, NY: Routledge. Collins, P. H. (2002). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. New York, NY: Routledge. Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic masculinity rethinking the concept. Gender & Society, 19(6), 829–859. Foucault, M. (1978). The history of sexuality: Vol. 1. An introduction (R. Hurley, Trans.). New York, NY: Random House. Katz, J. (2007). The invention of heterosexuality. Chicago, IL: University of Chicago Press. Rich, A. (1980). Compulsory heterosexuality and lesbian existence. Signs, 5(4), 631–660. Rubin, G. (1984). Thinking sex: Notes for a radical theory of the politics of sexuality. In C. S. Vance (Ed.), Pleasure and danger: Exploring female sexuality (pp. 267–319). London, England: Pandora.

Worthington, R. L., & Mohr, J. J. (2002). Theorizing heterosexual identity development. The Counseling Psychologist, 30(4), 491–495.

Histrionic Personality Disorder and Gender Histrionic personality disorder first became a diagnosis in 1980 with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) by the American Psychiatric Association. Since then, the relationship between histrionic personality disorder and gender has been an important topic.

Diagnosis To be diagnosed with histrionic personality disorder, an individual must exhibit at least five out of the following eight criteria: (1) striving to be the center of attention and feeling uneasy when this need is not met; (2) participating in sexually ­deviant behaviors, particularly with inappropriate targets (e.g., strangers, authority figures); (3) expressing emotions on a range that others may consider superficial or insincere; (4) dressing in physically inviting or provocative ways for attention; (5) using language that is oblique, indirect, and artificial; (6) speaking in melodramatic or sensational ways; (7) being susceptible to others, due to manipulation or approval; and (8) believing that relationships (e.g., romantic and sexual relationships, friendships) are more interpersonally connected and intimate than they actually are. Histrionic personality disorder has its roots in the diagnosis of “hysteria,” which appeared in the DSM-I and DSM-II and was a common diagnosis of Sigmund Freud for his female patients who had unexplained, transient medical conditions (e.g., temporary paralysis). In the interest of creating an atheoretical diagnosis (i.e., a diagnosis that was not based in psychoanalysis) and in the interest of distancing psychiatric diagnosis from psychoanalysis, histrionic personality disorder was found to have only some similarities with hysteria. Few studies have investigated the features, course, prognosis, and associated features of histrionic personality disorder, and no specific treatments exist for

Histrionic Personality Disorder and Gender

histrionic personality disorder, although metaanalyses have found that personality disorders in general respond to psychodynamic therapy and cognitive behavioral therapy.

Relationship Between Histrionic Personality Disorder and Gender A primary question regarding the relationship between histrionic personality disorder and gender has been whether the histrionic personality disorder category is a gendered description of a person. Although the description was intended to be neutral, some assert that it is difficult to imagine a man acting in the way of someone who is diagnosed with histrionic personality disorder and that it is much closer to the female stereotype of being verbal and dramatic. Evidence for this conclusion was based on a study that found that people with no previous experience with personality disorders had more difficulty learning associations between traits of histrionic personality disorder and “male” than “female” traits, suggesting that the traits of histrionic personality disorder are more closely aligned with the female stereotype. It is also possible that histrionic personality disorder is more common in women than in men when looking at base rates in the population. A study of the prevalence of histrionic personality disorder in all adult patients admitted to a psychiatric hospital (outpatient and inpatient) in Denmark found that of those diagnosed with histrionic personality disorder, 88.6% were women and 11.4% were men. This gender difference appeared to be increasing over time from 1995 to 2006. However, a U.S. study examining the prevalence of mental and substance abuse disorders in the community found equal prevalence of histrionic personality disorder in women (1.8%) and men (1.9%); another U.S. study found no relationship between gender and the diagnosis of histrionic personality disorder in a clinical sample when using structured interviews; and a third U.S. study found a minimal relationship between histrionic personality disorder and gender in a large community sample. The difference in results between these studies is another example of how it is possible that the female stereotype is associated with histrionic personality disorder, making it more likely for clinicians to diagnose women than men with the

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disorder when not using structured interviews or other tools that help decrease diagnostic bias. As suggested by the findings of the aforementioned epidemiological studies, the primary relation between histrionic personality disorder and gender might be in the area of diagnostic bias, or clinicians overdiagnosing histrionic personality disorder in women. Most often this issue has been researched using case vignettes in which the same clinical information is presented but the gender of the case is manipulated (i.e., changed) across research subjects. Despite the extent of the gender bias in diagnosis found in the clinical study in Denmark, the findings of the studies of case vignettes have been mixed. In several studies, the version of the cases that depicted females were rated as more histrionic, but those same studies also found no relationship between gender and histrionic personality disorder with other cases. Gender was not related to traits of histrionic personality disorder as well when the case was presented as a videotape rather than as a written document. One of the first studies of gender and histrionic personality disorder was conducted by psychiatrist Richard Warner and was published in two articles. The first article described clinical diagnoses for a case that was designed to have features of both antisocial and hysterical personality disorders. It described minor suicide attempts and failure to enjoy sexual relationships, to sustain close relationships, or to feel affection for others. It detailed an immature, narcissistic, and self-centered disposition with lack of remorse for an illegal act and an excitable, self-dramatizing, and flirtatious personality. The sex of the patient was randomly assigned across clinicians, and clinicians could choose from eight conditions, including antisocial and hysterical personality disorder, to make their diagnosis. When the case was female, 76% of clinicians diagnosed the case as hysterical and 22% as antisocial. When the case was male, 49% of clinicians diagnosed the case as hysterical and 41% as antisocial. From these data, Warner concluded that there was a tendency for clinicians to perceive the male versions of the cases as antisocial personalities and the female versions as hysterical personalities, even though the male version of the case was diagnosed equally as hysterical and antisocial. The abstract made the even stronger conclusion that antisocial and hysterical personality disorders are essentially

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sex-typed forms of a single condition. Despite the lack of evidence for Warner’s conclusion, this study set off a string of studies on sex bias in the diagnosis of hysterical and antisocial personality disorders. A year later, Warner published another article, revealing that the original study had actually included four cases and both race (i.e., White, Black, Chicano) and gender had been manipulated in the cases. The second case described simple schizophrenia, antisocial personality disorder, and drug dependence. The third case described anxiety neurosis and alcoholism, and the fourth case was intended to describe paranoid schizophrenia. For the second case, males were diagnosed with antisocial twice as often as females, although this difference was not statistically significant. The other cases also did not show significant gender differences. Thus, despite the positive findings for the first case for hysterical personality disorder and gender, gender was not found to be related to the diagnosis of hysterical personality disorder in the other cases. Other authors tested the reactions to videotaped male and female actors portraying a patient with depression in either a dramatic or a nondramatic fashion (i.e., dramatic presentation is a prominent trait of histrionic personality disorder). Clinicians watched the videotape and then were asked to rate how dramatic they thought the patient’s presentation was. Results showed that males and females were rated as equally dramatic. Thus, this study did not show a relationship between gender and a prominent histrionic trait (e.g., dramatization). An additional study further investigated ­Warner’s findings with a case of mixed histrionic and antisocial traits. This study included 18 cases with a male and a female version that represented five different kinds of pathology—(1) all antisocial behavior, (2) all histrionic characteristics, (3) a predominance of antisocial behavior with histrionic symptoms, (4) a predominance of histrionic descriptors with antisocial symptoms, or (5) an equal combination of antisocial and histrionic characteristics—along with 8 cases that described disorders “not commonly seen in either sex.” Clinicians were asked to rate on a scale from 1 to 11 the applicability of 10 diagnostic categories. The authors analyzed the ratings for antisocial and histrionic personality disorder across the five types

of cases with antisocial and histrionic features. The effect of sex was statistically significant for the histrionic category but not for the antisocial category. Thus, the female versions of the cases were consistently rated as more histrionic than the male versions of the cases, across cases that included a variety of histrionic traits. A later study investigated the gender associations with antisocial and hysterical personality disorders when cases had a variety of antisocial and histrionic traits. The study tested responses to cases that had met the diagnostic criteria for histrionic personality disorder or antisocial personality disorder, or had a mixture of antisocial and histrionic traits. The cases had a male, a female, and a gender neutral version. The participants were asked to rate the extent to which a case met the criteria for nine personality disorders. The authors found that when a case had both antisocial and histrionic traits, there were no gender differences in the ratings of histrionic personality disorder. However, the ratings of histrionic personality disorder were higher for female versions of the cases than male versions of the cases when the case met the criteria for antisocial personality disorder or histrionic personality disorder. Thus, the findings are getting more complicated. In 1990, David Adler and his colleagues investigated ratings when the case had various combinations of traits: This time the case met the criteria for histrionic, borderline, narcissistic, and dependent personality disorders. Clinicians were asked to indicate “no trait,” “trait,” or “disorder” for 11 personality disorder categories, with “trait” indicating that the person had some traits of the disorder but did not have enough traits to be diagnosed with the disorder. Male and female versions of the cases were distributed randomly to both male and female clinicians. Results indicated that patients’ sex was a significant determinant in whether they received a diagnosis, with more men being diagnosed as narcissistic and more women being diagnosed as histrionic. Thus, the relationship between gender and histrionic personality disorder is quite complex. Research suggests that the histrionic personality disorder characteristics are associated with the female stereotype. Given that finding, it is not surprising that more women than men are diagnosed with histrionic personality disorder in clinical

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samples. In epidemiological studies of community samples and when structured interviews are used, however, histrionic personality disorder is not found to be common in women. Instead, a series of studies suggest that the relationship between gender and histrionic personality disorder is more likely due to diagnostic bias on the part of the clinician. But this relationship does not occur with all cases. It has been difficult to determine under what conditions gender will affect the diagnosis of histrionic personality disorder. Most of this research into diagnostic bias with histrionic personality disorder is more than 25 years old, however, so the relationship between gender and histrionic personality disorder is not an area that is actively researched currently. Elizabeth H. Flanagan See also Antisocial Personality Disorder and Gender; Borderline Personality Disorder and Gender; Dialectical Behavior Therapy and Gender; Narcissistic Personality Disorder and Gender; Personality Disorders and Gender Bias; Self-Injury and Gender

Further Readings Adler, D., Drake, R., & Teague, G. (1990). Clinicians’ practices in personality assessment: Does gender influence the use of DSM-III Axis II? Comprehensive Psychiatry, 31, 125–133. Ford, M. R., & Widiger, T. A. (1989). Sex bias in the diagnosis of histrionic and antisocial personality disorders. Journal of Consulting and Clinical Psychology, 57, 301–305. Hamilton, S., Rothbart, M., & Dawes, R. (1986). Sex bias, diagnosis, and DSM-III. Sex Roles, 15, 269–274. Pedersen, L., & Simonsen, E. (2014). Incidence and prevalence rates of personality disorders in Denmark: A register study. Nordic Journal of Psychiatry, 68(8), 543–548. Slavney, P. R., & Chase, G. A. (1985). Clinical judgements of self-dramatization. A test of the sexist hypothesis. British Journal of Psychiatry, 146, 614–617. Trull, T. J., Seungnim, J., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality disorder diagnoses: Gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24, 412–426. Warner, R. (1978). The diagnosis of antisocial and hysterical personality disorders. Journal of Nervous and Mental Disease, 166, 839–845.

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Warner, R. (1979). Racial and sexual bias in psychiatric diagnosis. Journal of Nervous and Mental Disease, 167, 303–310.

HIV/AIDS The human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS). HIV is a viral infection that is not curable; however, HIV can be treated to help a person manage HIV-related symptoms. Following exposure to the HIV, HIV infection occurs when HIV germs infect the T-helper lymphocytes (CD4), or T cells in the immune system, which protects the body against infections and disease. The HIV reproduces by infecting CD4+ cells, which may result in a compromise in immune system functioning. This entry reviews the stages of HIV infection and forms of transmission. Next, it examines HIV diagnoses by gender, race, and age. The entry concludes by discussing testing, counseling, and prevention.

Stages of HIV Infection Acute HIV infection, also known as acute retroviral syndrome (ARS) or primary HIV infection, is the first stage of HIV infection. Acute HIV infection is characterized by significant amounts of the HIV in the blood or other bodily fluids, which occurs within 2 to 4 weeks during the initial phase of HIV infection. HIV transmission risk is exacerbated during the acute HIV infection phase because of the large quantity of HIV in the body. During this stage, a person seroconverts from HIV uninfected to HIV infected. The second stage, clinical latency or clinically asymptomatic HIV infection, manifests with the reproduction of the HIV at low levels in the body for a period of approximately 10 years. Individuals who are in the clinical latency stage of HIV may not experience major HIV-related symptoms, particularly when treated with HIV antiretroviral therapies (HIV medicines). HIV viral load tests can determine the amount of HIV in the body during this phase. Stage 3, the symptomatic HIV infection phase, occurs with a weakening in immune system

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functioning and opportunistic infections (e.g., pneumocystis pneumonia [PCP], tuberculosis, Kaposi’s sarcoma) or clinical symptoms (e.g., weight loss) manifesting in the body. In Stage 4, AIDS, the final stage of HIV infection, occurs, with a severe decline in immune system functioning accompanied by an increase in opportunistic infections. An HIV-infected person receives a diagnosis of AIDS when they develop opportunistic infections or an AIDS-related illness, or have a CD4 count below 200 cells per cubic millimeter of blood.

Transmission of HIV HIV transmission occurs through the blood, semen, preseminal fluid, vaginal fluids, rectal fluids, or breast milk of an individual who is HIV infected. HIV is transmitted through sexual behavior (oral, vaginal, or anal sex), injection drug use with needles or syringes, or blood transfusion, or from mother to child. The practice of anal intercourse without a condom has been shown to represent the greatest average precontact risk for HIV infection, followed by vaginal intercourse without a condom, due to the delicate lining of the mucous ­membranes in the anus as compared with the vagina. HIV behavioral research has indicated that receptive anal intercourse (i.e., when a sexual partner receives a penis into the anus during sex) has been indicative of a primary HIV transmission risk. Insertive anal intercourse (i.e., when a sexual partner inserts a penis into the anus during sex) also holds an increased HIV transmission risk but only secondary to receptive anal intercourse. Oral sex represents a lower HIV transmission risk when compared with anal or vaginal intercourse. However, HIV transmission risk is increased during oral sex when parts of the body are compromised (e.g., oral ulcers, genital sores, bacterial and viral sexually transmitted infections other than HIV). Much of the HIV prevention research has shown that substance use, abuse, and dependence, including substance use in conjunction with sex as well as multiple sex partners, increase HIV infection risk. Injection drug use holds an increased risk for HIV exposure due to the sharing of unsterilized needles or equipment (e.g., syringes, spoons, cookers, filters, rinse water). Injection drug use involves the injection of drugs into the muscle or just below the skull or into the veins and arteries.

Perinatal or mother-to-child HIV transmission involves the transmission of the HIV from an HIVinfected woman to a child during pregnancy, childbirth (i.e., during labor and delivery), and ­ breast-feeding. HIV prevention and treatment efforts have resulted in substantial reductions in mother-to-child HIV transmission rates in the United States. Biomedical prevention interventions through the administration of HIV medicines during pregnancy and childbirth as well as cesarean deliveries have reduced mother-to-child HIV transmission risk. In addition, research has observed reductions in perinatal HIV infection with the administration of HIV medications to infants with HIV-infected mothers for approximately 6 weeks. HIV medications have been shown to reduce the quantity of the HIV in the body of HIV-infected women, thus strengthening protection from HIV infection for the infant (e.g., reducing HIV exposure from bodily fluids) and facilitating a decrease in mother-to-child HIV transmission risk.

HIV Diagnoses by Gender, Race, and Age Approximately 1.2 million people are currently living with the HIV in the United States. Fourteen percent (1 in 7 people) are not aware that they are HIV infected. About 50,000 new HIV infections occur each year in the United States. Since the beginning of the HIV/AIDS epidemic, men who have sex with men (MSM; i.e., men who identify as gay, bisexual, or heterosexual and engage in male-to-male sexual behavior) have represented the largest proportion of people who have been infected with HIV in the United States. Among MSM, MSM of color (Asian, Black, Latin, and Native American) have disproportionate HIV infection rates. Within MSM of color communities, Black MSM, particularly young Black MSM, have been severely affected by elevated HIV infection rates. In 2010, young Black MSM (13–24 years of age) represented 55% of new HIV infections among MSM, while epidemiologic data have observed that young Black MSM are more likely to be unaware of their HIV status as compared with MSM from other racial/ethnic backgrounds. Regarding women and HIV diagnoses, according to the Centers for Disease Control and Prevention, women accounted for about one fifth of the estimated HIV diagnoses. The majority of women

HIV/AIDS

who are diagnosed with HIV/AIDS tend to become infected via heterosexual sexual contact, but about 13% become infected via injection drug use. While earlier reports found that HIV diagnoses were high among Black women, from 2005 to 2014, HIV diagnoses declined significantly among women in general (a decrease of 40%), as well as for Black women (a decrease of 42%). Furthermore, transgender women, particularly transgender women of color, have experienced significant HIV-related health risks, including ­ increasing HIV infection rates, unrecognized HIV infection, sex work, HIV sexual risk behavior (e.g., anal intercourse without condoms), and the administration of nonprescribed hormones (e.g., liquid subcutaneous silicon injections) by nonmedical providers as a method to feminize their physical appearance (e.g., face, breasts, thighs, buttocks). Transgender men’s sexual health, HIV infection rates, and HIV prevention needs have been understudied. Communities of color experience substantial HIV infection rates, with Blacks, or African Americans, reflecting the most substantial HIV burden. HIV epidemiologic research has shown that sociostructural factors have contributed to the disparate HIV infection rates among communities of color: higher HIV/STI (sexually transmitted infection) prevalence within sexual networks, acute HIV infection, irregular HIV testing patterns, late/undiagnosed and untreated HIV/STI infections, higher viral load (the amount of the HIV in the body), lower CD4 counts, stigma, poverty/lower income, and inadequate access to health care and treatment (e.g., HIV antiretroviral medications). Women, particularly women of color, have also experienced disparate HIV disease burden. Women account for approximately one in four HIV-infected people in the United States. The majority of women who are HIV infected have been diagnosed (88%), while a smaller proportion (45%) have been sufficiently engaged in HIV care and have reached viral suppression (32%) to regulate the amount of HIV. Adolescents and emerging young adults are at a substantial risk of acquiring and transmitting HIV in the United States. In 2010, young people between the ages of 13 and 24 years accounted for about 26% of new HIV infections in the United States, while reflecting about 17% of the U.S. population. Approximately 60% of HIV-infected youth are unaware of their HIV infection. The

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majority of new HIV infections among youth have occurred among young MSM (especially young MSM of color). During adolescence, core adolescent developmental processes that place adolescents and emerging adults at risk for HIV infection involve the experience of sexual desires and exploration and the centrality of the peer group in defining sexual behaviors (e.g., the influence of peer norms and pressures to have romantic relationships and sex). In addition, young people experiment with alcohol and illicit drugs, which places them at increased HIV transmission risk due to, for example, unprotected sex, multiple sex partners, and use of alcohol/drugs before or during sex. Sexual debut, or the first sexual intercourse, often occurs during adolescence, when young people engage in sex without a condom or contraception on a regular basis. Older adults (50 years and older) make up about one quarter of HIV-infected people in the United States. Advances in HIV treatment (e.g., HIV antiviral medications) have worked to increase life expectancy and to enhance the health of people infected with the HIV. People living with HIV or AIDS can have normal life expectancy. Older adults have a greater likelihood of receiving a late HIV diagnosis as compared with young adults. A late HIV diagnosis is indicative of a delayed engagement in HIV care and treatment, which influences health and survival outcomes. Key HIV risk factors for older adults include inadequate knowledge of HIV, HIV sexual risk behaviors, inadequate HIV testing patterns, and use of substances. For example, recreational drug use may influence sexual risk practices among men and women. Also, the use of erectile dysfunction drugs, such as Viagra, by men may influence situational contexts during sex (e.g., multiple sex partners, engaging in sex without a condom). Older adults may also have sex without a condom due to lower perceived pregnancy risk.

HIV Testing and Counseling HIV testing assesses whether a person is infected with the HIV. HIV testing is a salient component of HIV prevention, treatment, and care. HIV testing is germane for knowledge of HIV status and for preventing HIV transmission, and it is used as a basis to link people to HIV care and treatment. A variety of HIV tests are available to detect the

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presence of antibodies or antigens (i.e., proteins generated by the immune system to fight germs) and/or indications of the HIV in the body. There are three types of outcomes in HIV testing: (1) reactive (HIV antibodies are detected by the HIV test, indicating that a person is infected with the HIV), (2) nonreactive (HIV antibodies are not detected by the HIV test, indicating that the person is not infected with the HIV), and (3) indeterminate test results (HIV test results are inconclusive or unclear, requiring repeat HIV testing). The window period of HIV tests refers to the time from infection to when antibodies are at a high enough level to be detected on an HIV antibody test. The length of time for the window period is based on the type of HIV test used and a person’s body composition. Two HIV testing approaches are available from a health care provider: (1) anonymous HIV testing and (2) confidential HIV testing. Anonymous HIV testing refers to when a person’s identifying information (e.g., name) is not attached to their HIV test results (e.g., the person will receive a unique identifier to retrieve their HIV test results), while confidential HIV testing indicates that a person’s identifying information (e.g., name) is attached to their HIV test results (e.g., these test results can be a part of the person’s medical and/or insurance record). Three types of HIV testing (antibody, RNA [ribonucleic acid], and combination tests) are used to assess HIV infection in the body. Antibody testing (rapid tests, e.g., ELISA [enzyme-linked immunosorbent assay] or oral fluid tests) detects HIV antibodies in the blood, saliva, or urine (window period: 2 weeks to 3 months). The ELISA is a standard antibody test based on the collection of blood. An oral fluid HIV test detects the presence of HIV antibodies in cells located in the gum and cheeks of the mouth. Two types of rapid HIV tests are used (i.e., blood collected by the pricking of a finger and oral fluid test). Antibody tests are confirmed with a Western blot blood test. RNA testing (antigen tests) assesses the actual presence of the HIV in the body (window period: 1–3 weeks after HIV infection). Combination testing assesses antibodies for the HIV-1 and HIV-2 virus in addition to the p24 protein. In addition to individual HIV testing and counseling, couples HIV testing and counseling (CHTC)

are available. CHTC is an HIV-testing approach where two or more individuals in a sexual relationship have HIV prevention counseling, testing, and linkage to services together as a unit. There are three types of CHTC outcomes: (1) HIV concordant negative couple (i.e., the partners in a relationship test HIV negative), (2) HIV concordant positive couple (i.e., the partners in a relationship test HIV positive), and (3) HIV discordant couple (i.e., one partner tests HIV negative, while another tests HIV positive). In 2012, the U.S. Food and Drug Administration approved an HIV self-test, commonly referred to as home HIV tests. The HIV self-test is a commercial HIV test that assesses HIV antibodies and can be purchased in a pharmacy or online. In addition to HIV testing, measurements have been used to assess the health of people infected with the HIV. HIV viral load tests are available to assess the amount of HIV antibodies in the blood for people who are HIV infected. HIV viral load tests indicate the progression of HIV disease.

HIV Prevention A multitude of prevention modalities have been effective in reducing HIV transmission risk. The correct and consistent use of male and female condoms during vaginal and anal intercourse has been shown to promote protection from HIV and other STIs, such as gonorrhea, syphilis, and chlamydia. Behavioral (individual and group level), community, and structural interventions have been shown to reduce HIV transmission risk. The socioecological model provides a prevention framework for understanding the intersection among individual, relationship, community, and societal levels in addressing the HIV epidemic. The individual level addresses biological and person-level factors (e.g., age, education, substance use, sexual risk behavior), including the development of behavioral ­strategies that promote healthy attitudes, beliefs, awareness, and behaviors. The relationship level focuses on the role that close relationships (e.g., peers, partners, family members) have in influencing HIV transmission risk, with the development of prevention strategies that examine peer or family norms, for example. The community level examines the role of settings as influencing factors (e.g., schools, neighborhoods). The societal level

HIV/AIDS

explores how sociostructural or macrolevel factors influence HIV-related health inequities in policy and systems (e.g., legal and political systems that affect incarceration). Biomedical prevention strategies such as preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) are available to reduce the risk of HIV infection. PrEP refers to the usage of HIV medicines prior to HIV exposure as a form of treatment to reduce HIV infection in people who are at high risk of acquiring the HIV. PEP refers to the administration of HIV medicines to a person following potential HIV exposure as a form of treatment to reduce HIV infection. PEP must be taken as soon as possible but within 72 hours of exposure to the HIV. Both PrEP and PEP require follow-up care with a health care provider. Treatment advances in HIV antiretroviral therapies have worked to increase life expectancy and enhance the health of people living with HIV and AIDS. Adherence to HIV medicines, or taking HIV medicines as prescribed by a health care provider, is essential to achieving optimal health. Research has indicated that consistent adherence to HIV antiretroviral therapies can reduce HIV transmission to an HIV-uninfected sexual partner by approximately 96%. While HIV antiretroviral therapies have become the standard of care for HIV-infected persons, initiating significant reductions in HIV-related mortality, as well as decreases in viral load to undetectable levels of the HIV in the body and increases in CD4 cells in the immune system, drug-resistant strains of HIV have become more widespread. Drug-resistant or more virulent strains of the HIV may interfere with the effectiveness of HIV medications through viral resistance, even in people who initially responded to HIV treatment. The Patient Protection and Affordable Care Act (ACA) legislation was enacted into law in the United States under the leadership of President Barack Obama in 2010. The ACA, including the U.S. Supreme Court ruling in 2012 in the National Federation of Independent Business v. Sebelius legal case, established a significant milestone for health care reform in the United States. The ACA has core provisions that address ­ fundamental health care access inequalities (e.g., Medicaid expansion, health insurance exchanges, subsidies for people within 400% of the federal poverty line,

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individual health insurance coverage requirement) for people in the United States. For people living with HIV and AIDS, the ACA has been critical in strengthening access to health care, such as guaranteeing health care coverage for people who have preexisting conditions, increasing affordable private health coverage, reducing prescription costs for people with Medicare, and broadening the reach of Medicaid coverage for people who are economically disenfranchised. In 2010, President Obama issued the National HIV/AIDS Strategy as a model to guide the first national response to addressing the problem of HIV/AIDS in the United States. The vision for the National HIV/AIDS Strategy is as follows: The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/­ ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality life-extending care, free from stigma and discrimination.

The original formulation of the National HIV/ AIDS Strategy focused on three objectives: (1) reducing new HIV infections, (2) increasing HIV care access and strengthening optimal HIV outcomes, and (3) reducing HIV-related disparities. President Obama updated the National HIV/AIDS Strategy in 2015. The first two objectives were maintained, while the third objective was revised to include reducing HIV-related health disparities/ inequities. A fourth objective was also incorporated into the strategy: (4) achieving a more coordinated national response to the HIV epidemic. As primary HIV prevention focuses on the health needs of HIV-uninfected people, secondary HIV prevention provides emphasis to the health needs of HIV-infected people. With respect to secondary HIV prevention, the HIV care continuum, or HIV treatment cascade, is a model that was developed to conceptualize the phases of HIV medical care for HIV-infected people in order to promote optimal engagement in HIV care and health outcomes as well as to reduce new HIV infections: (1) diagnosis of HIV infection, (2) linkage to HIV care, (3) retention in HIV care, (4) provision of HIV antiretroviral therapies or medicines, and (5) viral suppression. In 2013, President Obama

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developed the HIV Care Continuum Initiative, which requires federal agencies to prioritize the HIV care continuum with respect to the National HIV/AIDS Strategy’s implementation. Leo Wilton See also Gay Men and Dating; Gay Men and Health; Health Issues and Gender: Overview; Heterosexual Men and Dating; Heterosexual Women and Dating; Safe Sex; Sex Education; Sexually Transmitted Diseases; Transgender People and Dating; Transgender People and Health Disparities

Further Readings Bennett, L., Hankins, C., & Sherr, L. (2013). AIDS as a gender issue: Psychosocial perspectives. London, England: Taylor & Francis. Centers for Disease Control and Prevention. (2014). HIV in the United States: At a glance, 2013. Retrieved from http://www.cdc.gov/hiv/statistics/overview/ataglance .html Levy, M. E., Wilton, L., Phillips, G., II, Glick, S. N., Kuo, I., Brewer, R. A., . . . Magnus, M. (2014). Understanding structural barriers to accessing HIV testing and prevention services among Black men who have sex with men (BMSM) in the United States. AIDS and Behavior, 18(5), 972–996. National Federation of Independent Business v. Sebelius, 567 U.S. ___ (2012). The White House. (2010). National HIV/AIDS Strategy for the United States. Retrieved from https://www .whitehouse.gov/sites/default/files/uploads/NHAS.pdf Wilton, L., Palmer, R. T., & Maramba, D. C. (2014). Understanding HIV and STI prevention for college students (Vol. 5). New York, NY: Routledge.

Homophobia Coined by George Weinberg in the late 1960s, the term homophobia initially referred to a fear of individuals who identify as homosexual, and worry that such same-sex sexual orientation was contagious and threatened the traditional values of the family. In developing a term for such attitudes, Weinberg revealed the prejudice inherent in them and established “homophobia” as a concept deserving further exploration, enabling these attitudes to be challenged. Since Weinberg’s original definition of homophobia, professionals have used

the term more broadly to refer to the fear that lesbian, gay, or bisexual (LGB) orientations are present in oneself, that others will believe one is LGB, that people can be converted to LGB orientations, and that accepting homosexuality will lead to the extinction of humanity. Under this broad concept of homophobia, extant literature acknowledges four subtypes of homophobia: (1) cultural, (2) institutional, (3) personal, and (4) interpersonal. Cultural standards and values that prioritize heteronormative ways of living while devaluing LGB lifestyles and concerns create an atmosphere termed cultural homophobia. Within any culture, however, organizations and institutions such as governing bodies, companies, and schools may discriminate against LGB individuals, a practice called institutional homophobia. Not only does homophobia exist at this broad level, but so too does it affect persons at an individual level. Personal homophobia exists when an individual experiences negative, prejudiced feelings about LGB persons. If the prejudiced individual acts on their negative feelings in any way (e.g., verbal or physical harassment), then the act is classified as interpersonal homophobia. Despite the prominent use of these terms, controversy regarding the labeling of fear of homosexuality as a “phobia” has developed, as many believe that this incorrectly suggests that clinically significant fear is the hallmark of homophobia. Although fear may be one response that occurs in persons with homophobic attitudes, recent research suggests that emotions such as anger and disgust are more characteristic of homophobic reactions. Actions accompanying homophobic attitudes can range from humor at the expense of those who identify as LGB to a deeply felt revulsion toward LGB people. Furthermore, there is a concern that the use of a clinical term can obscure the social context of oppression in which LGB people reside. Thus, many researchers have begun to use terms such as sexual stigma, sexual prejudice, heterosexism, and homonegativity to better encompass the nature of anti-LGB attitudes and actions in society. For this entry, however, the term homophobia will be used to refer to such prejudiced attitudes as well as the accompanying negative feelings and actions against LGB individuals, bearing in mind these linguistic and possibly conceptual discrepancies. In sum, the present entry reviews the factors that influence the development and maintenance of

Homophobia

homophobia, the current state of homophobia, and the effects of homophobia on LGB individuals.

The Western Development of Homophobia Before the 19th century, human behavior in ­Western culture was viewed from a largely Judeo-Christian religious perspective. Biblical sources and religious hierarchies labeled same-sex sexual behavior as an “abomination” that was punished by holy beings or religious bodies. This created an early atmosphere of societal beliefs that same-sex sexual behavior and orientation were unholy and sinful. Although these religious authorities ultimately lost power, secular governments of the 16th century (e.g., King Henry VIII in England) were heavily influenced by the preceding religious ideologies and perpetuated the belief that homosexuality is deviant and wrong. These governments began to legally regulate homosexual behavior with punishments including imprisonment and death. When the original U.S. colonies were formed, all 13 held laws utilizing capital punishment to enforce restrictions on homosexual behavior. In 1682, Pennsylvania reduced the penalty for homosexual behavior to include imprisonment for 6 months. South Carolina became the final colony to repeal capital punishment as a penalty for homosexuality in 1873. In the 19th century, the severely punitive responses to homosexuality were largely put to an end in Western nations when human behavior began to be examined scientifically. The inclusion of “idiocy/insanity” on the 1840 U.S. census marked the first effort by the government to gather statistical information about mental health. As the ­number of mental illness classifications grew, organizations such as the American Medico-Psychological Association, U.S. Army and Veterans Administration, and World Health Organization began to develop manuals of mental health categorizations in order to better gather statistical information. Development of manuals for classification became imperative when large numbers of service members returned from World War II seeking care for previously undefined mental illnesses. However, it was not until the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 that a manual contained descriptions of the many classifications of mental illness with the intention of clinical use.

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With this rise of scientific thinking and focus on clinical applications, undesirable human behavior became labeled as an illness rather than a sin or felony. This perspective regarded human qualities and behaviors as serving a function for the benefit of the species, and sexual behavior was no exception to this rule. Therefore, same-sex sexual orientations, which did not enable reproduction, were regarded as instinctual diseases that failed to serve the intended function of advancing the species. It was from this framework that homosexuality became labeled an illness that required psychiatric intervention to prevent the depopulation and deterioration of society. For years, this view of ­ homosexuality as a sickness in need of curing was purported as science in the field of psychology. Thus, homosexuality was included in the first ­edition of the aforementioned DSM under the category of “psychopathic personality with pathological sexuality.” Throughout this development of Western culture, heterosexual orientation has been legitimized, while same-sex sexual orientation has been framed as something to be avoided for fear of damnation, legal retribution, or mental contamination. Such negative views of homosexuality historically left little room for alternative beliefs that purport homosexuality as a normal and healthy form of human sexuality, and instead facilitated the evolution of the very fear, anger, and disgust that constitute homophobic attitudes. In addition to the historical context just described, there are additional factors that maintain the prevalence of homophobia in society today within individuals, communities, and nations. Several factors prominently discussed in the extant literature as being associated with homophobia include religion, ­traditional gender roles, and fear of AIDS.

Factors Influencing Homophobia Religion

Extant research identifies a strong link between religious beliefs and negative attitudes toward homosexuality. As previously noted, Judeo-­ Christian religious views of homosexuality appear to have influenced the development of homophobia in Western culture. However, it is not only these religious communities that have influenced the development and maintenance of homophobic

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attitudes. Researchers have investigated three criteria to determine the level of homophobic attitudes within a religion. These three criteria are negative attitudes toward homosexuality (1) in holy writings and (2) expressed by religious leaders, as well as (3) the strength of liberal and fundamentalist subdivisions within the religion. Based on these criteria, Islam, Catholicism/Orthodox Christianity, traditional Protestantism, and Judaism were found to express the more prejudiced attitudes toward homosexual individuals. Buddhism/Taoism/Confucianism was regarded as containing the fewest homophobic attitudes, followed by Hinduism. Although not considered an organized religion, atheism was found to hold the least homophobic attitudes overall. Not only does the content of a religion’s doctrine, its leadership, and its followers appear to influence homophobia, but so too does their approach to religious beliefs. In particular, religious fundamentalism has been identified as being strongly related to homophobia. This approach to religion is defined by the belief that there is only one true set of religious doctrines, that there is one correct way to adhere to these doctrines, and that adhering to these doctrines leads to a close connection with the holy being. Those who adhere rigidly to the teachings of religious leaders and the holy writings of their faith are likely to more strictly believe the prejudiced attitudes toward homosexuality that are provided through their religion. Furthermore, empirical research has found that the degree of homophobic prejudice is exacerbated because those with fundamentalist religious beliefs are more likely to hold prejudiced attitudes toward those with beliefs different from their own. Traditional Gender Roles

In addition to religious beliefs and fundamentalist approaches to religion, adherence to traditional gender roles is widely considered a primary factor influencing the prevalence of homophobic attitudes and actions. Research reveals that rigid, traditional views of gender roles and insecurity about one’s ability to fulfill the role of femininity or masculinity are linked to homophobia. One component of traditional gender roles involves the heteronormative conceptualization of romantic relationships as existing between a man and a woman. However, Alfred Kinsey’s research indicates that many people

experience some degree of same-sex attraction and that same-sex sexual behavior occurs in 10% to 35% of adults sampled. These findings reveal that homosexual activity is not a rare or sick aberration but is instead a normal and valid variation of sexuality. Thus, when men and women obey the stereotypical affective, cognitive, and behavioral roles assigned to males and females in their romantic relationships, they may be repressing their samesex feelings and developing a subconscious dislike of LGB persons to manage the weight of this repression. The conflict experienced in this act of repression is termed gender role conflict and occurs due to the dissonance between one’s real and ideal, performed self. Gender role conflict leads men and women to experience internal and interpersonal difficulties when monitoring and enforcing their own gendered behaviors as well as those of others who defy traditional gender roles. Although both heterosexual men and women exhibit homophobic attitudes toward members of the same sex who identify as homosexual, homophobia is more pervasive among men than among women. Masculinity is culturally valued, and men are therefore at greater risk of becoming devalued socially if they do not uphold their masculine gender role. Thus, strictly masculine men reject feminine behavior in themselves and other men, including what has traditionally been regarded as female sexual behavior (e.g., sexual behavior with men). These rigidly masculine men thereby exhibit prejudiced attitudes and actions toward gay men, using homophobia to maintain strict gender roles as well as interpersonal control. Fear of AIDS

Contributing to the view of homosexuality as an illness was the AIDS epidemic of the 1980s. In the early 1980s, AIDS began spreading rapidly in the United States. By 1985, thousands had already died from the disease in the United States, and the number of individuals being diagnosed was growing at a ratio of approximately 100% yearly. The high rates of AIDS diagnosis in LGB communities led Americans to fear not only the disease but homosexuality itself. Many began to refer to AIDS as the “gay disease” and believed that this diagnosis was primarily restricted to LGB communities. A poll from 1985 indicates that due to the AIDS

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epidemic, 37% of sampled individuals viewed LGB people less favorably than they had previously done. Although fear of AIDS is a separate construct from homophobia, there is a relationship between the two in that those who fear AIDS tend to also experience discomfort in the presence of LGB individuals. With the development of new, effective treatments for AIDS and the visible spread of the disease to other populations, the link between homophobia and fear of AIDS has lessened in the public eye.

The Current State of Homophobia Due to the aforementioned influences as well as many other sociopolitical and personal factors not mentioned here, homophobia has remained institutionalized in many nations, and there are many countries that continue to enforce laws prohibiting homosexuality. Currently, same-sex sexual acts remain illegal in 39% of United Nations (UN) states. Legal restrictions to homosexuality range from prohibitions of LGB “propaganda” to life imprisonment, to the death penalty. As of 2015, death penalties for same-sex sexual behavior were employed in six UN states: (1) Iran, (2) Mauritania, (3) Saudi Arabia, (4) Sudan, (5) Yemen, and (6) Brunei. These penalties are enforced by legal statute in five of these states and are imposed by vigilantes in one. In addition, death penalties for same-sex sexual behavior are enforced widely across Iraq as well as in parts of Nigeria and Somalia. These legislative and vigilante punishments for homosexuality reveal the prevalence of severe homophobic attitudes that are maintained through legal institutionalization. However, there are nations in which a shift appears to be occurring from widespread homophobic attitudes to greater acceptance of LGB orientations. Removal of Homosexuality From the DSM

After Kinsey’s revelation that homosexuality is a normal variation of human sexuality, Evelyn Hooker asked experts in the field of psychology to analyze the results of projective tests administered to men who were identified to be heterosexual and homosexual. Hooker did not inform the mental health professionals of the participants’ sexual orientation and found almost equal rates of psychopathology in the homosexual and heterosexual

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men sampled. The combined effects of Kinsey’s and Hooker’s research created new understanding of homosexuality as normal, which fueled the movement to remove the labeling of homosexuality as an illness from the DSM. Gay activists began to speak at APA conventions and to protest the speeches of those advocating for retention of the diagnosis of homosexuality in the DSM. It was as this activism rose that Robert Spitzer, a member of the APA’s Task Force on Nomenclature and Statistics, became convinced that homosexuality was a normal variation of human sexuality and sought to have the diagnosis removed from the DSM. In 1973, Spitzer’s resolution to remove the mental illness of homosexuality from the second edition of the DSM was approved by the Board of Trustees of the APA. However, variations of the diagnosis including egodystonic homosexuality and sexual disorder not otherwise specified were retained in the DSM-III and DSM-III-R (revised). As activists fought for the complete removal of homosexuality from the DSM throughout the 1980s, political change occurred in the United States regarding LGB issues. Politicians such as Barney Frank publicly revealed their same-sex sexual orientations. Sodomy laws were dismantled in some states, while they were added in others. This period represents a shift in Western thinking whereby homosexuality was no longer considered an illness or disorder, allowing for a flexibility in thinking that did not necessitate such extreme fear, anger, and disgust toward homosexual individuals. The Decline of Homophobia in Western Nations

This shift in thinking is evidenced in the declining rates of negative attitudes toward LGB orientations since the 1970s. Data from the 1970s and 1980s reveal that approximately 73% of individuals surveyed in the United States regarded adult same-sex sexual behavior as “always wrong.” By 2000, the percentage of individuals who held that belief fell to 58%, and even further to 51% in 2008. Evidence from all-boys’ schools in the United States and the United Kingdom supports these findings further, indicating that homophobia has declined in traditionally masculine institutions, where it was once highly prevalent. These results reveal the steady decline of negative attitudes regarding same-sex sexual activity throughout the past four decades in Western nations.

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As of 2015, same-sex sexual acts were legal in 61% of UN states. In addition, there are countries in which LGB individuals are gaining rights that had previously been granted only to heterosexual people. In the past decade, legislation in nations such as Canada, the United States, England/Wales, Denmark, and South Africa has provided LGB couples with the freedom to marry. This suggests that a social and political shift is occurring from heterosexist attempts to suppress homosexuality to more acceptance and recognition of LGB orientations. However, despite this shift in Western nations, homophobia is far from eradicated.

The Effects of Homophobia on LGB People Despite the decline in homophobia that is evidenced in Western nations, it is evident from the aforementioned statistics that many people within these nations continue to view same-sex sexual behavior and the individuals who enact these behaviors and hold LGB identities in a prejudiced and negative manner. Homophobic attitudes not only persist in institutions such as religions and governments but also fuel prejudice, discrimination, and victimization on an individual level. The pervasive and insidious nature of the many forms of homophobia in society inevitably takes a toll on LGB individuals and communities. Sexual Minority Stress

One framework for understanding this impact is the minority stress model, which explains that distal and proximal factors related to one’s sexual identity combine to create the experience of stress regarding one’s sexual minority status. These distal and proximal factors include (a) stressful external events, (b) the expectation that such events will occur in the future and caution in the world due to this anticipation, and (c) internalized negativity regarding one’s minority identity. The third, most proximal factor is termed internalized homophobia and occurs when LGB individuals begin to experience stress from self-stigmatization, whereby they direct society’s negative messages about sexual minorities inward toward themselves, even in the absence of current external minority stressors. Ultimately, it is theorized that this internalization

of homophobic prejudice leads LGB individuals to negatively evaluate their sexual identity and, consequently, negatively evaluate themselves as a whole person. This experience of minority stress is revealed to be highly detrimental to the psychological health of LGB individuals. Discrimination and Victimization

The stressful external events included in the minority stress model often include experiences of discrimination and victimization. LGB persons are at greater risk for experiences of discrimination and victimization throughout their lifetime than their heterosexual peers. For example, according to Sean Esteban McCabe and colleagues, 31% of heterosexual individuals who identify as a racial or ethnic minority reported experiencing discrimination related to race/ethnicity and 18% of ­heterosexual women reported gender-related discrimination within the past year. However, 50% of LGB individuals who identify as a racial or ethnic minority reported experiencing discrimination related to race/ethnicity, and 48% of lesbian and bisexual women reported gender-related discrimination. In addition to these sources of discrimination, 38% of LGB persons reported experiencing discrimination related to their sexual orientation within the past year. Regarding experiences of victimization, LGB children are more likely to be verbally, physically, and sexually abused than heterosexuals, even within the same family or social environment. Furthermore, Joseph G. Kosciw and colleagues noted in “The 2011 National School Climate Survey: the Experiences of Lesbian, Gay, Bisexual, and Transgender Youth in Our Nation’s Schools” that in their middle and high school years, 84% of LGB students reported having heard the word gay used with negative connotations and 71% reported hearing various other homophobic comments. These comments, made by other students and teachers/staff, constitute vicarious victimization that is both commonplace and harmful to the wellbeing of LGB people over the life span. In addition, LGB teens are subjected to more direct victimization; for example, Kosciw and colleagues found that 82% of LGB students surveyed reported experiencing verbal harassment, 38% reported encountering physical harassment, and 18% reported

Homophobia

being the victim of physical assault in the past year. These figures stand in contrast to those for the general population, in which 20% of adolescents reported experiencing emotional victimization and 22% reported physical victimization, according to Heather A. Turner and colleagues. These prevalence rates reveal that despite the changes in laws and institutions and the overall shifts in public attitudes, homophobia persists and puts LGB people at risk for negative experiences. In adulthood, LGB persons are also more likely to report experiences of sexual assault, physical victimization, and discrimination than their heterosexual counterparts. Health Disparities

Experiences of discrimination and victimization, as well as the other factors of sexual minority stress, take a toll on LGB people in the form of health disparities. Research supports this notion, consistently demonstrating small but significant differences between LGB individuals and their heterosexual counterparts in both mental and physical health outcomes and behaviors. For example, the rate of suicide attempts within 1 year is double among LGB populations compared with heterosexuals. Furthermore, LGB people are at greater risk for mental health disorders such as depressive and anxiety disorders, as well as health risk behaviors such as smoking and substance abuse over the lifespan than heterosexuals. These disparities have been linked empirically to minority stress factors such as discrimination, victimization, and internalized homophobia. Kimberly F. Balsam and Genevieve Heyne See also Gender Roles: Overview; Heterosexism; Heterosexist Bias in the DSM; Minority Stress

Further Readings Bayer, R. (1987). Chapter 1: From abomination to disease. In Homosexuality and American psychiatry: The politics of diagnostics (pp. 15–19). Princeton, NJ: Princeton University Press. Cabaj, R. (2009). Strike while the iron is hot: Science, social forces and ego-dystonic homosexuality. Journal of Gay & Lesbian Mental Health, 13(2), 87–93. doi:10.1080/19359700802716458

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Carroll, A., & Itaborathy, L. P. (2015). State-sponsored homophobia, a world survey of laws: Criminalisation, protection and recognition of same-sex love. Geneva, Switzerland: International Lesbian, Gay, Bisexual, Trans and Intersex Association. Retrieved from http:// old.ilga.org/Statehomophobia/ILGA_State_Sponsored_ Homophobia_2015.pdf De Block, A., & Adriaens, P. R. (2013). Pathologizing sexual deviance: A history. Journal of Sex Research, 50(3/4), 276–298. doi:10.1080/00224499.2012.738259 Drescher, J. (2012). The removal of homosexuality from the DSM: Its impact on today’s marriage equality debate. Journal of Gay & Lesbian Mental Health, 16(2), 124–135. doi:10.1080/19359705.2012.653255 Herek, G. M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research and Social Policy, 1(2), 6–24. doi:10.1525/srsp.2004.1.2.6 Hooker, E. (1957). The adjustment of the male overt homosexual. Journal of Projective Techniques, 21, 18–31. doi:10.1080/08853126.1957.10380742 Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., & Palmer, N. A. (2012). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian, Straight, Education Network. McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100(10), 1946–1952. doi:10.2105/AJPH.2009.163147 McDermott, R. C., Schwartz, J. P., Lindley, L. D., & Proietti, J. S. (2014). Exploring men’s homophobia: Associations with religious fundamentalism and gender role conflict domains. Psychology of Men & Masculinity, 15(2), 191–200. doi:10.1037/a0032788 Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. doi:10.1037/0033-2909 .129.5.674 O’Neil, J. M. (1981). Patterns of gender role conflict and strain: Sexism and fear of femininity in men’s lives. Personnel and Guidance Journal, 60(4), 203–210. doi:10.1002/j.2164-4918.1981.tb00282.x Turner, H. A., Finkelhor, D., Hamby, S. L., Shattuck, A., & Ormrod, R. K. (2011). Specifying type and location of peer victimization in a national sample of children and youth. Journal of Youth and Adolescence, 40, 1052–1067. doi:10.1007/s10964-011-9639-5

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Weinberg, G. H. (1972). Society and the healthy homosexual. New York, NY: St. Martin’s Press.

Homosexuality Homosexuality refers to being physically and emotionally attracted to persons of the same sex or gender. In more recent years, homosexual people are more commonly identified as gay for males and lesbian for females. For example, a gay man is an individual who is physically and emotionally attracted to other men, whereas a lesbian woman is an individual who is physically and emotionally attracted to other women. Some people find the term homosexuality to be offensive due to its association with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which had classified homosexuality as a mental disorder until 1974. In addition, some argue that the term homosexuality is insulting because it only refers to one’s sexual behavior and does not also include other relational aspects, including emotional attractiveness between samesex persons. This entry begins by reviewing the history of the term homosexuality; it then provides a basic overview of homosexuality as a sexual identity and concludes with a review of homosexuality throughout history.

Homosexuality as a Term The term homosexual has Greek and Latin ­origins—with homos from Ancient Greece to mean “same” and sexualis from Ancient Latin to mean “sexual.” It is believed that the first reference to the word homosexual in print was by an ­Austrian-born novelist named Karl-Maria ­Kertbeny, who published a German pamphlet in 1869 that used this term. The word homosexual became popular when in 1886 Richard von Krafft-Ebing published his book Psychopathia Sexualis, in which he used the words homosexual and heterosexual to describe sexual orientation. Modern style dictates against the use of the term homosexuality due to its historical clinical underpinnings of pathologizing gay and lesbian persons. Today, most individuals self-identify as either gay or lesbian and not as homosexual. Men

who have sex with men (MSM) and women who have sex with women (WSW) are terms sometimes used by the medical profession and others to describe same-sex sexual behaviors and to account for some persons who do not self-identify as gay or lesbian. As a whole, the community has been identified as lesbian, gay, bisexual, or transgender (LGBT). In recent years, additional letters have been integrated into this acronym to include those who identify as transsexual (T), queer (Q), questioning (Q), intersex (I), asexual (A), ally (A), and pansexual (P), to produce LGBTTQQIAAP, although this has been critiqued by some because it potentially excludes other types of sexual identity not represented.

Homosexuality as Sexual Identity In addition to bisexuality (i.e., being physically and emotionally attracted to persons of either sex or gender) and heterosexuality (i.e., being physically and emotionally attracted to persons of the opposite sex or gender), homosexuality is one of three main categories of sexual orientation or a person’s sexual identity. The Heterosexual-Homosexual Rating Scale, more commonly referred to as the Kinsey scale as it was developed by Alfred Kinsey, was the first measure developed to categorize sexuality across a heterosexual-homosexual continuum (0 = exclusively heterosexual to 6 = exclusively homosexual) that uses an individual’s sexual history or number of sexual episodes during a specific time period to make this classification. Other classification systems have been developed since then to categorize sexual orientation or sexual identity. It has been estimated that approximately 10% of the world’s population identify as either gay or lesbian, although this approximation has been critiqued by some who argue that it is an underestimation. In fact, the exact number of gays and ­lesbians (and other sexual minorities) in the world is difficult to pinpoint because some individuals are closeted or do not feel comfortable revealing their true sexual orientation due to the real or imagined fear of stigma, prejudice, and discrimination commonly experienced by most sexual minorities in society. Most national surveys do not include questions about sexual orientation or sexual identity, making it difficult to ascertain the exact number of gays and lesbians in a country. Reliable data on the

Homosexuality

number of gays and lesbians could help inform public policy regarding the costs and benefits of domestic partnerships, the impact of legalizing gay adoption and gay parenting, and many other social policies and programs that could have a positive impact on society in general. Although it is unclear what specifically determines why and how a person develops a particular sexual orientation or sexual identity, it is generally believed by most scientists around the world that it is likely due to a combination of both nature and nurture. Although it was once believed that an overbearing mother and/or an absent father could potentially make an individual become homosexual, there is no empirical evidence to demonstrate that parenting or early-childhood experiences will determine a person’s sexual orientation. In addition, most scientists agree that homosexuality is a natural aspect of human sexuality and not a byproduct of a mental disorder, as some psychiatrists and other mental health professionals once believed. Sexual orientation is generally not something a person selects or has control over, and therefore, the term sexual preference should not be used because it implies that a person has a choice over their sexual identity. Reparative or conversion therapy to change a person’s sexual orientation from homosexual to heterosexual has not been shown to be effective and has been condemned by most mental health professionals as being detrimental to sexual minorities. Research with a number of different animal species has found that same-sex relationships are quite common. These relationships include not only sexual activities but also other, nonsexual relational characteristics, such as showing affection, courtship, pair bonding, and parenting. Homosexual behaviors, in particular, have been documented among approximately 500 different species around the world. In fact, the same species may take on different forms of sexual activity that typically correspond to either same-sex or ­opposite-sex sexual behaviors. Most animal studies researchers are unclear as to why this may occur or the implications of these behaviors for humans. Revealing or disclosing one’s sexual orientation or sexuality has been referred to as the coming out process. This can be a daunting process for some and may be extended over a period of time and with different people. In general, coming out has

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been described as having three stages. The first stage is when one recognizes that one might be a gay or a lesbian. This is sometimes referred to as the internal coming out process. The second stage involves opening up to others such as family members or friends about one’s sexuality. The third and final phase is living openly as a gay or lesbian person. Most people today come out during high school or college, but in some rare instances, coming out might occur earlier or later in life.

Homosexuality Throughout History Acceptance of Homosexuality

The earliest historical record of homosexuality occurred in China during the year 600 BCE. Many famous works of Chinese literature include something about homosexuality. For example, in the classic novel Dream of the Red Chamber, stories of romance between homosexual persons are explored. In fact, gay male relationships are portrayed as being more fulfilling than heterosexual relationships in some of the literature of the time. In the late 3rd century, according to some Chinese writings, homosexuality was as common as heterosexuality. Similarly, in South Asia, there are writings that refer to a third sex, or persons who engaged in same-sex sexual activities and nontraditional gender expression. In Ancient Egypt, around 2400 BCE, a couple named Khnumhotep and Niankhkhnum is regarded as the first documented gay male relationship. Confirmation of this partnership is noted in Egyptian art that portrays the two men in an intimate nosekissing position surrounded by their heirs. In the northern Congo, there is evidence of male Azande warriors taking on young males to have sex with and to help out with household activities. Similarly, women in Lesotho engaged in motsoalle, which were long-term erotic relationships between women that were sanctioned by society. In Ancient Greece, homosexual male sexual activity between older and younger men was considered to be a normal part of a man’s sex life, which also included relationships with women. Over time, and in different Greek cities, these same-sex male relationships were constructed in a variety of ways. This typically included a free or nonenslaved adult male and a free or nonenslaved adolescent male who engaged in this type of union.

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It was believed that these relationships contributed to controlling overpopulation and taught younger males how to be adult men in Greek society. While more has been written about male homosexuality in Greece, the literature on female homosexuality is quite sparse. However, one famous lyric poet named Sappho, who was born on the Greek island of Lesbos, from where it is believed the word lesbian originates, is known for her work that highlights the love and passion between women. In Ancient Rome too, like in Ancient Greece, relationships between males were common. However, these male-male relationships were typically between older free or nonenslaved men, who acted as the insertive or active sexual partner, and male slaves or freed young men, who acted as the receptive or passive sexual partner. Historians have noted that the majority of Roman emperors, with the exception of Claudius, had male lovers. One famous homosexual relationship was between the Roman emperor Hadrian and a Bithynian Greek youth named Antinous, which occurred sometime after the year 123, although this relationship came to an abrupt end when Antinous was murdered. Inspired by Greece and Rome, male homosexuality was also widespread in northern Italy during the Renaissance period. In the Middle East, beliefs about homosexuality have varied across time and in different countries. Israel has been noted as historically having some of the most tolerant views of homosexuality in the Middle East and Asia. Specifically, Tel Aviv has been identified as one of the most gay-friendly cities in the world. Homosexuality was also accepted in ancient Assyria, which included parts of modern northern Iraq, northeastern Syria, and southeastern Turkey. In fact, there is evidence from some religious texts that homosexual relationships were blessed and even seen as equal to heterosexual relationships. Similarly, homosexuality and homoerotic expressions were allowed in Greater Iran. During 1501 to 1723, male houses of prostitution were legally recognized and paid taxes. In the South Pacific, same-sex relationships were an important part of Melanesia culture, particularly in Papua New Guinea. Prior to the introduction of Christianity by European missionaries, several Melanesian societies, including Etoro and Marind-anim, even honored male homosexuality as positively contributing to society. Traditional Melanesian culture would pair prepubescent boys

with older adolescent males, who served as mentors to the boys. It was believed that for the younger males to reach puberty they needed to be inseminated orally, anally, or topically over several years depending on the tribe. In the Americas, prior to colonization, twospirited individuals were Native people who possessed both a masculine and a feminine spirit. Historians have noted that two-spirited children were given an option by their parents to learn the customs of the opposite gender but that sexually they remained with members of the same sex. Some scholars have argued that two-spirited individuals embodied gay or lesbian persons, whereas others have indicated that they more accurately represented transgendered individuals. Either way, two-spirited individuals were accepted in Native American culture and were revered as shamans with extraordinary powers. This is similar to the situation in other precolonized societies, such as those in Latin America, which recognized and valued most LGBT persons. During the early 1700s, in England, several literary works included gay characters or described same-sex male sexual relationships. For instance, the original version of the novel Fanny Hill includes a scene with homosexual males. Other literary works at the time included same-sex relationships, but many of them were prohibited from being made publicly available or changed due to their reference to homosexuality. During the late 19th century, in Germany, Karl Heinrich Ulrichs published his work titled Research on the Riddle of Man-Manly Love and became the first openly gay man on record to publically speak in support of homosexuality and try to repeal the antihomosexual laws in Germany. Similarly, a book titled Sexual Inversion, which was published in 1896 by Havelock Ellis, challenged the assumption of homosexuality as being abnormal or deviant. In 1897, Magnus Hirschfeld started a group in Germany called the Scientific-Humanitarian Committee to protest against the antisodomy laws in the country. Around the same time, in Britain, Edward Carpenter and John Addington Symonds began a covert society among British intellectuals and writers to support homosexuality. Homogenic Love, which was published in 1894 by Carpenter, included prohomosexual writings. He would later reveal his own homosexuality in his book My Days and Dreams, published in 1916. In Germany,

Homosexuality

author Elisar von Kupffer published an anthology of homosexual writings at the turn of the century, in 1900. Opposition to Homosexuality

Although homosexuality was sometimes revered in certain cultures, other societies across time have been vehemently opposed to it. In some cultures, sodomy or nonprocreative sexual activity between people was criminalized. Endorsed by churches and the law, this included viewing homosexuality as an abomination and arguing for its eradication. Anal and oral sex between males, in particular, was condemned by Christianity and other religions because it was considered to be unnatural and against procreation. As discussed earlier, prior to religious influence, many different societies and cultures embraced same-sex relationships. From 618 to 907, during the Tang Dynasty in China, opposition to homosexuality began to percolate, due to the rising influence of Christian and Islamic values in the country. However, hostility toward homosexuality did not occur until the late Qing Dynasty and the Republic of China. In Ancient Greece, Plato, who had originally been supportive of same-sex relationships, eventually wanted to ban homosexuality for creating chaos in society. In the year 390, the Christian emperor Theodosius I established a law condemning the receptive or passive sexual male partners in same-sex relationships to be burned at the stake. Despite this ruling, boy brothels, where homosexual sex was still available for consumption, continued to exist, at least until the year 518. In 558, a new emperor named Justinian extended the law created by Theodosius to include the condemning of the insertive or active sexual partner to be burned at the stake as well. It was believed that engaging in homosexual behavior would lead to the eventual demise of many cities due to God’s wrath against homosexuality. During the Renaissance period, although there was widespread public support of same-sex relationships in northern Italy, under religious rule, the authorities at the time prosecuted, fined, and imprisoned a large proportion of men who were having sex with other men. Similarly, Native people in the Americas, after colonization by the Spanish, were persecuted, tortured, and murdered for engaging in same-sex sexual behaviors, which were influenced by Christian values.

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In most of Europe, during the second half of the 13th century, male homosexuality was punishable by death. In fact, even though there was relative artistic and erotic freedom at the time throughout Europe, morality took precedence over male-tomale sexuality. For example, the painter R ­ embrandt was forced to change some of his work due to its depiction of sodomy. In the Netherlands and England, during the early part of the 1800s, sodomy was punishable by law through execution. In today’s Middle East, homosexuality is criminalized in almost all Muslim countries, including Iran, Mauritania, northern Nigeria, Saudi Arabia, Sudan, and Yemen. If found guilty of same-sex intercourse in these Muslim nations, an individual is often sentenced to death. Contemporary Views of Homosexuality

Prejudice and discrimination continue to be experienced by gay and lesbian persons today on a regular basis. A national study conducted in the Netherlands in 2011 reported that more than half of the youth in this country rejected homosexuality. This finding is particularly surprising given that the Dutch are known for their liberal views and tolerance for difference. Stereotyping is also a major problem for gays and lesbians, which is often attributed to various forms of homophobia and heterosexism. Despite empirical evidence to the contrary, these negative characterizations of sexual minorities include the beliefs that gay men are more promiscuous and more likely to be pedophiles and abuse children than straight men, that gay men and lesbians are unable to form stable and committed relationships as straight couples do, and that gay men and lesbians hate the members of the opposite sex—all of which are untrue. Hate crimes committed against homosexuals are reported to the Federal Bureau of Investigation in the United States. In 2011, more than 20% of hate crimes were committed against sexual minorities, the majority of which were targeted at gay or bisexual men or those perceived to be so. Lesbians are subjected to hate crimes as well, although to a lesser extent than gay males, and they are also the victims of corrective rape, which aims to make lesbians straight. The most well-known and publicized hate crime committed against a gay male student was the murder of Matthew Shepard in 1998. In other parts of the world, honor killings

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Hormone Therapy for Cisgender Men and Women

are conducted by family members or relatives of LGBT people who are ashamed by their sexuality. Today, there are gay and lesbian persons who are recognized and supported all around the world. Although expressions of same-sex relationships may be different from the way they were historically, to a certain extent, fundamentally gay and lesbian persons primarily have sexual relationships with people of their own gender identity. Up to 60% of gay men and 80% of lesbians are in committed relationships, according to survey data collected in the United States. Several studies have also found that lesbian and gay relationships are comparable with heterosexual relationships in terms of happiness, commitment, and durability. Stronger support for same-sex civil rights, including marriage equality, gay adoption and parenting, equal access to health care, antidiscrimination laws for employment, and antibullying legislation to protect sexual minority youth, has increased over the past decade. According to the Pew Research Center, since the U.S. Supreme Court decision in June 2015 in Obergefell v. Hodges, guaranteeing the right to same-sex marriage, acceptance of same-sex marriage has increased from 57% in opposition in 2001 to 55% in support by 2016. Jacob J. van den Berg See also Heterosexism; Internalized Heterosexism; Sexual Orientation: Overview; Sexual Orientation Identity Development

Hormone Therapy Men and Women

for

Cisgender

Physicians prescribe hormone therapy for females who have had their ovaries removed, stopped having periods at a young age, or are currently menopausal. Women who are menopausal typically experience hot flashes, night sweats, irritability, vaginal dryness, and the need to urinate more often. Males typically receive hormone therapy to treat low testosterone levels; however, recent research has led to hormone therapy being used to treat men with prostate cancer. This entry explains the psychological impact of hormone therapy for cisgender men and women (i.e., men and women who identify with their birth sex) by comparing the biochemical effects of hormone therapy on male and female patients and by noting key similarities and differences. This entry begins with an overview of hormone therapy’s potential psychological impact by introducing the most common psychological side effects that different hormone therapies can have on a patient. The entry also focuses on the psychological effects associated with typical hormone deficiencies, how these deficiencies are treated, and how these treatments are relevant to either male or female patients. The conclusion of this entry explores the social and societal pressures influencing first-time hormone therapy patients who are considering treatment and the effect this pressure has on patients’ mental health.

Further Readings Crompton, L. (2003). Homosexuality and civilization. Cambridge, MA: Belknap Press of Harvard University Press. Halperin, D. M. (1990). One hundred years of homosexuality: And other essays on Greek love. New York, NY: Routledge. Halperin, D. M. (2002). How to do the history of homosexuality. Chicago, IL: University of Chicago Press. Mondimore, F. M. (1996). A natural history of homosexuality. Baltimore, MD: Johns Hopkins University Press. Pew Research Center. (2016, May 12). Changing attitudes on gay marriage: Public opinion on same-sex marriage. Retrieved from http://www.pewforum .org/2016/05/12/changing-attitudes-on-gay-marriage/

Common Hormone Deficiencies The common hormone deficiencies for cisgender men and women include deficiencies in corticol, dehydroepiandrosterone (DHEA), estrogen, melatonin, pregnenolone, progesterone, testosterone, and thyroxine and triiodothyronine. Cortisol

A steroid hormone, cortisol is unique in that it normally increases with age. In addition, cortisol can replace estrogen and progesterone in women who undergo significant stress. In this way, cortisol affects, and is affected by, psychological as well as biological factors. In males and females, weight

Hormone Therapy for Cisgender Men and Women

gain is the most common physical side effect of an overabundance of cortisol. There is extensive research into the psychological impact of increased cortisol levels, and stress is one of the most common aggravators. Dehydroepiandrosterone

DHEA is naturally present in young men and women, and it is normal for the level of DHEA to drop steadily in aging persons. Typically, only a fraction of DHEA remains as patients reach the ages of 60 to 70 years. In younger men and women, DHEA influences biological health, specifically immune function, metabolism, and muscle growth. DHEA naturally leaves the body by the time men and women approach 70 years of age. Estrogen

Estrogen is a female hormone that gradually diminishes in women as they approach and enter menopause. Estrogen deficiencies can negatively affect the sexual, psychological, and emotional well-being of patients. The most common side effects of estrogen loss or reduction are hot flashes, reduced libido, and vaginal dryness. There is ­ongoing research into estrogen deficiency and its ­correlation with Alzheimer’s disease, anxiety disorders, and depression. Melatonin

Melatonin exists naturally in both men and women and is a chemical by-product of the pineal gland. Melatonin deficiencies are most frequently found in men. These deficiencies can occur in young men but are more prevalent in aging males. Melatonin production is affected by outside factors such as drugs and alcohol. Pregnenolone

Pregnenolone is an essential building block of progesterone and testosterone. It is produced in the adrenal gland and is present both in males and in females. Pregnenolone deficiencies occur as a natural by-product of aging; however, it is essential that men and women have a healthy balance of pregnenolone because it is needed for the hormones progesterone, testosterone, and estrogen. Declining

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pregnenolone levels may result in minor decreases in cognitive function and may have an adverse effect on libido and sleep. Progesterone

Progesterone is a hormone that regulates hormonal balance in women. Biological side effects of progesterone deficiencies are most often associated with irregular, painful, or nonexistent menstruation. There is also research to suggest a correlation between progesterone deficiency and certain cancers. Progesterone deficiency can negatively affect mood. Testosterone

Testosterone is present in both men and women. However, it is commonly considered a male hormone because it is most essential to healthy male function. Testosterone governs libido, hair growth, weight, and stamina. Testosterone deficiencies are one of the most common reasons why men seek hormone therapy; however, men usually shy away from it because society views it as taboo. Health care workers and clinicians need to consider the societal taboos often associated with low testosterone in men. It is possible for testosterone to affect mental health and well-being because low testosterone levels can drastically affect mood, confidence, and sexual performance. Thyroxine and Triiodothyronine

Thyroxine and triiodothyronine are the two hormones responsible for thyroid and pituitary function. In addition to physical side effects typical of hypothyroidism, deficiencies in either thyroxine or triiodothyronine can cause anxiety and decreased libido. There is also research to suggest that thyroxine and triiodothyronine deficiencies negatively affect cognition and memory.

Perimenopause Perimenopause is a transitional period in a woman’s body preceding menopause. During this period, ovarian function desists in aging females. This transitional period typically occurs before women reach 50 years of age. The onset of perimenopause is often marked by irregular menstruation, weight

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gain, tiredness, and loss of some memory or cognitive function. It is crucial that clinicians and doctors give psychological reassurance to women entering this stage of their lives since many women feel as if the onset of menopause means a decrease in femininity. The reassurance that perimenopause is a natural step in the aging process may help the patient in the event that she feels depressed, anxious, or embarrassed about being perimenopausal.

Hypogonadism and Andropause The concept of andropause, often explained as male menopause, is a subject of debate among medical professionals. There have been several studies that explored the natural decline in male testosterone as men enter the 40- to 50-year-old range. Andropause refers to the advanced decline of testosterone that occurs as a result of dwindling testosterone production in the testicles, also known as hypogonadism. The subject of male menopause is a controversial one, and most health care professionals avoid this terminology. Andropause poses numerous psychological implications for a male patient’s mental wellbeing. It can give rise to depression and anxiety in men who are embarrassed to pursue treatment due to the social and cultural taboos that surround low testosterone in men. Doctors and clinicians must provide high-quality care if they are to serve patients entering this stage of life.

Psychological Effects of Hormone Therapy There are some studies that highlight the potential psychological effects of hormone therapy for cisgender men and women. Hormone therapy is thought to play a role in preventing Alzheimer’s disease; however, current research does not show any impact on preexisting Alzheimer’s disease. Research into the impact of hormone therapy on dementia for both male and female patients is promising. Female patients taking hormone therapy for menopausal symptoms show a decreased risk of acquiring dementia. They also benefit most from preventive hormone therapy. Male patients may benefit greatly from hormone therapy, as hormonal imbalances are typical aggravators of dementia. Regarding insomnia, studies have found that both male and female patients have reported improved sleep or decreased insomnia after starting hormone therapy.

Regarding depression, several studies have been conducted on the positive, psychological impact hormone therapy has on women who are just entering menopause (perimenopausal) or who have finished the process of menopause (postmenopausal). New research into the effects of hormone therapy indicates possible reduction in depression in perimenopausal and postmenopausal women. Women who enter menopause at a young age due to surgical removal of the ovaries are most likely to benefit from hormone therapy. Research shows that hormone therapy has a decreasing rate of effectiveness in women as they progress from the perimenopausal to the postmenopausal stage. Finally, there is some research to suggest that hormone therapy can have a positive impact on mood swings and irritability in female patients. Menopause can increase irritability in a patient or reduce her ability to control emotion, resulting in mood swings. Changes in mood are typical symptoms of menopause. Hormone therapy can help regulate the natural hormonal imbalances that occur during menopause.

Implications for Treating Patients With Hormone Therapy Menopause in females and low testosterone in males can create psychological side effects that negatively affect the patient’s quality of life, and careful consideration needs to be made before undergoing treatment. Pursuing hormone therapy, especially for men, is often considered taboo. As a result, menopause and low testosterone go untreated if the patient does not feel that hormone therapy is socially or culturally appropriate. Hormone therapy should be pursued only if the overall quality of the patient’s life can be improved. If hormone therapy is in the best interest of the patient, then health care professionals should reassure men and women that treatment offers more potential benefit than risk and that hormone therapy treatments simply replenish the depleted natural hormones. Patients should be reassured that modern society affixes no stigma on those seeking treatment for this natural condition. Doctors and other health care workers must ­ ensure that prospective hormone therapy candidates are provided all medical, emotional, and educational support. All patients deserve quality medical care, and eliminating any lingering taboo

Hormone Therapy for Transgender People

or misconceptions about hormone therapy is the duty of those providing this care. Clinical professionals must work to empower their patients and clients by eliminating the psychological suffering that has been exacerbated by the false, publicly held associations between waning femininity and menopause for women and between lack of masculinity and low testosterone for men. Clinical workers need to reassure clients that the decline of natural hormones is a natural progression of aging and that there is no shame in being treated for it and no sense in depriving oneself of treatment.

Hormone Optimization Hormone optimization most typically consists of preventive hormone therapy. Patients who wish to minimize the effect of natural hormone depletion use this treatment to supplement their hormone levels before a deficiency occurs. Patients are able to take charge of the aging process and minimize the negative psychological and biological impact natural aging can have on those left untreated.

Financial Limitations for Patients Seeking Hormone Therapy Societal and cultural perceptions are not the only factors governing patient choice on whether to pursue hormone therapy treatment. Aging patients may not always have access to health insurance, receive adequate pensions, or have family financial support when seeking hormone therapy. The inability to pay is often a more egregious deterrent for prospective patients than societal and cultural taboos. Moreover, the shame associated with the inability to afford hormone therapy can compound itself with the negative emotional side effects of menopause, low testosterone, and other diseases that affect the balance of hormones in the body. Clinicians and health care workers need to ascertain the reason why patients refuse treatment or are reluctant to start or continue hormone therapy. If financial reasons are part of the reason for patients refusing treatment, then clinical professionals or health care workers can supply the patient with information on generics or alternative treatments. Bassima Schbley

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See also Aging and Mental Health; Cultural Gender Role Norms; Gender Dynamics in Psychotherapy; Hormone Therapy for Transgender People; Menopause

Further Readings Kauffman, R., Castracane, V., & Hook, C. (2002). Postmenopausal hormone therapy and informed consent: A call for common sense. Journal of Women’s Health, 14, 592–594. Kaygusuz, I., Simavli, S., Eser, A., Gümüs¸, I., Yüksel, S., Duvan, Z., & Kafali, H. (2014). Effects of oral hormone replacement therapy on mean platelet volume in postmenopausal women. Turkish Journal of Medical Sciences, 44, 980–984. Maffei, S., Mercuri, A., Prontera, C., Zucchelli, G., & Vassalle, C. (2006). Vasoactive biomarkers and oxidative stress in healthy recently postmenopausal women treated with hormone replacement therapy. Climacteric, 9, 452–458. Reis, S., & Abdo, C. (2014). Benefits and risks of testosterone treatment for hypoactive sexual desire disorder in women: A critical review of studies published in the decades preceding and succeeding the advent of phosphodiesterase type 5 inhibitors. Clinics (Sao Paulo), 69, 294–303. Salpeter, S., Walsh, J., Ormiston, T., Greyber, E., Buckley, N., & Salpeter, E. (2006). Meta-analysis: Effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes, Obesity and Metabolism, 8, 538–554. Schbley, B. (2009). Socioeconomic factors in menopausal women’s use of hormone replacement therapy. Journal of Women & Aging, 21, 99–110. doi:10.1080/08952 840902837079 Zarrouf, F., Artz, S., Griffith, J., Sirbu, C., & Kommor, M. (2009). Testosterone and depression. Journal of Psychiatric Practice, 15, 289–305. doi:10.1097/ 01.pra.0000358315.88931.fc

Hormone Therapy for Transgender People Transgender hormone therapy is the process of administering masculinizing or feminizing hormones to individuals who desire a transition or change from their sex assigned at birth. Whereas some individuals desire maximum feminization or masculinization from hormone therapy, others want to relieve or minimize some of their

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secondary characteristics in order to achieve a more androgynous presentation. Not only is hormone therapy a method of inducing physical changes in an individual, but it is often a necessity for gender affirmation and improved quality of life for many individuals on the trans spectrum. Due to fear of being shamed for their gender identity or because of the cost, some individuals do not seek hormone therapy from professional health care practitioners but through unsafe or illegal methods. Many states have now mandated that both private and public insurance companies cover the cost of hormone therapy as well as transitionrelated surgical procedures. This has helped facilitate access for individuals who could otherwise not afford the care they need. It has also helped to eliminate some of the stigma that transgender and gender nonconforming (TGNC) individuals face and to produce a level of acceptance in the health care community. It has been shown that TGNC individuals may be at higher risk for depression, anxiety, and suicide, which is closely linked to social stigma and rejection. Approximately 41% of TGNC individuals attempt suicide in their lifetimes. Feeling empowered to receive the care that they need in a supportive and comprehensive primary care setting can have a significant impact on medical and mental health outcomes.

Considerations Prior to Starting or Maintaining Hormone Therapy There are several organizations that have outlined recommendations for hormone therapy for TGNC individuals. The Endocrine Society and the World Professional Association for Transgender Health have protocols for hormone management that have been widely used; however, many individual organizations have created their own protocols as well. Practices for hormone therapy vary from provider to provider and are altered based on a patient’s individual need. Before beginning hormone therapy, a thorough medical history and physical examination are advised. In addition, it is recommended that providers evaluate a patient’s experience with hormone therapy, as some patients may already be taking hormones, either prescribed by another provider or obtained from the Internet. Because it

is not uncommon for patients to inject hormones by using shared needles, providers should also test patients for other blood-borne infections (e.g., HIV, hepatitis C) and treat as needed. Given the risks associated with tobacco and hormone use, providers are advised to evaluate patients for tobacco use and incorporate smoking cessation counseling into patients’ visits. Certain coexisting medical conditions, such as breast cancer, active venous thromboembolism, or heart disease, can be contraindications to hormone use or may require a lower dose or alternate route of hormone therapy. With the initiation or maintenance of hormones, providers should include a risk-benefit discussion with the patient. Many protocols require a consent form to be reviewed and signed by both the provider and the patient. Although guidelines and protocols may exist to help guide hormone management, a patient’s specific preferences and goals must also be taken into consideration. Hormones should be tailored to each individual patient’s medical history and needs, and expectations of changes to one’s body should be addressed and managed early on. For example, a patient who is assigned male at birth not only may desire the feminizing effects of estrogen but also may want to maintain erectile function and thus not want to take an androgen blocker. Sometimes a patient may have anxiety surrounding hormone initiation, so hormone therapy can be started with lower doses and then increased, with frequent follow-up appointments for reassurance. If a particular patient has had gonadal removal, they may not need an androgen blocker or may need less estrogen or testosterone. Another important conversation for health care providers to have with patients prior to initiating hormones or while patients are taking hormones concerns fertility. Hormone therapy can affect fertility, sometimes permanently, even when the ­ hormones are discontinued. However, once the hormones have been discontinued, many transgender men and transgender women have had successful and healthy pregnancies through alternative reproductive options. These options include egg extraction and freezing, sperm banking, surrogacy, and artificial insemination. Preservation of egg and sperm is considered to be optimal if done prior to hormone initiation, but it can also be done after discontinuing hormones.

Hormone Therapy for Transgender People

Transgender men may continue to ovulate even after menses have stopped, so pregnancy is still possible, although the risk is reduced. Because testosterone can have adverse effects on a developing fetus, it is important for patients and providers to discuss contraception options early on. Long-­ acting reversal contraception, such as intrauterine devices, depot medroxyprogesterone, and etonogestrel implant, can be appropriate estrogen-free options for patients who desire contraception without increasing pill or injection burden. Sexual function may also be affected by hormone use. Testosterone tends to increase libido, whereas estrogen therapy and androgen blockers tend to decrease libido and affect erectile and ejaculation functions. This may or may not be consistent with an individual’s goals with hormone therapy, so it is important that providers inform patients of these changes and alter dosages accordingly. Increased libido can oftentimes lead to increased sexual activity, so it is recommended that providers incorporate the following into health care visits: (a) evaluation for safe-sex practices, (b) suitability for HIV pre-exposure prophylaxis, and (c) screening for sexually transmitted infections. Studies have shown that transgender men who identify as gay will oftentimes begin to have sex with nontransgender men after initiating testosterone. They tend to have condom-less v­ aginal/ anal sex and are poorly informed about sexual risk.

Hormone Therapy The following recommendations are a generalized approach to hormone therapy as outlined by the Endocrine Society and World Professional Association for Transgender Health. Estrogen

Estrogen can be given in several forms: estradiol tablets, patches, or injections. Patients most commonly prefer biweekly injections, but tablets or patches are options for patients who do not want injections. Estradiol patches may be preferred in certain circumstances, such as when the patient is over 45 years of age, has a history of venous thromboembolic disease, or has cardiovascular risk/disease.

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Progesterone

Progesterone has not been recommended as part of a hormone regimen because it causes unwanted side effects such as acne and balding. Antiandrogens

Oral antiandrogens can come in the form of androgen blockers or dihydrotestosterone blockers. They are oftentimes used in conjunction with estrogen as part of the feminizing regimen for transgender women. Dihydrotestosterone blockers can also be used in small doses for transgender men who want to minimize hair loss that can be caused by testosterone use. Testosterone

Injectable, transdermal (patch or gel), and oral testosterone are options for masculinizing hormone therapy. Injections are usually given biweekly. With the gel, transfer to others can occur, so patients are advised to cover the application site. Low-dose transdermal testosterone may not be sufficient for menses cessation, so long-acting reversal contraception or depot medroxyprogesterone may be added. It is important to note that if the levels of testosterone in the body are too high, testosterone converts to estrogen.

Effects of Hormone Therapy Feminizing Hormones

Changes resulting from feminizing hormones vary from person to person but often begin within 1 to 3 months and can take more than 2 years to fully occur. Some of the following changes are not fully reversible, whereas others are, but it is difficult to predict the reversibility: •• Decrease in sex drive •• Fewer erections and difficulty having and maintaining an erection •• Decreased ability to make sperm or ejaculatory fluid •• Slower growth of facial hair •• Nipple and breast growth •• Softening of the skin •• Decrease in muscle mass and increase in body fat •• Decreased testicular size

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Masculinizing Hormones

As with feminizing hormones, these changes vary from person to person, and they can also begin within 1 to 3 months but can take more than 1 year to fully occur. Similarly, some of the following changes are not fully reversible, whereas others are, and it is difficult to predict the reversibility: •• •• •• •• •• •• ••

Increased sex drive Vaginal dryness Clitoral growth Hair thickness and growth Oilier skin/acne Increased muscle mass/upper body strength Redistribution of body fat (more fat around the waist, less around the hips) •• Cessation of menses •• Voice changes •• “Male”-pattern balding

Side Effects and Risks of Hormone Therapy The side effects and risks associated with the use of feminizing hormones include increased risk for blood clots, stroke, heart disease, and gallstones; liver toxicity; and increase in blood pressure (which can be offset by the addition of the ­androgen blocker spironolactone, a blood pressure–­ lowering medication), prolactin, and/or prolactinsecreting tumor (prolactin is a hormone that causes breast milk production). Breast cancer is rare in transgender females, but patients should be evaluated for risk for estrogen-dependent cancers. Associated with the use of masculinizing hormones are the following side effects and risks: increase in bad cholesterol and decrease in good cholesterol; increase in blood pressure; increase in red blood cells and hemoglobin, which can increase risk for stroke and heart attack; worsening of headaches and migraines; and liver toxicity. Because testosterone can be converted to estrogen, patients need to be evaluated for risk for estrogen-dependent cancers. In addition, some patients may experience mood changes right after a dose of testosterone is given or right before another dose is due.

Barriers and Care Retention Although many states now mandate that insurance companies remove exclusions related to transitionrelated care, transgender individuals still face other barriers, such as a lack of culturally competent and

knowledgeable medical providers as well as being denied services on the basis of their transgender identity. Some transgender people may opt to access transition-related care outside of the formal medical system, including buying hormones from Internet sources or from friends and injecting soft tissue fillers (“silicones”) to modify their bodies, which may be associated with serious medical sequelae. One recent controversy has been the use of puberty blockers and hormones among adolescents. Although these interventions have been shown to be effective at relieving gender dysphoria, referrals to gender specialists may be delayed due to discomfort or lack of knowledge on the part of parents or health care providers. Transgender persons experience high rates of depression and suicidality. Research has shown that the depression is associated with stigma and discrimination (on the basis of gender identity), lack of social support, and violence. ­Having access to gender affirming services and social support, especially parental support, has been shown to result in improved mental health outcomes as well as engagement with medical services. Health centers that provide transgender ­inclusive services and transition care need to ensure that their environment is welcoming and that all staff, not just clinical staff, have been trained in cultural competency. Health care providers need to be aware of the current guidelines for transition care and be able to provide both general as well as transition-related care. Wrap-around services, such as case management, legal services, assistance with trans-affirming referrals, and information on support groups and other community-based transspecific resources can all result in improved patient satisfaction as well as enhance engagement with and retention in care. Meera Shah and Asa Radix See also Hormone Therapy for Cisgender Men and Women; Transgender and Gender Nonconforming Adolescents; Transgender People

Further Readings Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., . . . Zucker, K. (2011). Standards of care for the health of transsexual, transgender, and gender nonconforming people, Version 7. International Journal of Transgenderism, 13, 165–232.

Hostile Sexism Daniel, H., & Butkus, R. (2015), Lesbian, gay, bisexual, and transgender health disparities: Executive summary of a policy position paper from the American College of Physicians. Annals of Internal Medicine, 163, 135–137. Grant, J. M., Mottet, L. A., & Tanis, J. (2010). National Transgender Discrimination Survey Report on Health and Health Care. Washington, DC: National Center for Transgender Equality and the National Gay and Lesbian Task Force. Makadon, H. J., Meyer, K. H., Potter, J., & Goldhammer, H. (Eds.). (2015). The Fenway guide to LGBT health (2nd ed.). Philadelphia, PA: American College of Physicians. Padula, W. V., Heru, S., & Campbell, J. D. (2015). Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: A cost-effectiveness analysis. Journal of General Internal Medicine, 31, 394–401.

Hostile Sexism Hostile sexism is a form of sexism that is reflected in biased attitudes and behaviors toward people based on their gender. Specifically, hostile sexism is based on ideologies that seek to maintain and perpetuate the dominance of one group by focusing on the perceived inferiority of the other group. This type of sexism is one component of ambivalent sexism, which is a theory developed and described by Peter Glick and Susan Fiske to explain beliefs, attitudes, and behaviors concerning women and men. Hostile sexism has been associated with strict endorsement of traditional gender role behaviors that reinforce a patriarchal social structure. Adherence to such hostile sexist attitudes can lead to restricting equal opportunities and maintaining gender-based prejudices that result in negative psychological and emotional consequences for both women and men.

Hostile Sexism Toward Women Hostile sexism is most often associated with negative prejudice against and hostile views of women that are rooted in the belief that women are inferior to men. People who harbor hostile sexist ­attitudes toward women tend to view women as intellectually inferior to men. In many cultures, men dominate high-status positions in areas including business, politics, religion, the military, law,

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and other professional careers related to societal power. To maintain male control in society, women are relegated to subservient roles. Hostile sexist ideologies serve to maintain men’s dominant role in patriarchal societies; consequently, women who defy their prescribed gender role and behave in nontraditional ways are perceived in a negative light, derogated, and demeaned. Hostile sexism comprises several philosophies. One is the notion that men need to control “their” women because women are less intelligent and less competent than men. Women are perceived as too emotional, as easily offended, and as having a proclivity to create major issues over trivial events. Because women are perceived as incapable of making important decisions, hostile sexists believe that it is men’s responsibility to dictate to women what they should think and how they should behave. This dominant paternalistic view serves to keep women submissive and subservient to men. Hostile sexism also comprises beliefs that women do not belong in the workplace and are too sensitive and emotional to be in high-status positions. A hostile sexist might believe that women who do enter the workforce will likely make excuses for their own incompetence by complaining that they are victims of discrimination. Hostile sexists also perceive women as weak and dependent and not able to independently handle life situations; therefore, men need to be the ones in control. As such, women should be grateful for everything men do for them, and they should submissively accept their prescribed female gender role. Such hostile sexist beliefs incorporate the idea that a woman’s place is in the home and that women should be the ones to cook, clean, and take care of the children. Not too surprisingly, women oppose these hostile sexist attitudes more than men. Another notion underlying hostile sexism is the idea that women use their feminine wiles to gain special favors from men. In this view, women use sex to tempt and manipulate men in order to achieve power over them. Women are perceived as “whiny teases” who want to control men by using their sexuality. For instance, hostile sexists believe that women enjoy leading men on but whenever men respond by showing interest, women delight in shutting them down and refusing their advances. Furthermore, hostile sexist views include the perception that once in a relationship women will continue their attempts to control men by putting them on a “tight leash.”

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Hostile Sexism Toward Men Although hostile sexism is often associated with feelings and behaviors directed toward women, hostile sexism can also be directed toward men. As a response to being subordinated by men, some women hold negative views against men that include feelings of resentment and disgust. Women with this view tend to perceive men as inferior in several ways. For example, hostile sexists tend to have a negative perception of men as childlike and in need of someone to take care of them; for instance, they might believe that when men become sick they act like “babies.” Hostile sexism toward men also includes the idea that men are not capable of being successful without women to guide and care for them. Hostile sexists are likely to perceive men as arrogant individuals caring only about their own personal wants and desires and continually trying to gain the upper hand and to control women at every turn. Women who harbor hostile sexist beliefs tend to view men’s paternalistic attitudes and behaviors merely as selfish manipulation with the goal of asserting their superiority over women. Hostile sexists also hold the belief that men merely give lip service to the idea of gender equality. Although men might state that they are proponents of equality between the sexes, when it comes right down to it, men want “their” women to adhere to traditional gender roles. Hostile sexism toward men also includes the idea that men use sexual aggressiveness as a means to control and dominate women. Hostile sexists perceive men as interested only in their own sexual satisfaction and conquests, and they believe that men will do whatever it takes to achieve their goal, regardless of how it affects women. Not surprisingly, this view leads to deep resentment and hostility toward men. Tay Hack See also Ambivalent Sexism; Benevolent Sexism; Gender Role Behavior; Gender Stereotypes; Sexism

Further Readings Eagly, A. H., & Mladinic, A. (1993). Are people prejudiced against women? Some answers from research on attitudes, gender stereotypes, and judgments of competence. In W. Stroebe &

M. Hewstone (Eds.), European review of social psychology (Vol. 5, pp. 1–35). New York, NY: Wiley. Glick, P., & Fiske, S. T. (1996). The ambivalent sexism inventory: Differentiating hostile and benevolent sexism. Journal of Personality and Social Psychology, 70, 491–512. Glick, P., & Fiske, S. T. (1999). The ambivalence toward men inventory: Differentiating hostile and benevolent beliefs about men. Psychology of Women Quarterly, 23, 519–536.

Hostile Work Environment See Women’s Issues: Overview; Workplace Sexual Harassment

Human Rights Human rights may be defined morally or legally. Defined morally, human rights are the claims that every human should be able to make on society. If one can claim that no person should be a slave, the right not to be enslaved is a moral human right. Legally, human rights are the international laws designed to protect moral human rights. When the 1966 International Covenant on Civil and Political Rights stated that “no one shall be held in slavery” (Article 8), the moral right was made a legal right as well.

Early Historical Developments Both the moral consensus on human rights and legal human rights have evolved slowly across recent centuries. Prior to the 1700s, almost all accepted slavery as moral. Prior to the early 1800s, very few felt that women should vote or hold public office. Yet today, slavery is universally condemned, and few countries around the world deny political participation to women. Legally, in the late 18th century, most Western nations outlawed torture. Across the 19th century, slavery was ended by most nations, and international humanitarian law began to be developed in order to reduce war suffering. In the first half of the 20th century, women gained the right to vote in many countries.

Human Rights

However, most of these laws were national, not international.

International Human Rights International human rights law developed mainly after the United Nations (UN) was established in 1945. One of its purposes, as stated in the UN Charter, Article 1, is “promoting and encouraging respect for human rights.” As soon as the UN was founded, a Commission on Human Rights was created and given the task of preparing a universal bill of rights. Eleanor Roosevelt, the widow of U.S. president Franklin Roosevelt, chaired the commission, and many cite her wise leadership as a major reason for its early success. The commission decided to first write a declaration, a statement of human rights ideals, and to then prepare a covenant, binding international law on human rights. After 2 years of deliberation, the Universal Declaration of Human Rights was adopted by the UN General Assembly on December 10, 1948. Although just a statement of ideals, the Universal Declaration of Human Rights established the foundation for later human rights law. Its 30 articles include both civil and economic rights. As examples, its civil rights prohibit slavery and torture and proclaim the rights to nondiscrimination, a fair trial, and freedom of thought, conscience, and religion. Its economic rights include the rights to education and to “food, clothing, housing and medical care and necessary social services” (Article 25). Because Western and communist countries could not agree on whether civil or economic rights were more important, the decision was made to write two human rights covenants, one for each kind of rights. Thus, in 1966, the UN adopted the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights. Each one contains the kinds of rights its title suggests. The universal declaration and the two covenants are together called the International Bill of Human Rights.

Effects of Decolonization When the UN was founded, half of all people lived in colonies under foreign rule. But from the late 1940s through the 1960s, most of the colonies

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became independent nations and joined the UN. This change in UN membership had three major effects. First, the right of peoples to selfdetermination was introduced. The first article of the two covenants states, “All peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development.” Second, the United Nations Development Programme was established in 1965 to help the impoverished countries, mostly former colonies, develop better lives for their citizens. Third, the first human rights convention to protect specific groups, the International Convention on the Elimination of All Forms of Racial Discrimination (abbreviated CERD), was adopted the same year, largely at the urging of the new African nations.

Later UN Developments From 1979 through 2006, human rights conventions were created to protect the rights of four other specific groups: (1) women, (2) children, (3) migrant workers, and (4) persons with disabilities. Declarations on the rights of indigenous peoples and on sexual orientation were adopted in 2007 and 2008, respectively, but as of 2016, conventions on these do not yet exist. From 1948 through 2006, the UN also created human rights conventions to prevent and punish genocide, suppress human trafficking, prohibit torture and other cruel punishments, and protect persons from being caused to “disappear” by governments or by others groups. Each UN covenant and convention has an oversight committee that reviews how well each nation abides by the treaty. In other efforts to advance human rights, the UN created the role of High Commissioner for Human Rights in 1993, a stronger Human Rights Council in 2006 to replace the Commission on Human Rights, and an International Criminal Court in 2002. The Court can prosecute the crimes of genocide, crimes against humanity, war crimes, and aggression. It also adopted the Millennium Development Goals (MDG) in 2000 to address the world’s worst poverty, suffering, and gender inequalities. Although not all MDG were fulfilled, great progress was made. The MDG expired in 2015 and were replaced by the Sustainable Development Goals—new goals for ending poverty and

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inequality and reducing environmental problems by 2030.

Toward the Future Today, human rights are not fully realized, and human rights abuses continue. Nevertheless, great advances have been made, particularly since the UN was established. As more people come to share Mahatma Gandhi’s belief that “all humanity is one undivided and indivisible family,” we can hope that human rights will advance much further in the 21st century. Sam G. McFarland See also Gender Discrimination; Gender Equality; Reproductive Rights Movement

Further Readings Lauren, P. G. (2011). The evolution of human rights: Visions seen (3rd ed.). Philadelphia: University of Pennsylvania Press. McFarland, S. (2015). Human Rights 101: A brief college-level overview. Washington, DC: American Association for the Advancement of Science, Science and Human Rights Coalition. United Nations. (1945). Charter of the United Nations. Retrieved from http://www.un.org/en/charter-unitednations/ United Nations. (1966). International covenant on civil and political rights. Retrieved from http://www.ohchr .org/en/professionalinterest/pages/ccpr.aspx United Nations. (1966). International covenant on economic, social and cultural rights. Retrieved from http://www.ohchr.org/EN/ProfessionalInterest/Pages/ CESCR.aspx

Websites Office of the United Nations High Commissioner for Human Rights: http://www.ohchr.org/EN/Pages/ WelcomePage.aspx

Humanistic Approaches and Gender Humanism is the philosophical and practical belief in the value and worth of the individual as

an agentic and whole being who, by the very nature of their existence, is irreducible. This means that the worth and value of the individual is highly regarded to the extent that no construct can reduce the individual to parts that are less than their whole self. The humanist believes that people cannot be understood from a reductionist framework, but rather, they are best conceptualized from a holistic paradigm that honors the interrelationships among all facets of their personhood. Humanistic philosophy is grounded in the concept that humans are socially and contextually embedded in the world, while possessing the authority to experience and engage the world in uniquely self-directed ways. Humanistic ap­­ proaches focus on the rights of human beings to grow holistically, strive toward potentiality, be given respect, be valued, and honor their phenomenological experience. An understanding of contemporary humanism requires attention to the fact that it has often been presented as a way of being for the individual who is in the process of evolving into the ideal self. Simply put, as individuals are striving to evolve and to make sense and meaning of life, they develop a philosophy of existence. Therapeutic practice is grounded in a humanistic paradigm and requires a complex understanding of human behavior and existence with regard to growth and developmental transitions. Humanistic approaches see growth and development as a normative process in which each individual engages via social, contextual, and ecological environments, which are grounded in culture, history, and experience. From the perspective of the humanistic practitioner, there is an emphasis on authentic encounters first requiring relationship with oneself and then relationship with the client. The core tenets of humanism provide a context and basis for conceptualizing gender, biased binary thinking, and heteronormative perspectives regarding gender that impede growth and development.

Main Humanistic Approaches and Their Gendered Contexts The primary humanistic approaches reflected in the psychological literature are Maslow’s hierarchy of needs, existentialism, person-centered therapy, positive psychology, and Gestalt therapy. These five approaches are unified in their emphasis on

Humanistic Approaches and Gender

the subjective experience of humans, emphasis on irreducibility, focus on development and authenticity, and commitment to understanding human beings as inherently good and growth motivated. Considering the main methods from a gendered context expands the complexity of knowledge about humanistic approaches. Maslow’s Hierarchy of Needs

Abraham Maslow’s hierarchy of needs is a model for understanding what motivates human growth and development through needs fulfillment with the ultimate goal of self-actualization. Maslow identified five needs that are hierarchically situated, with the more basic needs having to be fulfilled before the more advanced needs can be addressed. The five needs in this model are (1) physiological, (2) safety, (3) love and belonging, (4) esteem, and (5) self-actualization. Toward the end of his career, Maslow explored self-transcendence as another need tied to self-actualization, yet the bulk of his model is focused on the original needs. From Maslow’s perspective, the most basic need is physiological and includes all the requirements for survival, such as food, shelter, and water. After the physiological needs have been met, an individual is motivated to fulfill the need for safety and security. At times, due to natural disasters or life crises, the safety and security needs may dominate an individual’s focus and motivate their actions. Safety and security needs must be fulfilled before an individual can master love and belonging needs. Humans need to feel a sense of belonging, and so they are motivated to meet their love and belonging needs through social groups such as family and friends. Prior to achieving self-actualization, individuals must also master esteem needs, which are correlated to respect for self and other. Individuals need to feel respected and valued by others and need to internalize that to experience feelings of self-respect. For Maslow, self-actualization is understood as achieving one’s potentiality in a domain that can only be understood by traversing the other four needs that are a part of the model. Maslow’s hierarchy of needs has been criticized for its male-biased emphasis on an individualistic self-actualization that does not privilege relatedness and connection. For Maslow, love and belonging were necessary precursors to self-actualization and were not necessary components of an individual

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who is actualizing. Focusing on relationships might preclude self-actualization by preventing the development of self-reliance and independence, ­ both of which are masculine and Western constructs of well-being and fundamental to Maslow’s understanding of actualization. Similarly, one’s relationship to the environment is overcome through actualization, according to the model. Feminists and existentialists have criticized Maslow’s framework as gender biased and not affirming of the relationship needs and experiences of human beings. Affirming the role of relationships in health, well-being, and actualization would be more inclusive of women and men. Existentialism

Existentialism is concerned with the human condition and what it means to exist as a human being. The focus is on understanding how an individual is in the world and how the person finds meaning amid the anxieties and challenges of life. A healthy person is one who lives with an openness to self, others, and the world while enacting a level of truthfulness about the realities of one’s existence. There are two types of organizing relationships: the “I-It” and the “I-Thou.” In the I-It relationship, the other is an object and is not engaged in a meaningful relationship. Existentialism espouses the need for I-Thou relationships in which authentic encounters emerge in the space between individuals. The individual is responsible for actively cultivating an authentic life imbued with authentic relationships. Existentialists encourage practitioners to interact with clients from both a masculine and a feminine framework depending on the client’s needs. The ability to be fluid in terms of one’s own gender identification and enactment is an important component of how authentic existentialists support their clients. Given existentialism’s emphasis on freedom and responsibility, there is the potential for not honoring the oppressive systems that are perpetuated along gender scripts in society. A focus on human agency and freedom can both silence the oppressive factors happening in society and privilege a male-biased definition of well-being. Person-Centered Therapy

Person-centered therapy emphasizes the transformative power of the relationship and privileges

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the experience of an unconditionally positive, congruent, and empathic relationship as being curative of psychological distress and disconnection. Person-centered therapy, as developed by Carl ­ Rogers, describes humans as inherently good and striving toward actualization. Rogers believed that humans are the experts of their own experience and can uncover their own solutions to their challenges. Psychological distress emerges when a person is functioning under conditions of worth and is experiencing a lack of congruence between the ideal and real selves. The most powerful mechanism for alleviating such distress is to create a therapeutic encounter that provides the optimal conditions for growth and actualization. Actualization, in Rogers’s approach, involves the striving toward meeting one’s potential and optimal engagement as a human being. A fully functioning person is one who has a high level of emotional awareness, is creative, is present in the here and now, enacts a congruence with oneself, and believes in the ability to choose one’s life and path. In the person-centered approach, the process of therapy is critical and needs to include unconditional positive regard, congruence, and accurate empathy. Rogers believed that these core conditions would create an environment that optimizes an individual’s capacity to grow toward actualization. By eradicating conditions of worth and wholly accepting the individual as a human being unconditionally, the practitioner fosters the client’s ability to be more genuine and to develop congruence between the ideal and real selves. Integrating accurate empathy from a congruent stance ­ encourages the client to experience a ­transformative relationship of understanding and ­genuineness, thereby promoting an environment supportive of actualization. As with criticisms of Maslow’s concept of selfactualization, the actualizing tendency in personcentered therapy has been criticized as male biased and ethnocentric. The emphasis on self-direction of the individual can be interpreted within the context of traditional gender role socialization, with masculine constructs being more aligned with such a definition of a fully functioning human. Conversely, the emphasis on relationship and congruence in person-centered therapy resonates with feminist constructs of relatedness and intuitive self-knowing. Person-centered therapy requires an individual to have a high level of self-knowledge

and awareness and to reflect continually on their own development. It also stresses the criticality of understanding the other’s self through empathy and cultural competence. Unconditional positive regard must be manifested in ways that counter the restrictive rhetoric of binary constructions of gender, so that clients who are gender nonconforming can also experience the optimal conditions for growth. The gendered context of person-centered therapy vacillates based on the unique components of the therapeutic relationship and how accepting the practitioner is of the gender enactment and congruence of the client. Positive Psychology

Positive psychology has emerged as an approach that emphasizes health, well-being, growth, human good, and development to the same degree as disorder and distress. Wellness and growth become central organizers of the therapeutic experience. Positive psychology emphasizes strengths and how psychological qualities are beneficial for humans. From a positive psychology framework, gender is perceived within a cultural context that provides insight into one’s strengths and resiliencies. Gender serves as an organizing structure for one’s lived experience, and it cannot be situated within a binary understanding of gender. Theorists in positive psychology argue that gender-based traits vary based on cultural, social, and historical factors, and therefore, positive gender-based traits are not universal truths but, rather, the interpretation of such traits will vary based on cultural differences. Gestalt Therapy

Gestalt therapy focuses on awareness as the curative factor for human beings. It emphasizes a here-and-now focus, a phenomenological understanding of individuals and systems, and contact through relationships. Gestalt therapy integrates a multitude of techniques to enhance awareness of body language, language usage, and affective experiences. People experience distress because they have unfinished business that is affecting their here and now or because they are stuck at an impasse and unable to move forward. From a gendered perspective, Gestalt therapy’s emphasis on polarities resonates with the binary construction of masculine and feminine. The

Humanistic Approaches and Gender

Gestalt goal is to create integration and fluidity between polarities. Applying such integration to gender would encourage the internalization of a gender identity that is both masculine and feminine while being best understood as a complex whole of all facets of gender awareness and enactment.

Gender Analysis of Fundamental Humanistic Constructs Conducting a gender analysis on fundamental humanistic constructs provides a conceptual framework to understand how gender interacts with humanistic approaches. A gender analysis tends to be situated in a binary model of gender scripts—namely, masculine and feminine—which does not capture the complexity of gender identification and expression present in human beings. Gendering our understanding of concepts is prevalent in our society and encourages the recognition of potential ways of knowing that are privileged or silenced in our knowledge construction. Subjective Well-Being

Humanistic practitioners recognize the impact of institutional and systemic barriers and the critical role they play in biasing and affecting individual gender realities and identities. In addition, there is a recognition that subjective well-being can be affected through heteronormativity and heterosexist ideology and the perpetuation of gendered microaggressions, which cloud the fact that how an individual enacts gender is a critical aspect of the agentic self. Heteronormativity is defined as the covert privileging of heterosexuals and the marginalizing of individuals who do not see themselves as falling within the same gender identities. Heteronormative behaviors serve to perpetuate the privileged status within current society held by those who identify as heterosexual by categorically ostracizing the individual who does not fall within the dominant identity category of heterosexual. This, coupled with microaggressions in the form of language and behavior, has the potential to significantly affect overall well-being. The humanistic practitioner relies on the belief that individuals should be allowed to cultivate their own meaning of gender, femininity, and masculinity and embrace their individual fluidity,

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which may be perceived by cisgendered individuals as residing on the margins of gender identity. The humanist has a contextual understanding that individual gender definition and gender identities are not exclusively connected to or diametrically opposed to gender roles. At the same time, the humanistic practitioner challenges the notion that the social construction of gender and gender expression serves as the definitive voice of the individual. Rationality and Dialogical Knowing

Within humanistic approaches, there is an emphasis on consciousness and rationality. Humanistic approaches value an individual’s ability to make meaning of experience and to engage in selfdirection. Such an emphasis on rationality is situated within a masculine paradigm and can be contrasted to dialogical knowing. Dialogical knowing is the knowing that emerges between the I-Thou and the I-It. Humanistic approaches focus on dialogical knowing in that it is through relationships that we come to form our knowledge of self and others. Dialogical knowing is more focused on meaning making than truth discovery. Locus of Control

Within humanistic ideology, there is an emphasis on the agentic being of the individual and their will to be within the world. A critical challenge to an understanding of this concept and its connection to gender is through socialization and a subsequent external locus of control. External ­ socializations and pressures generated by friends, family, education, social media, and gendered othering contribute to a lack of internal locus and propagate an externally focused way of being. For example, when posting images and personal narratives of self, there can be an overwhelming sense of pressure to simultaneously stand out as a unique individual and, at the same time, conform to norms based on a binary philosophy of gender.

Humanistic Approaches and Women’s Ways of Knowing Whereas humanistic approaches embrace the womanist notions of relatedness, intuitive selfknowledge, and growth, they have been criticized

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as privileging the masculine concepts of self-­ direction, individuation, and self-control. For humanistic approaches to integrate women’s ways of knowing, they must emphasize caring, relationships, feelings, and meaning making. Relatedness in knowing is an important construct that affects humanistic notions of the human experience, human growth, and discovery. Relatedness is correlated to empathy, which is most aligned with the existential, person-centered, and positive psychology approaches. Relatedness transcends women’s ways of knowing and encompasses the process of self-knowledge and other knowledge. The self is experienced in relation to others and the environment, or through relatedness. Fluidity between individuation and relatedness is important, and this way of knowing can conflict with the outcome emphasis present in Maslow’s hierarchy of needs and person-centered therapy. The indivisibility of self that is central to humanistic approaches is extended to be the indivisibility of self, indivisible from context and relationships.

Humanistic Approaches and Masculinity Historically and stereotypically, men have been socialized to highlight their masculine nature, be rational, serve as good providers, be goal oriented, and focus on their masculine strengths as a tool for advancement. It is important to keep in mind that masculinity is a social construct that has been delineated as a marker of strength, power, and privilege. This ideology has been contraindicated by a deficit model of focus that has contextualized masculinity as the catalyst for poor relationships and unsatisfactory well-being, and as a character flaw in men and boys. In addition, being goal driven, rational, and driven to succeed is seen as the hallmark of a self-centered and egotistical individual. The belief that masculinity, in and of itself, is a deficit-focused character flaw is counter to humanistic philosophy and undermines the value of the self as agentic and whole. The overarching belief that men are and should be rational beings who are flawed impedes the fluid nature of their being while simultaneously perpetuating gendered stereotypes about masculinity, men, and their existence in the world. A deficit focus on masculinity not only takes away from the

fluid nature of being in men but also detracts from women, who are on a varied continuum where they embrace masculine parts of self. A humanistic ideology sees masculinity as a component of the construct of gender that is critical to being in the world. Masculinity is a trait that all humans possess, and it takes many shapes and forms. Critical to a humanistic narrative of masculinity is the continuum on which it exists in all beings and that stereotypical views of masculinity hinder individual agency, perpetuating discrimination and oppression. Gender is fluid and is a social construct that is all too often misconstrued to mean something more than it actually does. From a humanistic perspective, gender and masculinity are constructs that are to be explored in concert with the client. The focus in humanistic approaches would be best served by celebrating masculine ways of knowing.

Humanistic Approaches and Transgender Issues and Gender Nonconformity The humanistic approach asserts that gender minorities need to be contextualized and understood from a strengths-based perspective. Such an argument runs counter to many theories and perspectives that perceive individuals who identify as transgender or gender nonconforming from a d ­ eficit and pathology model. There is a historical precedent for pathologizing gender nonconformity, and the implementation of humanistic approaches with transgender or gender nonconforming individuals needs to be understood from the context of such deficiency and stigmatization. Humanistic approaches tend to be reluctant to focus on diagnosis and labeling, due to the restrictive impact of such action on individuals. Diagnosis can reduce the individual to one part, thereby eradicating a commitment to irreducibility and holism. Humanistic approaches may thus provide an opportunity for transgender and gender nonconforming individuals to explore their experiences in an environment that is fundamentally different from other medical and psychological experiences. Furthermore, humanism’s emphasis on the whole person and the value of such a complex being resonates with the need for individuals to express and enact gender in a manner that is meaningful and liberatory to them.

Humanistic Theories of Gender Development

Conversely, humanistic approaches have perpetuated the perspective that individuals live as rational beings with assigned genders. The commitment to rationality inhibits an understanding of gender that rejects heteronormativity. Without recognizing the sociopolitical nature of gender, humanistic approaches can make rational assertions that gender is binary, with predetermined gender expressiveness expectations. The fundamental tenets of humanism, if applied in ways not reflective of awareness of heteronormativity and subjugation, can be used to collude with oppressive systems by encouraging individual acceptance and transcendence. Gender is then continually identified as binary in its normative manifestation, thereby silencing the narrative of many humans who experience gender in different ways. Such dichotomization prevents transgender and gender nonconforming individuals from experiencing the therapeutic benefits of humanism’s commitment to growth, self-understanding, and irreducibility. Linwood G. Vereen and Nicole R. Hill See also Existential Approaches and Gender; Existential Theories of Gender Development; Gender Dynamics in Psychotherapy; Humanistic Theories of Gender Development

Further Readings Cosgrove, L. (2011). Humanistic psychology and the contemporary crisis of reason. The Humanistic Psychologist, 35, 15–25. Kass, S. A. (2014). Don’t fall into those stereotype traps: Women and the feminine in existential therapy. Journal of Humanistic Psychology, 54, 131–157. Smith, L. C., Shin, R. Q., & Officer, L. M. (2012). Moving counseling forward on LGB and transgender issues: Speaking queerly on discourse microaggressions. The Counseling Psychologist, 40, 385–408.

Humanistic Theories of Gender Development The emergence of humanistic philosophy in the field of psychology has greatly influenced conceptualizations of gender and gender development.

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Humanism is constituted by a set of theoretical suppositions that emphasize human potential, personal agency, and the irreducible nature of human experiencing. From this perspective, gender identity development is a dynamic and fluid process, shaped by sociocultural constructions of gender, relational interactions, and individual meaningmaking systems. This entry illustrates the pivotal figures in humanism and the humanistic movement in psychology, major therapeutic concepts, and how these ideas influence mental health professionals’ understanding of gender. Also discussed are current trends in humanistic philosophy in light of recent social justice efforts and the effects of this shift on theories of gender development. The entry concludes with a discussion of therapeutic considerations in working with gender.

Humanistic Psychology and Gender: Past, Present, and Future Humanistic philosophy has an extensive genealogy that spans more than 2 millennia and contains philosophical contributions from some of the most notable thinkers in written history. The roots of humanism can be traced to many major schools of thought throughout human history, including early-6th-century Buddhism, medieval Islam, and the philosophy of Ancient Greece. The philosophers of classical humanism rejected the mystical and supernatural explanations of phenomena that reflected the religious doctrine of the time and, instead, affixed scientific knowledge in the experiences of humans, contemplative thought, and observable phenomena. Classical humanists, such as Socrates, Plato, and Aristotle, used rationality and logic to explore the complexity of both human experience and the natural world, instead of simplifying and reducing such knowledge to merely “God’s work.” Later, during the Renaissance period, scholars such as Erasmus and da Vinci expanded on these themes in rebellion against the medieval Church by emphasizing the achievements and ingenuity of humans, rather than venerate divinity. Humanists of the 17th and 18th centuries, such as Søren Kierkegaard, Jean-Paul Sartre, and Friedrich Nietzsche, were harbingers of the ­existential-humanistic movement, which was distinguished by the belief that humans are intrinsically autonomous, agentic beings capable of exercising

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free will and self-determining personal freedom. A distinguishing feature of early humanism was the significance and validity ascribed to the capacity of human thought, a notion that helped establish the physical, social, legal, and political sciences of centuries to come. Major Tenets of Humanistic Psychology

In the early to mid-1900s, the existentialhumanistic movement ultimately sparked the emergence of humanism into psychology. During that time, existentialist psychotherapists such as Victor Frankl and Rollo May revolutionized the fields of psychiatry and psychology, offering innovative perspectives on the importance of life meaning, human struggle, and phenomenological experiencing in the quest for a satisfying and fulfilling life. In 1964, James F. T. Bugental posited humanism as the “third force” in psychology and listed five basic precepts of the humanistic orientation: 1. Humans are greater than the sum of their parts. 2. Humans are relational and must be considered within their relational contexts. 3. Humans are self-aware and reflexive to their experiences. 4. Humans are agentic and, thus, can exhibit choice in their environments. 5. Humans exact meaning from their experiences and demonstrate purpose and intent as informed by these meanings.

Although gender identity was seldom directly discussed in early humanistic scholarship, several important themes emerged during the existentialhumanistic movement in psychology that served as a platform for future gender scholars. Frankl, a psychiatrist and survivor of the Jewish concentration camps of World War II, posited that a central motivating force for humans is the search for meaning and purpose through suffering, joy, communion, and other experiential tasks. From this perspective, client wellness is achieved by asserting the client’s intrinsic freedom in excavating these deeper meanings—affirming the notion that gender can be self-determined and observable through sustained contemplation and reflexivity.

Similarly, May recognized the vast courage required for each person to move through life in the face of isolation, loss, and frequent pain. A key hallmark of the existentialist tradition is that humans are constantly “becoming” in the world; that is, by searching for one’s purpose and facing the existential “givens” in the world (i.e., death, responsibility, isolation, and meaninglessness), a person is constantly evolving throughout the life span and is in a constant state of self-actualization. Abraham Maslow, often regarded as one of the most influential humanistic scholars in psychology, researched the concept of self-actualization extensively, citing that all humans are compelled toward realizing their fullest potential, a characteristic representing optimal mental health and life satisfaction. According to Maslow, one feature of a self-actualized individual is congruence and acceptance of one’s identity. Similarly, from the existentialist perspective, a basic component of the human condition is the creation and recognition of one’s identity, which necessarily includes one’s gender identification and the totality of experiences that contribute to this identity. In addition, humans are innately relational and social creatures, so much so that fear of isolation may hinder one’s ability to live an authentic self or congruent gender identity when that identity is perceived to be at odds with what others desire. According to existential humanism, isolation and aloneness are among the most prominent human fears, which may serve as a powerful deterrent to actualizing identity characteristics that may interrupt social connectedness. Identity development thus becomes a complex process for gender nonconforming individuals, because within Western society, gender has historically been tethered to biological sex and sexual orientation, thus rendering transgender and nonbinary individuals as nonnormative and potentially undesirable. Person-centered therapy (also called client-­ centered therapy) was developed by Carl Rogers in the 1940s and is often considered the most widely recognized and utilized therapeutic approach in counseling and psychology. The primary postulates of person-centered therapy are as follows: 1. People are naturally equipped with the means and skills to enact positive change in their lives and are, thus, “experts” on themselves and their unique needs.

Humanistic Theories of Gender Development

2. People are resourceful, resilient, and capable of self-healing through the process of integration and self-reflection. 3. Therapists can facilitate a growth-oriented therapeutic environment by asserting specific relational attributes, called the “necessary and sufficient conditions” required for therapeutic change.

Rogers theorized that these conditions included the therapist’s ability to (a) be authentic and genuine in therapeutic interactions, (b) possess and demonstrate unconditional positive regard toward all ­clients, and (c) demonstrate accurate empathy, determined by the therapist’s ability to correctly recognize and acknowledge the client’s presenting emotion. Because the person-centered approach is centralized on the client’s capacity for self-change, therapy is a reflexive process that is determined by the client’s individual strengths and limitations. Therefore, a therapist approaches gender identity from the client’s expertise and personal frame of reference, ­conscious not to impose a “correct way of being” or specify predetermined therapeutic outcomes. From the person-centered perspective, relationships are the impetus for all human growth and are central to identity integration and self-acceptance. A person-centered understanding of gender emphasizes the changing and mutable nature of identity, specifically with regard to the social construction of gender, including relational meaning-making processes that facilitate gender construction. As such, gender identity development is regarded as an innately social process, whereby individuals fulfill the gendered expectations gleaned from significant relationships throughout the life span. Early relationships have the capacity to support or hinder gender identity development depending on the existence of the core relational conditions of empathy, authenticity, and unconditional positive regard. Consider the role of a parent or guardian’s unconditional positive regard for a child who presents as gender nonconforming. If the child expresses gender dysphoria and the parent approaches these feelings with acceptance, love, and respect, this nurturing relationship can foster the child’s gender congruence. If the parent rejects or disavows the child’s feelings of gender dysphoria, it is likely that the child will experience gender incongruence and internalize messages of shame and guilt.

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Humanism in the Postmodern Era

In light of the women’s liberation and civil rights movements, midcentury humanism was called into question by feminist, social-­ constructivist, and multicultural scholars. This changing social paradigm, referred to in this entry as postmodernism, ushered a wave of criticism throughout the field of psychology, specifically challenging humanists’ ignorance of the specific ways in which social, political, and economic systems affect experience and disenfranchise the most vulnerable populations. Humanism and postmodernism share considerable theoretical overlap, specifically in the rejection of the medically oriented approaches of psychology (e.g., psychoanalysis and behaviorism), critiquing that the medical model reduces individuals to diagnoses based on symptoms that may be best attributed to social, cultural, and environmental factors rather than to individual pathology. Many scholars have additionally contended that humanism was a philosophical precept of the social justice and postmodern movements. However, postmodernism highlights the ways in which power, privilege, and oppression affect individual experience and shape a person’s multiple and intersecting “selves” or identities, including gender. From this perspective, therapists recognize the impact of systemic power differentials on the ­regulation of individual gender development and validate a diversity of gendered experiences, challenging hegemonic assumptions of sex/gender complementarity, patriarchy, and heteronormativity. While humanists of the 20th century may have suggested that gender identity development is a dynamic process determined by biological sex characteristics, social interactions, and individual phenomenology, postmodern humanists have argued that gender is a kind of production, performance, or stylization of the body that facilitates an expression of gender (i.e., masculinity and ­femininity) that contributes to individual identity. Many postmodern scholars also asserted that a purely humanistic approach risked ascribing responsibility for maladjustment to the individual rather than to the external forces (i.e., legal, social, and cultural structures) that affect mental health. Traditionally, humanistic psychotherapists championed the client’s personal agency and will to live in the pursuit of self-actualization; however, an individual-based approach to therapeutic change

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could support erroneous beliefs that mental illness is merely a result of a person’s inability to go out and “do something about it”—that is, clients may be considered inept, incapable, less intelligent, morally weak, or lazy, rather than victims of a social structure that systematically disenfranchises certain identities. Without acknowledgment of the ways in which privilege and oppression are distributed across sociocultural groups, discriminatory assumptions may be proliferated based on who is most negatively affected—for example, people of color, women, gender and sexual minorities, or people from the lower social classes. Postmodern scholars proposed that client empowerment stemmed from increasing awareness of how these environmental and societal factors affected their physical, mental, emotional, and relational functioning, while expanding their understanding of how they can be agentic within dehumanizing social systems. This perspective seeks to empower the client by increasing insight and awareness and also by providing clients with useful tools to combat environmental challenges and social barriers. Postmodern scholars also posit that therapists are ethically mandated to reflexively explore and evaluate their worldviews, personal ideologies, and biases. Contemporary humanism has necessarily evolved to incorporate many of the key tenets of feminist, social-constructivist, and multicultural theoretical orientations of psychotherapy. At present, several humanistic scholars have articulated a postmodern humanism, which acknowledges and celebrates the dialectic between the unwavering capacity for human potential and the social embeddedness of people within immediate relational, cultural, political, and historical milieus. In addition, this recent transformation has highlighted the ill effects of psychological truth claims and unchecked power differentials between the counselor and the client. For instance, a therapist working from the truth claim that gender identity is inborn and rigidly tied to biological sex characteristics runs the risk of silencing and disempowering clients with incongruous narratives. Postmodernism challenges humanistic therapists to disregard the search for objective truths and, rather, to facilitate conversations that excavate clients’ multiple and evolving subjectivities. From a practical standpoint, this requires the therapist to not only allow

the client to self-define the goals of therapy but also facilitate opportunities for the client to cultivate a language of possibility, fallibility, and uncertainty.

Working With Gender Issues in Therapy Humanistic philosophy centers on the premise that humans are, above all, resilient and contemplative beings capable of deriving their personal experiential meanings, despite the inextricable nature in which humans are influenced, constructed, and inhibited by a network of relational, social, and environmental systems. With the potential for forethought and self-awareness, clients are also capable of self-determining their own solutions and goals for therapy as experts of their own lives. A praxis of humanistic therapy is guided by the following tenets: 1. Client growth is facilitated by the extent to which the therapeutic relationship is genuine, authentic, and unconditionally supportive. 2. The therapist should cultivate through nondirective interventions the client’s ability to self-reflect on their own inner resources. 3. Therapy should strive to expand current definitions or “truths” about human experiencing rather than reduce or categorize them. 4. Power hierarchies are a central force in both the therapeutic relationship and the client’s life, and disparities should be attended to and analyzed.

With these considerations in mind, the purpose of the current section is to offer guidance for mental health professionals who wish to implement a humanistic therapeutic approach in working with gender. The defining hallmark of the humanistic perspective is that a strong therapeutic relationship must be facilitated for client change to occur. This relationship, according to person-centered scholars, is established by the therapist’s ability to be authentic and genuine with the client, to comprehend the client’s subjective thoughts and feelings and compassionately reflect this understanding to the client, and to communicate support, caring,

Humanistic Theories of Gender Development

and unconditional positive regard to the client. From this perspective, the therapist’s capacity to engage in a meaningful relationship with the client is the sole instrument of change. When gender identity is the primary topic in therapy, it is often because the client is experiencing distress or confusion regarding their own understanding or presentation of their internal gender identity. This distress may be exacerbated by the fear of being judged or pathologized by the therapist, which further emphasizes the need for a secure, trusting, and genuinely caring therapeutic connection. In a confident and bonded connection, clients are empowered to explore their own meanings about their gender and the ways in which their family members, social support systems, communities, and cultures may come to understand their gender identity. Humanistic therapists are tasked with eliciting clients’ individual strengths in the pursuit of therapeutic growth, rather than focusing on the elimination of perceived deficits. Through reflective and nondirective communication, therapists encourage clients’ introspection of internal resources; specifically, clients are responsible for locating their own areas of growth and identifying the pathways that are required in the accomplishment of this growth. With respect to gender, clients may not have immediate awareness of what exact “goals” they may want to accomplish but are rather seeking a space where they might process their inner congruence and envision new avenues of self-integration. This process is elaborated by a discussion of the various contextual influences that are creating significant challenges for the client by obstructing goals and general life satisfaction. For example, a female client experiencing shame and guilt regarding a new sexual relationship may benefit from reflecting on the messages that she has received about female sexuality from her family, community, and society, specifically those messages that seek to regulate or control women’s pursuit of pleasure, autonomy, and self-determination. Clients’ internal dialogue about the self and the self in relation to others is shaped by external factors; thus, the focus of ­treatment revolves around affirming the individual to inspire new perspectives for overcoming the identified obstacles. From this perspective, therapists and clients are empowered to challenge patriarchal gender hierarchies by examining the ways in

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which individuals are constrained by gendered expectations and may subsequently challenge and ­ overcome these systems with self-advocacy and personal agency. Because therapy is led by the client’s specific and unique needs, the therapist is challenged to let go of expectations surrounding “ideal” therapeutic outcomes by resisting diagnostic categorizations and rigid treatment planning. This additionally includes the perspective that gender is inherent, stable, and readily “knowable” by the client. It is possible instead that clients are in an active state of constructing and reconstructing their gender identities with each new experience and increasing insight—as such, therapists are encouraged to be flexible to a multiplicity of client “truths.” This also includes the notion that there are no essential gender characteristics but, rather, a diversity of gender experiences that are idiosyncratic and reflective of the client’s lifeworld. Rather than assuming authority and expertise, the therapist acknowledges and celebrates the client’s individuality, autonomy, knowledge, and diversity, as well as the client’s personal construction of gender from life experience. As such, the client’s lived experience is valued and positioned in equivalence with the therapist’s knowledge and training. The client becomes an active participant in treatment planning, rather than a passive object of the therapist’s authority. Therefore, a central goal of humanistic psychotherapy is to restructure the inherent power differential in the therapeutic relationship to better foster a shared mutuality and trust between the client and the therapist. Megan Speciale and Adam Clevenger See also Behavioral Theories of Gender Development; Cognitive Theories of Gender Development; Gender Development, Theories of; Gilligan’s Moral Development Theory; Humanistic Approaches and Gender; Kohlberg’s Stages of Moral Development

Further Readings Frankl, V. (1963). Man’s search for meaning. Boston, MA: Beacon Press. Gergen, K. J. (1995). Postmodernism as a humanism. The Humanistic Psychologist, 23, 71–82. Hansen, J. T. (2005). Postmodernism and humanism: A proposed integration of perspectives that value human

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Hypochondriasis and Gender

meaning systems. Journal of Humanistic Counseling, Education and Development, 44(1), 3–15. Hansen, J. T., Speciale, M., & Lemberger, M. (2014). Humanism: The foundation and future of professional counseling. Journal of Humanistic Counseling, 54, 170–190. May, R. (1975). The courage to create. New York, NY: W. W. Norton. Moss, D. (2015). The roots and genealogy of humanistic psychology. In K. J. Schneider, J. F. Pierson, & J. F. Bugental (Eds.), The handbook of humanistic psychology: Theory, research, and practice (2nd ed., pp. 3–18). Thousand Oaks, CA: Sage. Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95–103. Rogers, C. (1980). A way of being. Boston, MA: Houghton Mifflin. Serlin, I. A., & Criswell, E. (2015). Humanistic psychology and women: A critical-historical perspective. In K. J. Schneider, J. F. Pierson, & J. F. Bugental (Eds.), The handbook of humanistic psychology: Theory, research, and practice (2nd ed., pp. 27–40). Thousand Oaks, CA: Sage.

perceive painful soreness of the neck as the onset of multiple sclerosis or indication of a serious viral infection. Subsequently, these irrational perceptions may amplify and exacerbate the bodily sensations in the neck area. The worry and anxiety that follow these disruptive and persistent thoughts may lead to frequent visits to medical clinics or to multiple doctors, which seldom alleviate the somatic symptoms and anxiety. Taken together, it is clear that hypochondriasis is physically and mentally draining: consuming daily life and replacing it with burdensome anxiety. It is important to note, however, that hypochondriasis exists on a spectrum, where health anxiety, the anxiety one feels toward one’s health, varies in severity and persistence. Epidemiology research has not shown any substantial gender differences in the rate of hypochondriasis. Although there are limited epidemiology data, in the few studies to evaluate the prevalence and incidence of hypochondriasis, there appear to be comparable rates between men and women, at between 0.8% and 8.5%.

Health Anxiety

Hypochondriasis

and

Gender

Hypochondriasis is a mental disorder characterized by excessive and disruptive thoughts, feelings, or behaviors regarding one’s health, reinforced by the presence of somatic symptoms, or physiological pain or sensations. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which reclassifies hypochondriasis as somatic symptom disorder, the presence of somatic symptoms, whether or not they are medically explained, is central to the disorder, as it is these bodily symptoms that fuel the severe and persistent anxiety concerning health. Although the individual may experience specific, localized pain (e.g., pain in the lower back) or nonspecific pain or discomfort (e.g., fatigue), the somatic symptoms may not necessarily point to serious illness but, rather, are perceptually amplified bodily sensations or discomfort. However, regardless of the nature and root cause of these symptoms, the individual’s suffering is real and significantly disrupts daily life. For instance, a person with hypochondriasis may

Hypochondriasis, due to the presence of somatic, bodily symptoms and the anxiety associated with these symptoms, is the most severe type of health anxiety. The DSM-5 classifies the less physiologically severe type of health anxiety as illness anxiety disorder. Illness anxiety disorder is defined as having extensive and persistent worries about health, where there is an absence or only mildly intense presence of somatic symptoms. In other words, the distress and worry arise not from the presence of persistent bodily pain or discomfort but rather from the severity and life-changing significance of a suspected medical diagnosis. For example, an individual who feels shortness of breath and fatigue after intense physical activity may develop severe anxiety and concern about the potential significance of these symptoms in the context of a serious medical illness, such as heart disease. Although shortness of breath and fatigue are normal after most types of physical activity, these symptoms are perceived as abnormal and, consequently, elicit intense worry and anxiety. This distress creates a preoccupation with health and disease that involves an array of behaviors that aim to alleviate worry

Hypochondriasis and Gender

and anxiety but commonly lead to further distress. However, the behaviors associated with this preoccupation are a facet of health anxiety as a whole, whereby both illness anxiety disorder and hypochondriasis, despite having distinctive diagnostic criteria, have similar behavioral components. There are three significant behaviors that manifest from worry and anxiety about health and the potential presence of serious medical illness: (1) body checking, (2) reassurance seeking, and (3) a higher frequency of medical visits. Body checking, or the monitoring of the body for any abnormalities or dysfunctions, is a healthy behavior when performed in moderation. Conversely, constant checking of the body may cause widespread worry and anxiety because minute changes in physical symptoms are frequently noticed, but this rarely leads to any useful solutions or information. In addition, body checking involves constant poking or prodding, which can cause further exacerbation and worry. The constant monitoring of the body is commonly accompanied by reassurance seeking, whereby an individual seeks multiple perspectives from doctors, family, and friends. These individuals may excessively search the Internet and online medical forums to read about and discuss their symptoms and suspected medical diagnosis. Although these reassurances may temporarily alleviate worry and distress, this is shortlived, as the severe anxiety manages to return once the symptoms seem to worsen or change. Thus, an individual may constantly seek reassurance, resulting in a higher frequency of medical visits. Research suggests that primary care patients who have high levels of health anxiety not only have higher rates of medical care utilization but also tend to have higher medical costs, burdening the health care system. Taken together, these three behaviors play integral roles in contributing to the vicious cycle of health anxiety, where they influence one another and only worsen the anxiety, distress, and disruption to daily life. One risk factor for health anxiety is anxiety sensitivity (AS). AS is the degree to which someone monitors their internal physical state and reacts with anxiety when there are perceptible changes (e.g., change in heart rate). Developed originally to account for panic disorder, AS has since been shown to be elevated in a wide range of ­anxiety disorders and other psychopathology. This

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monitoring for possible physical threat puts an individual at greater risk for health-related concerns that cuts across anxiety disorders, such as generalized anxiety disorder (e.g., worry about one’s physical health), panic disorder (e.g., acute and sudden fear of getting a heart attack), and even obsessive-compulsive disorder (e.g., concerns about illness due to contaminants).

Gender Differences in Anxiety In general, research suggests that women experience greater levels of anxiety than men. While epidemiology and experimental research do not bear this out for hypochondriasis per se, for anxiety in general, this is quite consistent. One ­ theoretical perspective that attempts to explain this difference is based on gender differences in behavioral inhibition, which is generally higher in women, beginning at approximately age 2 years and remaining so through adulthood. Briefly, behavioral inhibition is the tendency to avoid possibly aversive sensations. The degree to which one is sensitive to aversive conditions is one’s behavioral inhibition sensitivity. The theory that suggests that behavioral inhibition accounts for the gender differences in anxiety further points to the social factors that foster this in women. This leads, in turn, to a self-perpetuating process whereby ordinary life stressors are experienced as more aversive by women than by men, which in turn potentiates the experience of anxiety. Gender Differences in Hypochondriasis and Health Anxiety

While it appears that the rate of hypochondriasis is not different for men and women, the manifestation of health-related anxiety is distinct between the sexes. Overall, women have higher health care utilization and exhibit higher levels of somatic symptoms and associated anxiety. Findings such as these have led some practice guidelines to include mental health screening as a standard of primary care medicine, particularly for women. Interestingly, among men with elevated behavioral inhibition, health care utilization is comparable with that for women and, in some cases, may surpass it. This suggests that when men experience health anxiety and hypochondriasis, their symptom expression is

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more severe. One potential explanation, as noted in the theory of gender differences, is that social norms allow, and even anticipate, that women would find health-related concerns to be stressful, while the same norms do not apply as readily to men. Put another way, it is socially expected for women to be more concerned about their health than men, and when men do experience healthrelated concerns, there are fewer social reference points for them to cope with the experience, leading to a more severe expression of the problem and greater levels of anxiety. In fact, some research has suggested that social norms associated with lower behavioral inhibition in men may also be associated with poorer physical health (through, e.g., lower rates of annual physical exams) in men. Accordingly, while the emphasis has been on the higher levels of anxiety in women compared with men, this may be an adaptive quality associated with better health outcomes. Gender Differences in AS

As noted earlier, AS was originally developed to predict panic disorder and panic severity. AS also predicts a range of physical ailments, with differences observed between men and women. Notably, among individuals with panic and elevated AS, women have higher rates of irritable bowel syndrome. Irritable bowel syndrome has been associated with anxiety generally and is rated as the second leading cause of work disruption after the common cold. Furthermore, and in line with the theoretically defined differences in behavioral inhibition, pain tolerance is lower in women who also have elevated AS. That is, AS mediates the relationship between gender and pain tolerance. Finally, it appears that AS influences behavioral expressions of anxiety (i.e., through avoidance) based on cognitive rather than emotional factors. That is, physiological expressions of anxiety (e.g., heart rate, blood pressure) are not higher in women than in men, but the way these experiences are interpreted are distinct, with women generally making more threat-based inferences.

Treatment of Hypochondriasis and Health Anxiety Presently treatment for hypochondriasis and health anxiety emphasizes cognitive behavioral therapy (CBT). This approach focuses on two broad areas.

First, behavioral interventions such as exposure are applied to reduce the levels of anxiety experienced due to health-related concerns. One specific exposure approach, called interoceptive exposure, involves practicing, under controlled conditions, experiencing the physical sensations associated with anxiety and health concerns. This might include rapid breathing to experience increased heart rate and respiration, pressing on one’s abdomen to mimic mild gastrointestinal distress, or spinning to practice tolerating dizziness. This approach is considered highly efficacious and is a central part of many of the well-validated therapy protocols used in both clinic and primary care settings. Second, cognitive interventions are applied. These are aimed at addressing individual beliefs about the threat risk and catastrophes associated with the physical health concerns. This approach involves structured and self- and clinician-guided methods of challenging individually held anxietyrelated thoughts. Through repeated practice, these anxiety-related beliefs begin to shift to be less anxiety provoking. Recent large-scale research findings indicate that there is no difference between men and women in treatment outcomes using CBT. While it is encouraging that CBT is an efficacious psychosocial intervention for health anxiety and hypochondriasis, there are some limitations. Most notably, some patients do not accept that their health-related concerns are anxiety based rather than due to a real medical etiology. This can substantially interfere with their willingness to engage in psychosocial interventions. There is a small but growing literature that shows that the application of a pretherapy intervention referred to as motivational interviewing can increase the acceptability of psychosocial interventions such as CBT.

Future Directions The existing research suggests that there are no differences in the incidence or prevalence of hypochondriasis between men and women. However, there are significant gender differences in anxiety, which is adaptive under some circumstances. While treatment is effective, not all patients with hypochondriasis or health anxiety accept it or are willing to engage in it. Although some methods have been developed to increase interest in psychosocial interventions, there remain limits in the degree to which these approaches engage patients. Antoine Lebeaut and Dean McKay

Hysterectomy See also Acceptance and Commitment Therapy; Ethics in Psychotherapy and Gender; Gender Bias in the DSM; Health Issues and Gender: Overview; Men’s Health; Obsessive-Compulsive Disorder and Gender

Further Readings Craske, M. G. (2003). Origins of phobias and anxiety disorders: Why more women than men? Amsterdam, Netherlands: Elsevier. Olatunji, B. O., & Wolitzky-Taylor, K. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135, 974–999. Taylor, S., & Asmundson, G. J. (2004). Treating health anxiety: A cognitive-behavioral approach. New York, NY: Guilford Press.

Hysterectomy Hysterectomy refers to partial or total removal of a woman’s uterus. Over the span of centuries, hysterectomy has had a long, somewhat controversial history, which continues to surface during debates on women’s physical, sexual, and psychological health. Hysterectomy is still one of the most common medical procedures for women worldwide and can be performed vaginally or abdominally, with recent technological advancements allowing minimally invasive (i.e., laparoscopic) procedures. This entry discusses the history of hysterectomy, including ancient and modern perspectives; ­surgical methods for hysterectomy and potential complications; and the social and psychological ­ implications of hysterectomy.

Historical Background The word hysterectomy has its roots in the term hystera, the Greek word for “womb.” Hysteria was a term introduced later in ancient Egypt and Greece to refer to a range of medical symptoms exhibited by women and attributed to problems with the uterus, including problems with respiration, inability to speak, and other neurological issues. Hippocrates claimed that problems with speech were a result of the womb seeking moisture and climbing toward the throat and mouth. Later writings on hysteria correlated women’s sexual activity to incidences of hysteria, encouraging women to marry and engage in sexual intercourse in order to avoid

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its symptoms. During the Renaissance, hysteria was attributed to demonic possession and resulted in prescriptions of sexual stimulation. As medical understanding increased throughout the 18th and 19th centuries due to contributions from doctors, such as Jean-Martin Charcot and Sigmund Freud, possible neurological sources of hysteria were identified. Freud, in his development of psychoanalysis, theorized that past traumatic experiences created neurological problems that were at the root of hysterical symptoms, particularly in the upper class families he treated. There is also some documentation that men were thought to suffer from forms of hysteria attributed to blockage in the release of sperm. Today, hysteria is no longer a medical diagnosis. However, the word hysterectomy still reflects the historical past when women’s symptoms were attributed to issues with the uterus.

Surgical Procedures and Complications Women may get a hysterectomy for multiple reasons, including endometriosis (i.e., a painful condition involving cells inherent to the inside of the uterus forming on the outside of the uterus), unusual bleeding, cancer, or uterine prolapse (i.e., uterus moving into the vaginal canal). Generally, hysterectomy is of two types: partial and total. Partial hysterectomy involves removing the upper region of the uterus and leaving an intact cervix. In a total hysterectomy, the entire uterus and cervix are removed. In addition, a radical hysterectomy is a total hysterectomy with the removal of the uterus, cervix, and tissue surrounding these areas, usually when uterine or cervical cancer is present. Removal of the ovaries is different from hysterectomy and is referred to as an oophorectomy. Hysterectomy can be performed either abdominally or vaginally. Traditional abdominal hysterectomy involves making an incision in the abdomen and then removing a part or all of the uterus. The incision is then stitched, resulting in several days of recovery time and an abdominal scar. However, laparoscopic hysterectomy is also performed, and it involves using a laparoscope (i.e., a flexible fiberoptic instrument) and surgical tools to perform a hysterectomy through several small incisions from outside the body. The uterus is often removed through the belly button, abdomen, or pelvis. The camera on the laparoscope transmits the surgical footage onto a screen for the health care provider’s

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reference. Robotically assisted laparoscopic hysterectomies may also be performed. During a vaginal hysterectomy, an incision is made in the vagina, the uterus is removed, and the incision is stitched, usually resulting in decreased recovery time and no visible scar. Traditional abdominal hysterectomy generally results in greater risk for infection and other complications compared with vaginal or laparoscopic hysterectomy. The most common complications across the types of hysterectomy are hemorrhages, allergic reaction, unintended damage to blood vessels, and cardiac or respiratory arrest. The use of perioperative antibiotics can decrease the likelihood of infection, regardless of the type of surgery.

lubrication and ability to reach orgasm and also more frequent sexual relations after hysterectomy. This finding may be due to the relief from negative sexual symptoms associated with the problems that necessitated hysterectomy, such as pain during intercourse. Hysterectomy may be pursued as part of a female-to-male transition for transgender individuals. Some individuals may elect to have the uterus and other female reproductive organs removed (e.g., the ovaries) either prior to or at the same time as sex reassignment surgery. Simultaneous hormone therapy using testosterone and surgery for a more masculine chest (i.e., mastectomy) may accompany hysterectomy during the reassignment process.

Sexual and Psychological Implications

See also Motherhood; Orgasm, Psychological Issues Relating to; Perimenopause; Pregnancy; Reproductive Cancer and Mental Health in Women; Sexual Desire; Sexuality and Women; Women’s Health

During female sexual arousal, the autonomic nervous system facilitates increased blood flow to the genitals and enables vaginal lubrication. However, as a result of hysterectomy, vaginal blood flow and lubrication are often decreased during sexual arousal. In particular, radical hysterectomy results in considerable nerve damage, which may drastically affect bodily response to arousal. Often, women in this scenario still self-report normal feelings of arousal and desire, but there is a lack of physical bodily response and blood flow due to the nerve damage. This type of sexual dysfunction can be damaging psychologically for women and may cause dissatisfaction in sexual experiences or issues in relationships. Some women may choose to engage in hormone therapy in an attempt to combat the effects of hysterectomy nerve damage. Research has shown that prehysterectomy characteristics of individuals may be related to their posthysterectomy sexual outcomes, with higher rates of psychological factors, such as depression, before the operation being associated with more negative sexual outcomes after the surgery. In addition, some women report no sexual arousal or sexual relation differences pre- and posthysterectomy. On the other hand, some research has reported that hysterectomy may result in sexual arousal benefits. Some women report increased

Rachel H. Messer and Elizabeth Devon Eldridge

Further Readings Davies, A., Hart, R., Magos, A., Hadad, E., & Morris, R. (2002). Hysterectomy: Surgical route and complications. European Journal of Obstetrics & Gynecology, 104, 148–151. doi:10.1016/S0301-2115 (02)00068-4 Edwards, M. (2009). Hysteria. Lancet, 374, 1669. doi:10.1016/S0140-6736(09)61979-6 Maas, C. P., ter Kuile, M. M., Laan, E., Tuijnman, C. C., Weijenborg, P. T., Trimbos, J. B., & Kenter, G. G. (2004). Objective assessment of sexual arousal in women with a history of hysterectomy. BJOG: An International Journal of Obstetrics and Gynaecology, 111, 456–462. Rhodes, J. C., Kjerulff, K. H., Langenberg, P. W., & Guzinski, G. M. (1999). Hysterectomy and sexual functioning. Journal of the American Medical Association, 282(20), 1934–1941. doi:10.1001/ jama.282.20.1934 Sutcliffe, P. A., Dixon, S., Akehurst R. L., Wilkinson, A., Shippam, A., White, S., . . . Caddy, C. M. (2009). Evaluation of surgical procedures for sex reassignment: A systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62, 294–308.

I Social Identity Construction: The Development of Self Through Others

Identity Construction

Current models of identity construction use different terms to describe identity development. It may be summarized as a process of identity negotiation and manipulation that depends on self-definition and definition by others. According to the l­ iterature on human development and social psychology, identity is often a complex interplay between cultural context and self-definition. As social actors, human beings often define themselves in relation to others and by comparison with social groups. This eventually becomes internalized. Erving Goffman and Judith Butler described social identity as a type of performance. Goffman coined the terms frontstages and backstages to describe how identity is performed in both public and private spaces. This is a form of impression management and identity negotiation—identity is not a fixed construct. Extending Goffman’s theatrical metaphor of the stage, Butler described ­gender as a performance, as something people do rather than something they are. Stage theories of social identity development exemplify how people develop, adapt, or discard individual identities in conjunction with others. Social identities are contingent on the state of individual and group identity. Self-definition is ­ partially dependent on the definitions of others. Current social identity models stem from the identity development processes of several minority groups. Identity development has been studied

Identity status refers to identities assigned by self and others. Identity construction is a general term that refers to the social construction of identity based on self-concept, the incorporation of group perception, and the internalization of multiple identity statuses. Social identity is commonly defined as the recognition of membership in a particular social group or category. It may be based on grouping within an organization or the larger social world. Gender, race, and class are three commonly discussed forms of identity. Feminist ­ scholars typically define social identity as a reflexive, dialogical process. The study of identity is one of inherent multiplicity. Each person has multiple selves connected to power and privilege, oppression, and stigma. Identity construction has been explored under lenses including identity politics and intersectionality. Typically, feminists use intersectionality to describe how identities interact and cannot be isolated. This entry examines identity as a constructivist process dependent on others, and the role of minority status in identity construction. Emphasis is placed on scholars who describe identity in ­relation to others as a process of negotiation and minority identity development. The entry ­concludes with directions for further research, including additional longitudinal studies and research on coping with stigmatized identities.

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based on racial and cultural identity, sexual orientation, and other stigmatized identities. Researchers argue that specific models should not focus on specific identity groups, but instead, they should critically examine current models of identity construction. Processes are described as mostly linear, but theorists note that identity vacillates across the life span and this growth is never finished. Existing work on social identity theory uses models of cultural and racial identity development to understand the development of other social identity theories in tandem. Recent studies of social identity development focus on college students and the multiple identities they hold. This research is important because it focuses on the dynamic nature of social identity. However, young adulthood is a time in life span development when identities are tried on and discarded, providing only a temporary vista in the overall landscape of identity. Augmented longitudinal studies could potentially demonstrate how these identities change over time, including what helps and hinders the lives of people with minority identities. Current models trace the development of racial and social identities as a series of phases and processes when an individual self-compares against dominant groups. Derald Wing Sue and David Sue’s revised 2008 racial and cultural identity development model describes socially constructed identity stages. The researchers argue that minority group members progress from an unawareness of being different to an integration of minority identity into the full aspect of self. Similarly, social-constructivist theorists describe identity as an ongoing, meaning-making process of negotiation and manipulation. As such, identity develops in accordance with assigned and selfclaimed identities. Social mirrors determine what is seen, what is projected outward, and how identities are revised in relation to others. Charles Horton Cooley referred to this concept as the ­ “looking glass self.”

Identity Construction and Minority Status Traditionally, feminists use standpoint theory to describe social locations and the intersection of identities. Intersectionality explains where people are situated and how multiple identities affect

social locations, especially for those with one or more minority identities. Standpoint theory is a social construction dependent on social capital and the ways they intertwine (in other words, both ascribed and assigned status). This encompasses the statuses people are born with and those assigned by others, whether membership is claimed or not. Standpoint theory explains how social stratification pivots according to gender and other power dynamics. A variety of social categories contribute to positioning in society: (a) disability, (b) gender, (c) sexual orientation, (d) ethnicity or race, and (e) social class. These identities cannot be separated out—they work in concert to determine access and sense of self in society. Society places appearances, actions, and people into one category or another while punishing those without dominant status.

Further Research Research on identity construction now looks at how minority group members challenge stigma and the negative identities attributed by others. Interdisciplinary research is becoming increasingly popular as scholars use gender studies, psychology, and sociology in unison to understand how i­ de­ntity is constructed by others with more social capital. Minority group members look for ways to acknowledge the gaze of oppression and challenge it in small-group interaction and structural conflict. Additional longitudinal research with larger sample sizes is needed to understand how identity constructs shift across the life span and how those with limited social capital may challenge and diffuse stigma, including microaggression. Stacey L. Coffman-Rosen See also Ability Status and Gender; Bisexual Identity Development; Disability and Adolescence; Identity Development and Aging; Identity Formation in Adolescence; Intersectional Identities

Further Readings Abes, S. E., Jones, S. R., & McEwan, M. K. (2007). Reconceptualizing the model of multiple dimensions of identity: The role of meaning-making capacity in the construction of multiple identities. Journal of College Student Development, 48(1), 1–22.

Identity Development and Aging Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Gregg, G. S. (1995). Multiple identities and the integration of personality. Journal of Personality, 63(3), 617–641. Jones, S. R., & McEwan, M. K. (2000). A conceptual model of multiple dimensions of identity. Journal of College Student Identity, 41(4), 405–414. Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice. Hoboken, NJ: Wiley. Taub, D. E., McLorg, P. A., & Fanflik, P. L. (2004). Stigma management strategies among women with physical disabilities: Contrasting approaches of downplaying or claiming a disability status. Deviant Behavior, 25(2), 169–190. doi:10.1080/01639620490269012

Identity Development

and

Aging

Aging presents developmental challenges for identity. The specific ways in which individuals ­ address these challenges influence their identity development. While aging is a biological and ­ chronological reality, the ways in which individuals psychologically construct their sense of self as they age make a difference in their identity development and adaptation to life. Recognition of the constructive nature of identity is a common attribute of many approaches to aging. This entry summarizes the insights of some of the major approaches.

Identity and the Development of Consciousness Robert Kegan proposed a realistic vision of adaptation in aging, originating from his theory that includes three orders of consciousness for adult development. Each order represents a general psychological structure that strongly influences an individual’s sense of identity. Through the first order (the socialized mind), the individual identifies with the values and expectations of society and interpersonal relationships. The second order (the self-authoring mind) transcends this identification and incorporates social expectations within a more complex psychological structure. The ­identification at the second order is with a psychological system based on the autonomy of the self.  Some individuals begin to transcend this

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self-system as the third order of consciousness (the self-­transforming mind) emerges. Individuals who organize experience from the third order identify with the process of transformation. Kegan’s third order of consciousness resonates with the experience that Lars Tornstam identified and proposed as gerotranscendence, based on the reports of many people in old age. Gerotranscendence represents a heightened inner peace and identification with life processes in a way that transcends a personal sense of self. Gerotranscendence includes a redefinition of reality beyond a strictly rational view and a shift away from material concerns toward an appreciation of one’s ­existence as an integral aspect of life. However, Kegan argued that the third order of consciousness is not a realistic next step for most adults. Rather, considering that many adults still operate within or slightly above the first order of consciousness, the self-authoring mind (the second order) can be an appropriate developmental vision, the realization of which could improve individual and social well-being significantly. Elizabeth Mutran and Peter Burke examined old age identity based on its subjective meaning to individuals. Mutran and Burke found evidence for an old age identity that is distinct from prior developmental periods. Accordingly, older people are less interested in work and politics and relatively more involved in the social world. Peter Coleman, Christine Ivani-Chalian, and Maureen Robinson also viewed identity from a constructivist view, emphasizing examining the skills of adaptation to changing life circumstances, such as increasing frailty. However, based on evidence from a 20-year longitudinal study, Coleman and colleagues argued that there is strong continuity in the themes of identity throughout late adulthood.

Stability and Change in Identity The relative stability in the sense of self can be seen as a source of resilience. For example, by maintaining a youthful conception of themselves, older people may be protected from the harmful impact of negative social stereotypes about aging. This is an example of identity assimilation (i.e., constructing experiences to fit the existing sense of self) according to Susan Whitbourne’s identity process theory. On the other hand, adaptation may be

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compromised if the individual is not able to make appropriate adjustments that the changing life conditions call far. For example, it may be necessary to relinquish the goals of earlier periods that are no longer attainable based on the psychological, physical, and social constraints. Realistic assessment and perceptions of one’s changing abilities, and the corresponding adjustment of aspirations, are seen as critical aspects of identity development and adaptation in old age. This is an example of identity accommodation (i.e., making changes in identity in response to experience). According to identity process theory, there is a third process called identity balance, representing a dynamic equilibrium including both age-related changes in identity and a sense of coherence over time. Identity balance cultivates what Erik Erikson proposed as the major developmental quality in old age: integrity.

Generativity and Integrity According to Erikson, there are eight crises of development: 1. Trust versus mistrust 2. Autonomy versus shame and doubt 3. Initiative versus guilt 4. Industry versus inferiority 5. Identity versus role confusion 6. Intimacy versus isolation 7. Generativity versus stagnation 8. Integrity versus despair

In adulthood, the fundamental adaptive qualities in adulthood are generativity and care, which function as developmental building blocks for the experience of integrity and wisdom in old age. Erikson viewed the major tasks of adulthood as the creation of and care for new generations, ideas, and products for the sustainability of human life in society. This process includes new creations regarding the self in the development of one’s identity. If these tasks are not sufficiently fulfilled, selfabsorption and stagnation may be more likely to prevail than generativity. Generativity has a direct

impact on identity development and adaptation in old age. According to Erikson, vitality in old age depends on vital involvement, reflecting a mechanism he called a “grand-generative function.” ­Consistently, Katie Ehlman and Mary Ligon found support for the adaptive significance of generativity in old age. Building on and incorporating the strengths of the seven previous developmental periods (hope, will, purpose, competence, fidelity, love, and care), integrity can mature gradually throughout the life span, culminate in old age, and serve as a force of resilience against physiological and mental disintegration. To the extent that the aging person resolves the crisis between integrity and despair in the eighth psychosocial stage of development, wisdom emerges as the major strength of old age. On the other hand, it is adaptive to recognize and accept disdain as a natural reaction, which Erikson called the “antipathic counterpart to wisdom.” Erikson proposed that hope (as the major strength of infancy) evolves throughout the life span and matures as faith and functions as a buffer against despair and disdain. As an alternative to Erikson’s emphasis on integrity, Jacob Lomranz proposed “aintegration,” representing an adaptive quality in adult development and aging. Aintegration reflects the dialectic capacity to hold in consciousness and experience seemingly contradictory realities without the need to turn them into an integrated whole. Aintegration includes polarities in the experience of life and the self as an open system. Aintegration represents the ability to sustain and appreciate complexity, ambiguity, and paradox. Aintegration can be ­adaptive throughout the life span but may be particularly critical in old age, when deterioration in physical and mental functions may substantially increase uncertainty and anxiety and hence challenge individuals to reconstruct their sense of self and identity. Consistently, Joan Erikson formulated a ninth stage of development, when the ­challenges of advanced old age may force individuals to face the negative qualities of each of the previous eight crises (e.g., mistrust, guilt, despair). In this context, Joan Erikson stressed the importance of faith and humility through acceptance of loss and decline. Ulas Kaplan

Identity Formation in Adolescence See also Ageism; Aging and Mental Health; Body Image and Aging; Community and Aging; Gender Socialization in Aging

Further Readings Coleman, P. G., Ivani-Chalian, C., & Robinson, M. (1999). Self and identity in advanced old age: Validation of theory through longitudinal case analysis. Journal of Personality, 67(5), 819–849. doi:10.1111/1467-6494.00074 Erikson, E. H., & Erikson, J. M. (1997). The life cycle completed. New York, NY: W. W. Norton. Kegan, R. (1994). In over our heads: Mental demands of modern life. Cambridge, MA: Harvard University Press. Lomranz, J. (Ed.). (1998). Handbook of aging and mental health: An integrative approach. New York, NY: Plenum Press. Tornstam, L. (2005). Gerotranscendence: A developmental theory of positive aging. New York, NY: Springer. Whitbourne, S. K. (1986). Adult development. New York, NY: Praeger.

Identity Formation

in

Adolescence

Adolescence is a developmental period in which challenging adaptations have to be made. One of the most central struggles for many adolescents is their effort to achieve a sense of identity. Establishing an identity is an adaptive developmental accomplishment that prepares an adolescent to transition to the adult world and contribute to society. ­Adolescence is a period of searching to understand who one is by integrating established self-concepts from childhood with future ideals that affirm one’s strengths, values, and self-worth. This entry examines what it means to form an identity, according to psychoanalyst Erik Erikson and other theorists, and discusses the states of identity development. Finally, general issues related to identity development, including the timing of identity development, individual and contextual influences, antecedents and consequences, and gender differences in the development of identity, are examined.

What Is a Sense of Identity? In the 1950s and 1960s, Erikson put forth perhaps the most compelling and comprehensive theory of

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identity development. Erikson’s psychosocial approach proposed that life span development consists of eight stages, each of which contains a psychological or social crisis that must be met and resolved to achieve positive outcomes later in life. According to Erikson, the key developmental task of adolescence is the formation of an identity. He claimed that it was a common and universal concern in adolescence to address questions such as “Who am I?”, “Where am I going in life?”, “What am I all about?”, “What makes me unique?”, and “How can I make it on my own?” In childhood, these questions are generally of lesser concern. However, in adolescence, these questions become central as teenagers become absorbed in the task of actively seeking answers and solutions to these uncertainties of identity. Identity development can be viewed more broadly as a process or defined in a more specific or contextualized sense. As a process, identity involves identifying and evaluating the values, beliefs, and priorities that reflect possible identity commitments. Identity also can be defined in a more context-specific fashion, as referring to the specific domains that are meaningful and important in one’s self-structure and the commitments that one has made to the identities or roles in those domains (e.g., vocational, interpersonal, moral). Specifically, an identity is the sum of physical, ­psychological, and social components, but it can be broken down into multiple identities, including vocational identity, cultural or ethnic identity, ­religious identity, gender identity, and so forth.

Theories of Identity Formation According to Erikson, identity formation can be described as involving progressive developmental shifts. To achieve a sense of identity, adolescents go through a progressive state of evaluating and defining who they have become during their childhood and who they would like to become in the anticipated future. A well-formulated identity is also a balance of how adolescents perceive themselves, how they believe others perceive them, and what they believe others expect of them. Identity development involves experimenting with various personalities and roles in a deliberate effort to find an identity that fits, whereby undesirable roles are generally discarded. Thus, for Erikson, identity

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Identity Formation in Adolescence

involves consideration of both the self and the community. Although Erikson’s theory of identity is perhaps the most widely cited, other theories have also examined identity development. According to attachment theories, identity develops out of a secure attachment to parental figures, formed out of a trusting and accepting relationship, where there is not only support and guidance but also a safe base from which to explore. Children who are unable to form this bond lack confidence, are confused, and have difficulty trusting themselves and others. Cognitive developmentalists argue that identity formation begins in adolescence as a result of more developed cognitive and reasoning skills. The adolescent becomes aware of the future and the need to prepare for it. Social learning theorists view identity formation as emerging from the development of a self-concept that is based on evaluations of self-worth, and as a way of ­interacting in the world that comes from modeling and identification with role models. Finally, ­sociocultural perspectives examine the social and cultural influences that shape identity. Each of these approaches holds value for understanding how identity develops in adolescence. However, a clear operational definition of the construct of identity is yet lacking. Across the ­ various definitions and perspectives on identity ­ development, operationalizations of identity include some or all of the following elements: (a) a clear selfdefinition; (b) commitments to particular values, beliefs, and priorities; (c) engaging in activity r­ elevant to the commitments; (d) considering and exploring ­various identity alternatives; (e) developing an identity that is both fulfilling and meaningful to the self; (f) finding exceptionalities and ­distinctiveness compared with others; and (g) self-confidence in one’s goals and priorities for the future.

What Crises Do Youth Face During Adolescence? According to Erikson, adolescents who do not successfully resolve their identity crisis experience identity confusion, which is a temporary period of distress or upheaval as they experiment with various roles and personalities until they finally arrive at a mature identity. Identity is cultivated from all successive identifications from the earlier years of

childhood coming in conflict or crisis with the new identifications made through friends and others outside the family. While contemporary theorists agree that identity formation involves a reevaluation of values, characteristics, and goals, the term crisis is no longer used to refer to this process. These theorists argue that identity development can be a sudden distressing and traumatic experience for some, involving storm and stress and evoking images of the rebellious teen. However, turmoil and conflict are not inevitable or even a common occurrence for most teens. In fact, cross-cultural research ­provides evidence that most teens are quite happy and confident as they move toward adulthood. More recent research by James Marcia and subsequent theorists and researchers focuses on two elements of identity development. First, exploration is the process of trying out alternative roles and personalities in various domains. This element of identity formation can indeed be potentially distressing and anxiety inducing for many adolescents. Second, the commitment process involves selection among different identity alternatives and engaging in relevant activities that lead to the formation of an enduring and organized subset of identity alternatives. Adolescents tend to fall into one of four clearly differentiated identity statuses, based on their ­levels of exploration and commitment: 1. Identity diffusion occurs when an adolescent has largely failed to explore various identity alternatives and has made no commitments as yet. 2. Foreclosure indicates that the adolescent has committed to an identity without any exploration. 3. Moratorium is typically a transitional status. It signifies that the adolescent is actively exploring identity alternatives, though commitment is tentative. 4. Finally, identity achievement occurs when an adolescent has actively and comprehensively explored various identity alternatives and has made a commitment.

During adolescence, individuals may either remain relatively stable or shift from one status to another as part of identity formation. As a result of

Identity Formation in Adolescence

this, the identity status paradigm has received much criticism as to whether this model truly reflects a developmental pattern or process.

Characteristics and Outcomes for Various Identity Statuses In terms of mental health and well-being, research shows that moratorium and diffusion statuses are associated with lower psychological well-being while foreclosure and achievement statuses are associated with higher psychological well-being. Each of the identity statuses is associated with distinct characteristics, patterns of social interaction, behavioral outcomes, and well-being. Adolescents in moratorium status tend to exhibit higher levels of anxiety as a result of the combination of rigorous explorations and low levels of commitment. This is closest to what Erikson referred to as being in a state of crisis. As a result of their anxious state, these individuals often need to look to others for reassurance and support. They are skeptical about knowing anything with certainty and tend to be more analytical and philosophical. Individuals in the moratorium status also tend to experience greater conflict with others. Socially, these individuals tend to be fairly independent as children, with parents who emphasized independence in their child rearing. Adolescents and emerging adults in the moratorium stage can have fulfilling and meaningful social relationships but have not yet committed to a long-term partner. Having a sense of identity characterized by ­diffusion can be less damaging to psychological well-being than moratorium, as lower levels of commitment are not as much an issue when little exploration is being done. Adolescents who are in a state of diffusion tend to experience adjustment difficulties. They tend to be low on autonomy and self-esteem. These individuals seem to go wherever circumstances take them, and many decisions are left to fate or fortune. Diffuse individuals live in the moment and therefore have poor abilities when it comes to adapting to environments, time ­management, planning, problem solving, and organization. This group is most likely to be influenced by peer pressure, making these adolescents the most likely to use and abuse drugs. Adolescents in diffusion tend to be the most disagreeable and neurotic, as well as the least conscientious. These

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individuals are prone to a general sense of hopelessness about their future, increasing their risk for mental health problems such as depression and suicide. Interpersonally, adolescents in diffusion most likely come from homes where parents or caretakers were distant and rejecting and with whom they developed poor or weak attachment. These individuals are less likely to develop close relationships and instead tend to have more superficial ones or avoid them altogether due to their poor communication skills and tendency to use manipulation or exert influence on others. When adolescents are in a state of diffusion for extended periods of time, they tend to be the least mature in identity development. Psychological well-being is greater when ­identity commitment is strong, as in foreclosure. Adolescents in foreclosure tend to be highly attached to family, exhibit higher moral reasoning, and display more conformity, while experiencing low levels of anxiety. However, they tend to be more rigid, inflexible, and narrow-minded; often refute differences in opinion that challenge their ideals or beliefs; and are generally not open to new experiences. Adolescents in foreclosure also tend to fear rejection by those they are dependent on for self-confidence, recognition, and affection. They tend to be less critical in deciding the ideals they commit to and often believe that their life is controlled by factors beyond their control. As a result, they are the least likely of all the statuses to think and integrate ideas analytically, often making errors in judgment, assuming that absolute certainty can always be established. Socially and interpersonally, individuals in foreclosure often have shallow and trivial relationships and are generally more concerned with the superficial features of the relationship. They tend to come from families in which parents were overly involved and protective and discouraged individual expression and exploration, making them more likely to be anxiously attached or detached in their attachment profiles. In identity achievement, psychological wellbeing is again high due to strong levels of commitment. Adolescents who have achieved an identity generally have a higher level of selfesteem and self-satisfaction. They tend to be more motivated, conscientious, and extraverted, and have an internal locus of control. They function

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well under stress and have highly advanced ­problem-solving abilities, critical thinking skills, and moral reasoning. Interpersonally, these individuals tend to have the greatest i­ntimacy and are the most secure and open in their relationships with others. These individuals generally come from families in which individuality, independence, and connectedness to the ­family were all highly encouraged. Finally, Erikson believed that a stable and confident identity is a necessary prerequisite to being able to hold intimate relationships later in life. Having a strong sense of self, or having formulated a well-developed and mature identity, is associated with the formation of intimate connections and relationships. When adolescents remain in a state of identity crisis or confusion, they tend to withdraw socially from others or, alternatively, ­ immerse themselves in meaningless activities, following others and getting lost in the crowd. In sum, achievement, and to a lesser extent foreclosure, are more desirable psychosocial ­outcomes for identity development than diffusion or moratorium. Those with a more developed ­self-identity are more cognizant of their distinctiveness and their similarities with others, as well as their own strengths and weaknesses regarding their abilities to make it in an adult world. When the self-identity is less developed, individuals are more confused about what makes them unique from and must rely on other external sources of self-evaluation.

Why Is Adolescence an Important Period for Identity Development? There are several functions of developing an identity in adolescence. For instance, identity provides a connection and continuity among who one has been in the past, the current individual, and who the adolescent hopes to become in the anticipated future. Adolescents face the change from being taken care of by parents to needing to be self-­ sufficient, independent, and responsible for themselves and their own life. A sense of identity needs to be achieved in order to become productive, well-functioning, and content adults. Developing a sense of identity is a fundamental force that drives many decisions in life. During adolescence, teens face many developmental issues

that become the focus of their identity crisis. For example, youth start to prepare for and select a career that is both personally meaningful and socially recognized. Adolescents also begin to adopt social roles and engage in activities that are in line with their roles, including sexual roles and orientation, relationships and marriage, and parenting. Ideals and personal commitments regarding religious, moral, and political beliefs also begin to form. Adolescents must make commitments in the identity domains or contexts that are most meaningful to their self-concept to further their development.

Timing of Identity Development Erikson initially posited that the “crisis” of identity formation versus identity confusion took place in adolescence between the ages of 12 and 18 years. More recent research suggests that identity formation can continue well beyond 18 years. More adolescents today are attending college and university programs. College and university students often have more opportunities to explore various career options and try out different lifestyles than high school students, thereby broadening their life experience and prospective alternatives. The consensus among most identity researchers is that identity development is a lengthy process that begins in adolescence and continues into adulthood as individuals try out various identity ­statuses in progressive developmental shifts. Identity formation is fluid and dynamic. It is not a specific end state to be achieved but is constantly changing over time. In fact, many adolescents, and adults even, move into and out of identity crises as they test the viability of their identity choices. Furthermore, at any given point in identity development, an adolescent might fall within different identity statuses depending on the identity domain or context. Most, if not all, identity theorists and researchers concur that identity formation is typically the result of progressive changes from a relatively unstable set of beliefs, values, and priorities toward a clearer and more concrete delineation of identity-related ideals. Finally, researchers agree that finding an identity is not a permanently stable resolution for the remainder of one’s life. An individual might experience many identity resolutions throughout life.

Identity Formation in Adolescence

Influences on Identity Development As adolescent identity development is a dynamic and ongoing process between the self and contextual elements, various factors can affect identity formation. Some of the most influential domains for successful identity development include family, peers, and social and historical contexts. The family has a considerable influence on various developmental factors from infancy through childhood and into adolescence. Identity formation is promoted when parents are emotionally supportive, when they allow the freedom to explore and be independent, and when they provide a secure foundation from which their teens can integrate into the outside world. When parenting style is characterized by low warmth, when communication in the family is low, and when parents are too attached and do not provide opportunities for healthy separation, adolescents tend to end up in a state of foreclosure. As adolescents begin to spend less time with their families and more time with peers, this allows for greater exposure to other ideas, values, beliefs, and identity alternatives. Much like the influence of parents, when teens have peers who are supportive and encourage exploring various alternative identities and roles, it promotes identity ­development. In contrast, when peers are too influential, it may interfere with the adolescent’s ability to make identity commitments. The social and historical contexts in which an adolescent develops greatly contribute to the process and outcomes of identity formation. These contexts include the school environment and the community in which one is raised. For example, communities and schools that provide access to rich and varied opportunities, including numerous extracurricular and community events, and positive role models, such as teachers and coaches, enable adolescents to try out many roles and activities. Larger societal influences may also affect identity development. Some societies might place more influence on gender role and vocational commitments, whereas others might emphasize the importance of establishing religious and political identities.

Role of Gender in Identity Formation Early theorists, Erikson included, suggested that males and females could differ with respect to

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identity development, particularly when considered at the domain level. Males were presumed to be more committed to vocational and ideological domains, whereas affiliative concerns were more central to females, who were more interested in relational domains including marriage and child rearing. Females have much stronger vocational interests today than they did a few decades ago. Few gender differences have been observed in the various identity domains related to individual choices or beliefs, such as academic and vocational choices and religious or political affiliations. ­However, gender differences have been found with respect to identity domains that pertain to relational and interpersonal identities. Females tend to be more reflective than males when it comes to sexual identities, and priorities and attitudes related to interpersonal (friendship) and romantic ­(partner) relationships. Therefore, females tend to be more advanced than males in this domain of identity development. Despite the potential differences in this domain, males and females do not differ in  their ability to develop an identity. Research shows that there are also few gender differences in the frequencies with which males and females are in the states of identity achievement, diffusion, moratorium, or foreclosure. In general, males and females equally experience the various identity statuses as they work to formulate an identity. Katherine Magner and Patrick L. Hill See also Family Relationships in Adolescence; Friendships in Adolescence; Identity Construction; Identity Development and Aging; Sexual Identity; Social Role Theory

Further Readings Adams, G. R., Gullotta, T. P., & Montemayor, R. E. (1992). Adolescent identity formation: Advances in adolescent development. Newbury Park, CA: Sage. Archer, S. L. (1989). Gender differences in identity development: Issues of process, domain and timing. Journal of Adolescence, 12(2), 117–138. doi:10.1016/ 0140-1971(89)90003-1 Cramer, P. (2000). Development of identity: Gender makes a difference. Journal of Research in Personality, 34(1), 42–72. doi:10.1006/jrpe.1999.2270 Erikson, E. H. (1968). Identity: Youth and crisis. New York, NY: W. W. Norton.

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Erikson, E. H. (1974). Identity and the life cycle. New York, NY: W. W. Norton. Kroger, J. (2000). Identity development: Adolescence through adulthood. Thousand Oaks, CA: Sage. Marcia, J. E. (1980). Identity in adolescence. In J. Adelson (Ed.), Handbook of adolescent psychology (pp. 159–188). New York, NY: Wiley. Marcia, J. E., Waterman, A. S., Matteson, D. R., Archer, S. L., & Orlofsky, J. L. (1993). Ego identity: A handbook for psychosocial research. New York, NY: Springer. Meeus, W. H. J. (1996). Studies on identity development in adolescence: An overview of research and some new data. Journal of Youth and Adolescence, 25, 569–598. doi:10.1007/BF01537355 Waterman, A. S. (1993). Developmental perspectives on identity formation: From adolescence to adulthood. In J. E. Marcia, A. S. Waterman, D. R. Matteson, S. Archer, & J. L. Orlofsky (Eds.), Ego identity: A handbook for psychosocial research (pp. 42–68). New York, NY: Springer. Waterman, A. S. (1999). Identity, the identity statuses, and identity status development: A contemporary statement. Developmental Review, 19, 591–621. doi:10.1006/drev.1999.0493

Identity Formation

in

Childhood

Identity development in childhood can be understood through various theoretical traditions and lenses. This area of study is the exploration of how individuals develop their identity or who they are over the course of their life. Varying theoretical frameworks and epistemological traditions define identity and the process of identity formation in many different ways. However, almost all research and theoretical traditions within the field of identity development in individuals recognize the formative effects of childhood and childhood ­ experiences. Much of the research on identity development during childhood relies heavily on the developmental stage theory developed by Eric Erikson, who was significantly influenced by Sigmund and Anna Freud. The Eriksonian perspective has been taken up by many different fields to inform research and practice.

Psychosocial Identity Formation Erikson’s conception of ego identity was multifaceted and included internal factors and social and

cultural considerations that are synthesized through positive and negative outcomes. Erikson delineated eight stages within his psychosocial model of development, ranging from infancy to adulthood. Through each developmental stage, the individual faces “crises,” which they have to resolve. Although Erikson indicated that his stages of development are generally consistent in the development of a human from infancy to adulthood, he also suggested that the stages do not necessarily require a definitive resolution. Rather, an individual reaches a point of balance that allows them to grow. Specifically, Erikson asserts that in the fifth stage of development, known as identity versus role confusion, identity really begins to take shape. Taking place during adolescence, this is the stage in which young people begin to wrestle with and explore who they are and how they fit in the world. Although this stage is often the starting point for identity research and inquiry for scholars, the preceding stages are equally important in the formation of identity and are of particular interest to educators and other ­child-focused professions. Erikson’s first stage, trust versus mistrust, occurring during infancy, is when infants begin to learn whether or not they can trust others, particularly their primary caregivers, to establish a sense of security. Some would argue that this is fundamental in forming healthy relationships as the child grows. In the second stage, autonomy versus shame and doubt, toddlers begin to develop autonomy as they are becoming more physically capable of satisfying and even articulating their own nee