Experiences of Transmasculine Spectrum People Who Report Nonsuicidal Self-Injury: A Qualitative Investigation

Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock's model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people (N = 18) who reported a history of NSSI. Their mean age was 24.9 years old (SD = 5.43, range = 17-38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development. Public Significance Statement This study suggests that nonsuicidal self-injury (NSSI) among transmasculine spectrum people may be related to a combination of known risk factors for NSSI and experiences of stress from stigma due to their transgender identity. Findings highlight the need for health care providers to anticipate stressors related to transgender identity development in the context of societal stigma attached to gender minority identities and NSSI, take steps to intervene at the individual and family levels, and advocate for changes in policy to reduce stigma and facilitate gender affirmation.