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. Author manuscript; available in PMC: 2025 Sep 13.
Published before final editing as: J Interpers Violence. 2025 Jun 19:8862605251345466. doi: 10.1177/08862605251345466

Child Sexual Abuse as a Predictor of Multiple Forms of Victimization Among Transgender Adults in the United States

Caitlin I Laughney 1, Yong Gun Lee 2, Emily Allen Paine 1, Theodorus Sandfort 1, Elwin Wu 3
PMCID: PMC12427014  NIHMSID: NIHMS2104025  PMID: 40538121

Abstract

Transgender people disproportionately experience high rates of violence across multiple contexts throughout the life course compared to cisgender individuals. Among the cisgender population, child sexual abuse (CSA) is associated with multiple forms of victimization; however, these associations have not been examined among transgender adults. This study evaluated whether transgender adults who have experienced CSA were more likely to report specific forms of victimization and cumulative experiences across types of violence (i.e., more than one type of maltreatment). We conducted a cross-sectional secondary analysis of data from a national probability sample (N=274) of transgender adults (U.S. Transgender Population Health Survey, 2016-2018). CSA was measured using the child sexual abuse subsection of the survey’s implementation of the Center for Disease Control’s Behavioral Risk Factor Surveillance System Adverse Childhood Sexual Experience module (CDC BRFSS ACE). Adult experiences of victimization were measured using six questions that assessed experiences of criminal victimization, harassment, and threats. Nearly half (45%) of participants reported having experienced CSA. The majority (85%) of transgender respondents reported having experienced at least one type of adult victimization, with 40% reporting four or more types of victimization (i.e., cumulative victimization). Compared to transgender adults who had never experienced CSA, transgender adults who had experienced CSA victimization were significantly more likely to have experienced individual types of physical and verbal abuse as well as cumulative experiences of victimization. Results of this study indicate that transgender survivors of CSA, like cisgender persons, are at increased risk of specific types of victimization and cumulative experiences of victimization as adults.

Introduction

Transgender people in the U.S. experience disproportionately high rates of multiple forms of psychological, physical, and sexual forms of victimization across the lifespan (Dank et al., 2014; Griner et al., 2020; Hoxmeier & Madlem, 2018; Thoma et al., 2021). Upwards of 89% of transgender adults have experienced gender-based violence, which includes forms of victimization that are perpetrated due to ascribed gender differences (Wirtz et al., 2020). A national study of transgender adults in the U.S. found that over a third of participants reported experiencing at least one type of victimization (e.g., intimate partner violence, nonpartner sexual assault), and that transgender people across marginalized subgroups (e.g., women, racial-ethnic minorities, sexual minorities) experience a broad range of victimization types (Messinger et al., 2021). Black and Latina transgender women experience higher rates of hate crimes compared to White transgender people, further indicating that victimization disparities exist among transgender people due to multiple forms of discrimination such as racism and transphobia (Dinno, 2017). In the U.S., transgender people frequently experience social exclusion and lack of legal protections, which can increase vulnerability to victimization across the life course (Baams, 2018).

Beyond victimization in adulthood, transgender people disproportionately experience higher rates of childhood adversity, including multiple forms of victimization during childhood (Baams, 2018; Thoma et al., 2021). Notably, transgender people experience high rates of child sexual abuse (CSA), with prevalence rates ranging from 19% to 88% (Fernández-Rouco et al., 2017; Hall et al., 2020; Schnarrs et al., 2019; Thoma et al., 2021; Tobin & Delaney, 2019; White Hughto et al., 2017), with one U.S. national probability sample indicating a 45% prevalence rate (Laughney et al., 2024). CSA has been associated with numerous negative long-term health outcomes, including binge drinking and posttraumatic stress among transgender CSA survivors (Laughney et al., 2024). Despite high rates of CSA among transgender people, and negative long-term health implications of CSA, limited research has examined associations between CSA victimization and subsequent experiences of multiple forms of victimization in adulthood.

Revictimization

Revictimization is a phenomenon where people who have survived maltreatment are at increased risk of subsequent experiences of victimization (Walker et al., 2019). There is robust evidence in the violence prevention literature that has found that survivors of violence are more likely to experience revictimization later in life (Classen et al., 2005; Roodman & Clum, 2001; Widom et al., 2008). Much of the revictimization literature has focused on sexual revictimization among cisgender women and survivors of childhood sexual violence (Bellot et al., 2024; Decker & Littleton, 2018; Walker et al., 2019). For example, a meta-analysis found that about half of CSA survivors experience sexual violence again in the future (Walker et al., 2019). Although there is limited revictimization research among sexual and gender minority people (SGM), there is evidence that transgender people experience high rates of violence at multiple points across the lifespan (Stotzer, 2009), and recent research has explored the health implications of sexual and other forms of revictimization among sexual minority populations (Blackburn et al., 2023; McGeough & Sterzing, 2018; Xu et al., 2024). Within this literature, researchers specifically highlighted the lack of–and need for–current revictimization research among transgender people due to the high rates of victimization experienced by this population (Blackburn et al., 2023).

Cumulative victimization

Researchers have theorized that survivors of maltreatment are more likely to experience cumulative victimization, which is the “summation of victimization experiences across multiple contexts” (Wojciechowski, 2022, p. 417). Research has shown that survivors with higher cumulative victimization have worse health outcomes, including revictimization, than those who have not experienced victimization. (Mustanski et al., 2016; Wojciechowski, 2022). As a phenomenon, cumulative victimization is important because it recognizes that experiences of violence may not just be isolated incidents but instead may be part of a larger pattern of vulnerability to abuse or maltreatment across multiple domains of a person’s life (Scott-Storey, 2011). Despite transgender people shouldering high rates of violence across multiple contexts, limited research has explored associations between multiple forms of victimization among this population.

Present Study

The present study aims to examine associations between CSA and specific forms of victimization and cumulative experiences across types of adult victimization among a nationally representative sample of transgender adults in the United States. Extensive research among cisgender individuals has established that compared to those who have never experienced CSA, CSA survivors are significantly more likely to experience victimization later in life as an adult (Widom et al., 2008; Xu et al., 2024). Despite this knowledge base, limited research has examined these associations among transgender people. We hypothesize that transgender adults who have experienced CSA are significantly more likely to report higher rates of specific forms of victimization and cumulative experiences across types of adult victimization compared to transgender adults who have never experienced CSA. This study is an important contribution to the revictimization literature, which has historically centered cisgender people, by exploring the long-term health implications of CSA among transgender people.

Methods

Participants

Eligibility criteria for the parent study and the current analysis included self-identification as transgender, being 18 years or older, having completed a 6th-grade education, ability to conduct the survey in English, and living in the United States. A two-step process for gender identification used questions about self-identified gender and sex assigned at birth (Meyer, 2021).

Data collection and procedures

We analyzed data from the U.S. Transgender Population Health Survey (TransPop), obtained from the Inter-university Consortium for Political and Social Research (ICPSR) online public archive (Meyer, 2021). This study utilized data from TransPop’s cross-sectional national probability sample of U.S. transgender adults (N=274). The main goals of the TransPop study were to describe demographic parameters and basic health outcomes, as well as discrimination and transgender identity-related experiences among a national probability sample of transgender adults in the United States (Meyer, 2021). Participants were recruited from April 2016-August 2016 and June 2017-December 2018 by Gallup, Inc., using random digit dialing and address-based sampling methods. Detailed information about the TransPop study can be found elsewhere (Feldman et al., 2021; Meyer, 2021). All study procedures were approved by the Institutional Review Board (IRB) at Columbia University.

Measures

Child sexual abuse (CSA).

Three sexual abuse questions from the Center for Disease Control’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) Adverse Childhood Sexual Experience (ACE) module were used to measure CSA (CDC-BRFSS, 2010; Meyer, 2021). Participants were asked how often an adult or anyone at least five years older than them did any of the following three behaviors before they were 18 years old: 1) “ever touch you sexually; 2) “try to make you touch them sexually;” and 3) “force you to have sex.” This variable was dichotomized so that any reports of sexual abuse during childhood were coded as “positive” for having experienced CSA.

Types of Victimization in Adulthood.

Adult experiences of victimization were measured using six questions about forms of victimization, harassment, and threats (Herek, 2009). Participants were asked how often (never, once, twice, three or more times) they had experienced any of the following experiences after they were 18 years of age: 1) “You were hit, beaten, physically attacked, or sexually assaulted;” 2) “You were robbed, or your property was stolen, vandalized, or purposely damaged;” 3) “Someone tried to attack you, rob you, or damage your property, but they didn’t succeed;” 4) “Someone threatened you with violence;” 5) “Someone verbally insulted or abused you;” 6) “Someone threw an object at you.” Participant responses for each type of adult victimization were dichotomized (yes=1, no=0). A cumulative adult victimization variable was created for this study by calculating the sum of the six binary adult victimization factors with a score range of 0-6 (0 = no experiences of adult victimization; 6 = experienced all six types of adult victimization). On average, transgender participants in this sample experienced three distinct types of adult victimization; this cumulative adult victimization variable was then dichotomized (yes/no) with a cut-off score of 4 to reflect the number of participants in this sample who experienced a higher-than-average number of types of adult victimization. This approach was used to highlight potential associations between CSA and a higher-than-average victimization burden in adulthood, rather than identify an optimal threshold of adult victimization (e.g., via Receiver Operating Characteristic curve analysis).

Only participants who stated that they had experienced a form of victimization were then shown the following survey question: “If you said you had any of these experiences (being assaulted, robbed, threatened with violence, insulted, and abused), would you say they happened because of your…Please mark all that apply.” Response options included age; sex ( female or male); transgender; gender expression or appearance; race/ethnicity; income level or education; sexual orientation; physical appearance (e.g., weight, height); religion/spirituality; and/or disability. This sequential structure ensured that participants were only asked to consider intersections of their identities (e.g., age, weight) after answering victimization questions. This variable was included only to provide descriptive statistics about self-identified reasons for victimization in adulthood but was not included as a covariate.

Covariates.

Sociodemographic characteristics included age, gender, sexual orientation, urbanicity, census poverty, employment, education, race, and relationship status.

Age was included as a continuous variable. Gender identity categories included man/trans man, woman/trans woman, and non-binary. Sexual orientation was included as a collapsed binary variable (heterosexual, sexual minority) with the sexual minority category including participants who identified as lesbian, gay, bisexual, same-gender loving, queer, pansexual, asexual spectrum, or “other” self-identified sexual minority identity. The parent study calculated the urbanicity variable using respondents’ zip codes; for detailed information, see TransPop’s methodology and technical notes (Krueger et al., 2020). The parent study calculated Census poverty as a binary variable (yes/no) using Census estimates for poverty thresholds (Krueger et al., 2020). Employment categories included employed full-time or part-time, unemployed, and “other” employment. The “other” category included participants who were a student, homemaker, on disability, retired, or some “other” type of employment status. Education included two categories, “some college or more” and “some high school or less.” Race included four categories (White, Black, Latino, or “Other”). The “other” category included individuals who identified as biracial, Native Hawaiian/Pacific Islander, Asian, or an “other” listed racial identity. For the relationship status variable, participants were asked whether they were “currently in a relationship or feel a special commitment to someone” with yes/no binary response options. Missing data were imputed by the parent study when possible (Meyer, 2021). The current study used any imputed variables available (i.e., census poverty, urbanicity, CSA).

Statistical analyses

Sample weights were applied per instructions by the parent study’s methodology and technical notes, using Complex Samples software in SPSS v29 (Krueger et al., 2020). An Analysis Plan file was created using code discussed in the parent study’s technical notes to apply sample weights. Then, SPSS Complex Samples software procedures could be applied to analyze the weighted data. When the sample weights are applied, the results are generalizable to the U.S. population of transgender adults (Krueger et al., 2020). Complex Samples Descriptives (CSD) and Complex Samples Crosstabs (CSC) were used for univariate analyses. Adjusted Samples Logistic Regression (CSLR) was used for multivariable analyses.

Results

Sociodemographic characteristics.

Weighted descriptive statistics of categorical sociodemographic characteristics can be found in Table 1. The majority of transgender adults in this sample identified as women (38%), a sexual minority, i.e., not heterosexual (82%), and currently in a relationship (58%). Participants ranged from 18 to 72 years or older; the mean age was 34. Half of the participants were employed (51%), college-educated (56%), and white (56%), and most participants lived in an urban environment (83%) and did not live in poverty (73%).

Table 1.

Weighted Estimates of Categorical Sociodemographics From a Probability Sample (N=274) of Transgender Adults in the U.S., 2016-2018

Sample Characteristics %
Gender
 Man/Trans man 30.9%
 Woman/Trans woman 37.8%
 Nonbinary 31.3%
Sexual Orientationa
 Sexual minority 82.4%
 Heterosexual 17.6%
Urbanicityb
 Urban 82.8%
 Non-urban 17.2%
Census Povertyc
 Living in poverty 27.2%
 Not living in poverty 72.8%
Employmentd
 Full-time or part-time 50.8%
 Unemployed 9.3%
 Other 39.9%
Educationd
 Some college or more 55.9%
 Some high school or less 44.1%
Race
 White 56.5%
 Black 9.5%
 Latino 15.7%
 Other 18.3%
In a Relationshipe
 Yes 57.8%
 No 42.2%
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Note. The present table represents the percentage (%) of categorical sociodemographic characteristics within the total sample of transgender adults. aN=271 due to 3 missing observations. bPrior to imputation, N=266 due to 8 missing observations. cPrior to imputation, N=259 due to 15 missing observations. dN=270, due to 4 missing observations. eN=272, due to 2 missing observations.

Victimization.

Weighted descriptive statistics of victimization experiences can be found in Table 2, and self-identified reasons for victimization in adulthood can be found in Table 3. Nearly half (45%) of participants reported any history of CSA victimization, and nearly all (85%) participants had experienced at least one type of victimization as an adult; 40% of participants had experienced four or more types of adult victimization, and the most frequently reported form of violence was being verbally insulted or abused (76%). The most frequently reported self-identified reason for victimization in adulthood was gender expression or appearance (39%).

Table 2.

Weighted Estimates of Child Sexual Abuse and Adult Experiences of Types of Victimization From a Probability Sample (N=274) of Transgender Adults in the U.S., 2016-2018

Types of Victimization %
Before 18 Years Old
Child Sexual Abusea 44.5%
18 Years or Older
Physically Attacked or Assaultedb 47.6%
Robbed or Property Damagedc 45.1%
Attempted Attack, Robbery, or Property Damageb 28.5%
Threatened with Violenceb 61.1%
Verbally Insulted or Abusedd 76.0%
Target of Thrown Objectb 40.5%
Cumulative Victimizationd,e 39.8%
Any Types of Adult Victimizationf 84.8%
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Note. aPrior to imputation, N=249 due to 25 missing observations. bN=271 due to 3 missing observations. cN=270 due to 4 missing observations. dN=269 due to 5 missing observations. dN=268 due to 6 missing observations. eCumulative victimization is defined as having experienced four or more types of adult victimization. fN=268 due to 6 missing observations.

Table 3.

Weighted Estimates of Self-Identified Reasons for Adult Victimization From a Probability Sample (N=274) of Transgender Adults in the U.S., 2016-2018

Self-Identified Reasons for Victimization in
Adulthood		 %
Age 17.4%
Sex (Being Female or Male) 30.5%
Being Transgender 28.3%
Gender Expression or Appearance 39.0%
Race/Ethnicity 13.9%
Income Level or Education 8.4%
Sexual Orientation 30.5%
Physical Appearance (E.g., Weight, Height) 30.7%
Religion/Spirituality 4.7%
Disability 9.0%
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Note. These are weighted percentages from the total sample of transgender adults (N=274).

Associations with adult victimization.

Results from the adjusted multivariable analysis can be found in Table 4. Compared to transgender adults who had never experienced CSA, CSA survivors were significantly more likely to have experienced physical assault (aOR 6.25, CI [3.02-12.94]), robbery or property damage (aOR 2.57, CI [1.26-5.24]), an attempted attack or robbery (aOR 3.52, [1.53-8.14]), threats of violence (aOR 3.45, CI [1.62-7.32]), verbal insults (aOR 6.17, [2.19-17.38]), being a target of a thrown object (aOR 3.77, CI [1.84-7.73]), and to have experienced cumulative adult victimization (aOR 4.82, CI [2.24-10.38]). Gender, age, education, and sexual orientation were also significant predictors of adult victimization. Participants with an older age and sexual minority identity were more likely to report adult victimization compared to younger and heterosexual participants. Some high school or less education and being a man or transgender man were protective factors for adult victimization, compared to participants who had some college or more education and who were nonbinary.

Table 4.

Associations Between Child Sexual Abuse and Victimization in Adulthood From a Probability Sample (N=274) of Transgender Adults in the U.S., 2016-2018

Overall Physically Attacked
or Assaulted		 Robbed or
Property Damaged		 Attempted Attack
or Robbery		 Threatened with
Violence		 Verbally Insulted Target of Thrown
Object		 Cumulative
Victimization
a0R (95% CI) a0R (95% CI) a0R (95% CI) a0R (95% CI) a0R (95% CI) a0R (95% CI) a0R (95% CI)
CSA
Yes 6.25 *** (3.02-12.94) 2.57 ** (1.26-5.24) 3.52 ** (1.53-8.14) 3.45 *** (1.62-7.32) 6.17 *** (2.19-17.38) *** 3.77(1.84-7.73) 4.82 *** (2.24-10.38)
No Ref Ref Ref Ref Ref Ref Ref
Gender Identity
 Man/Trans man 0.34 * (0.12-0.97) 0.95(0.39-2.31) 0.79(0.24-2.59) 0.99(0.35-2.81) 1.20(0.35-4.10) 1.43(0.52-3.92) 1.00(0.36-2.78)
 Woman/Trans woman 0.73(0.29-1.81) 2.00(0.81-4.94) 1.66(0.63-4.38) 2.20(0.85-5.70) 0.86(0.29-2.58) 1.60(0.63-4.07) 1.79(0.70-4.61)
 Gender nonbinary Ref Ref Ref Ref Ref Ref Ref
Sexual Orientation
 Sexual minority 1.37(0.54-3.50) 1.93(0.81-4.60) 2.66(0.97-7.27) 2.90 * (1.10-7.63) 4.28 * (1.21-15.18) 1.61(0.60-4.33) 3.11 * (1.12-8.60)
 Heterosexual Ref Ref Ref Ref Ref Ref Ref
Age 1.03 * (1.00-1.06) 1.02 * (1.00-1.05) 1.02(1.00-1.05) 0.99(0.97-1.01) 1.00(0.97-1.03) 0.99(0.97-1.02) 1.03 * (1.00-1.05)
Urbanicity
 Urban 1.58(0.61-4.12) 0.53(0.21-1.35) 0.46(0.17-1.28) 0.52(0.19-1.43) 0.43(0.13-1.39) 0.92(0.38-2.27) 0.87(0.32-2.36)
 Non-Urban Ref Ref Ref Ref Ref Ref Ref
Census Poverty
 Living in poverty 1.38(0.56-3.40) 1.38(0.58-3.30) 1.30(0.54-3.17) 1.90(0.81-4.54) 1.81(0.49-6.62) 1.54(0.66-3.55) 1.45(0.59-3.57)
 Not living in poverty Ref Ref Ref Ref Ref Ref Ref
Employment
 Full-time or part-time Ref Ref Ref Ref Ref Ref Ref
 Unemployed 1.63(0.31-8.70) 1.00(0.22-4.61) 1.39(0.19-10.16) 0.71(0.34-1.48) 0.67(0.10-4.26) 0.83(0.14-4.90) 1.38(0.21-9.30)
 Other 1.20(0.57-2.56) 0.64(0.31-1.30) 0.97(0.45-2.10) 0.71(0.34-1.48) 0.46(0.19-1.07) 1.08(0.54-2.19) 0.83(0.41-1.69)
Education
 Some college or more Ref Ref Ref Ref Ref Ref Ref
 Some high school or less 0.55(0.24-1.27) 0.40 * (0.18-0.88) 0.37*(0.16-0.88) 0.49(0.23-1.06) 0.23 *** (0.09-0.55) 0.69(0.33-1.43) 0.55(0.26-1.16)
Race
 White Ref Ref Ref Ref Ref Ref Ref
 Black 1.93(0.55-6.70) 1.22(0.39-3.84) 0.77(0.24-2.49) 0.74(0.21-2.66) 0.23(0.04-1.51) 0.76(0.22-2.61) 0.53(0.16-1.82)
 Latino 3.67(0.96-14.11) 2.91(0.87-9.77) 1.73(0.50-6.04) 2.70(0.82-8.88) 0.71(0.23-2.24) 2.07(0.78-5.49) 3.07(0.98-9.66)
 Other 0.49(0.20-1.21) 0.91(0.34-2.47) 1.10(0.39-3.12) 1.31(0.50-3.43) 1.37(0.40-4.72) 1.22(0.48-3.12) 0.95(0.36-2.51)
In a Relationship
 Yes 1.73(0.81-3.67) 1.13(0.56-2.26) 1.30(0.54-3.17) 1.50(0.71-3.19) 0.74(0.32-1.75) 1.5(0.73-3.08) 0.99(0.46-2.12)
 No Ref Ref Ref Ref Ref Ref Ref
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Note. “Never” was the reference group for all of the individual types of adult victimization. The reference group for cumulative victimization was reports of three or fewer experiences of adult victimization types. CSA: child sexual abuse. Ref: Reference group. CI: Confidence interval. P-values: p<0.05* p≤0.01**. p≤0.001***.

Discussion

Results from this study indicate that CSA and other forms of victimization in adulthood are highly prevalent among transgender people in this US-based sample. Specifically, verbal insults and abuse were the most frequently reported form of victimization, and gender expression or appearance were the most reported self-identified reasons for victimization in adulthood. These findings support previous literature that has documented that transgender people frequently report multiple forms of verbal, physical, and sexual victimization across the lifespan and that many of these experiences are experienced by transgender people as forms of gender-based violence (Domínguez-Martínez et al., 2023; Wirtz et al., 2020). Beyond understanding verbal, physical, and sexual forms of victimization among transgender people, greater research attention is needed to understand gender-based victimization and associated health outcomes among transgender people.

This study indicates that transgender people who are survivors of CSA have higher odds of experiencing a variety of forms of victimization in adulthood (e.g., physical assault, robbery, verbal insult) compared to transgender people who have never experienced CSA. Transgender survivors of CSA in this study were also more likely to experience cumulative experiences of victimization in adulthood compared to transgender people who had never experienced CSA, indicating that there are pervasive and long-lasting health implications of sexual violence during childhood. These results are consistent with extensive literature that has established that cisgender people who have experienced CSA are more likely to experience multiple forms of victimization later in adulthood compared to cisgender people who have not experienced CSA (Scoglio et al., 2021; Walker et al., 2019). A systematic review of risk and protective factors for revictimization after CSA among cisgender people found that perceived parental care was the only identified protective factor (Scoglio et al., 2021). Parental support is associated with less depressive symptoms, parental abuse, and LGBTQ+ disclosure distress among transgender and gender expansive youth, and should be examined as a protective factor for revictimization among transgender survivors of CSA in future research.

In addition to CSA, other sociodemographic factors in the final adjusted models were also significantly associated with adult victimization. Older age was positively associated with assault, robbery, or property damage and cumulative experiences across types of adult victimization. These associations may be due to older transgender people having lived long enough to experience more forms of violence compared to younger transgender people. Additionally, older transgender people faced greater historical disparities (e.g., less access to legal protections) than younger transgender people, which may contribute to higher rates of victimization. Sexual minority transgender people were more likely to have experienced threats of violence, verbal insults, and cumulative experiences across types of adult victimization compared to heterosexual transgender people, indicating that transgender people with multiple marginalized identities (i.e., transgender and sexual minority) additionally shoulder a greater burden of victimization experiences. Transgender men were significantly less likely to be physically assaulted compared to nonbinary people, further underlining the importance of examining experiences among transgender people, given that certain groups within the transgender community may be more likely to experience victimization than others. Surprisingly, lower education (some high school education or less) was a protective factor against robbery, property damage, and verbal insults. These results tentatively suggest that transgender people with a higher education interpret experiences of victimization differently than those with a lower education, and future research should explore the impact of education on transgender people’s experiences of violence.

Implications of Revictimization

Violence against transgender people is a serious public health issue, and this research indicates that transgender people frequently experience multiple forms of violence across their lifespan. The results of this study are congruent with the robust revictimization literature among the cisgender population and reflect an urgent need for comprehensive violence prevention efforts for transgender people from childhood through adulthood (Bellot et al., 2024; Blackburn et al., 2023; Walker et al., 2019). Despite strong evidence that revictimization is a powerful phenomenon among survivors of abuse, it is unclear why victimization is associated with further victimization. Potential mechanisms for these associations include individual, dyadic, environmental (e.g., community-level discrimination), and structural (e.g., discriminatory policies) factors.

Coping mechanisms.

Researchers have posited that maladaptive coping behaviors (e.g., substance use) in response to trauma (e.g., CSA) may increase a survivor’s likelihood of experiencing revictimization (e.g., adult sexual victimization) (Fereidooni et al., 2024). Gender-affirming and trauma-informed therapy and clinical services for transgender survivors of violence may be useful in preventing revictimization through the adoption of positive coping mechanisms (e.g., regulated sleep schedule and parental support) (Scoglio et al., 2021). However, it should be noted that the adoption of positive individual-level coping mechanisms is not a sufficient solution to systemic and structural forms of transphobic stigma and violence in our society. Future research should examine multiple levels of potential protective factors at the individual, community, and societal levels, as moderators and mediators of revictimization among transgender survivors of violence.

Relationship contexts.

Researchers have suggested that high rates of revictimization among survivors of violence may be inflated by the actions of a few perpetrators that are known to the victim over an extended time (e.g., parents/family, intimate partners), as opposed to high rates of violence perpetrated by numerous strangers (Walker et al., 2019). However, transgender people experience disproportionate rates of intimate partner violence and are frequently victims of transphobic hate crimes, and consequently may experience violence from known and unknown assailants (Gyamerah et al., 2021; Peitzmeier et al., 2020). Future violence prevention research among transgender people needs to explore the role of relationship dynamics (e.g., stranger, intimate partner, family member) within violent contexts to assess potential differences between violence experienced by known and unknown persons.

Alternatively, social support is well-known as a protective factor for negative health outcomes among CSA survivors as well as an important factor for positive developmental well-being among LGBTQ+ people (Domhardt et al., 2015; Snapp et al., 2015). Future research should investigate the protective and mediating role of social support, particularly parental support, among transgender people who have experienced violence across the lifespan (Scoglio et al., 2021). Additional research and contextual information about experiences of victimization and revictimization, such as relationship contexts and social support, is important because recommendations for violence prevention strategies for transgender people may vary depending on the relationship and social dynamics between the person experiencing violence and the person(s) perpetrating abuse.

Environmental norms.

Disproportionate and high rates of victimization, revictimization, and cumulative victimization among transgender people may be a result of chronic exposure to violent transphobic cultural environments and sociopolitical climates across the lifespan. Beyond individual- and dyadic-level factors, systemic changes are needed to shift responsibility from individuals to the community, state, and federal levels. State and national-level anti-violence and discrimination policies for transgender children and adults need to be developed, implemented, and assessed as potential protective factors for victimization, revictimization, and cumulative victimization among transgender people over time (Divan et al., 2016; Lombardi & Sahni, 2024; Wirtz et al., 2020).

Structural violence prevention interventions for transgender and gender-expansive youth need to be developed and evaluated. For example, a systematic review and meta-analysis found that school-based sexual abuse prevention programs can increase children’s self-protective skills in recognizing and responding to potential abuse (Walsh et al., 2018); however, few transgender-inclusive interventions currently exist. Future research should develop, implement, and evaluate LGBTQ+ inclusive school-based sexual abuse prevention programs and assess their long-term effectiveness in preventing violence against transgender youth.

Violence prevention interventions for transgender people are also needed across the lifespan. Research has shown that anti-transgender rhetoric and legislation are significantly associated with violence against transgender people—specifically, increased rates of homicide (Brightman et al., 2024). Transphobic political discourse and policy are structural forms of violence against transgender people because they legitimize discrimination and risk emboldening harmful actions toward transgender people. Longitudinal studies and natural experiment designs could examine causal relationships between policy implementation and rates of violence among transgender people to better understand the structural impacts of sociopolitical climates and social determinants of violence.

Limitations

This study has several limitations to consider. Social desirability bias may result in underreporting of victimization, particularly stigmatized experiences of victimization (e.g., sexual violence), and impact the observed strengths of associations. This study is cross-sectional and cannot establish causal relationships between CSA and adult experiences of victimization. Experiences of victimization may occur simultaneously (e.g., robbery combined with physical assault), and summing forms of victimization may not capture this potential overlap. Additionally, this study captured only six experiences of forms of victimization in adulthood, and adult experiences of intimate partner violence (IPV) were not assessed in the parent study. This is a limitation due to extensive research among cisgender populations that has found associations between CSA and subsequent experiences of IPV in adulthood (Shields et al., 2020; Wu, 2018). This US-based study sample includes mostly White transgender people who do not live in poverty, and the results of this study may not be generalizable to transgender people in other socioeconomic, cultural, and international contexts. Future research should consider focusing on better understanding the experiences of violence among domestic and international populations of transgender people living in poverty and who are people of color.

Conclusions

Transgender people in the United States shoulder high rates of specific forms of victimization and cumulative experiences of types of victimization across the lifespan. Compared to transgender people who have never experienced CSA, transgender survivors of CSA were more likely to experience specific types of victimization (e.g., assault, verbal abuse) as well as cumulative experiences of victimization as an adult. These findings are congruent with previous revictimization literature among other populations and suggest a need for further research to understand the underlying mechanisms for revictimization and cumulative victimization among transgender survivors of violence. Implications of this research include additional public health attention towards violence prevention efforts for transgender people and research to better understand the potential mechanisms that underlie revictimization among transgender people, including individual- and environmental-level contexts.

Acknowledgments

We would like to express our deepest gratitude to the researchers who conducted the TransPop Study, and the participants who made this work possible.

We have no known conflicts of interest to disclose. This research was supported by grants from the National Institute of Mental Health (T32MH019139, PI: Sandfort) (P30MH043520, PI: Remien). Dr. Paine’s time was supported by a grant from the National Institute of Mental Health (K01MH128117, PI: Paine). The secondary data used in this study are publicly available online at the Inter-university Consortium for Political and Social Research (TransPop, United States, 2016-2018, ICPSR 37938). This study was not preregistered.

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