Cisnormativity and the frustration of core emotional needs among transgender and gender diverse individuals

Abstract

Introduction

Cisnormativity is a sociocultural narrative that contributes to the marginalisation of transgender and gender diverse (TGD) people. The schema therapy model theorises that humans have five core emotional needs that must be met to support psychological well‐being. Experiences of marginalisation may result in TGD people feeling as if their core emotional needs are not being met. Integrating the schema therapy model with an ecological systems perspective, this study aimed to examine how manifestations of cisnormativity across different levels of the social ecology impact the extent to which TGD people feel their core emotional needs are met.

Methods

An online qualitative survey was completed by 101 TGD adults, and the data were analysed using reflexive thematic analysis.

Results

Cisnormativity greatly impacted TGD people in ways that reflected the denial of numerous core emotional needs under the schema therapy model. The frustration of these needs was represented in four themes: disconnection and rejection; representation and reputation; suppressing and performing gender; and autonomy. The sources for these unmet needs were present across multiple levels of people's ecological systems.

Conclusion

Integrating an ecological systems perspective with the schema model demonstrated how the sociocultural context can directly and indirectly interfere with the meeting of core emotional needs. Some of the needs constructs demonstrated conceptual overlap, necessitating further investigation of the schema therapy model. This study documented the wide‐ranging impacts of cisnormativity on TGD people, highlighting novel considerations that should be incorporated into the schema therapy model and models of TGD mental health and well‐being.

INTRODUCTION

Diverse experiences and expressions of gender have existed throughout history in cultures all around the world (Haefele‐Thomas & Combs, 2019). The term transgender and gender diverse (TGD) encompasses those whose gender does not align with the gender that is socially linked with their presumed sex at birth (Coleman et al., 2022). This includes experiences of gender that fall within or outside of the gender binary, and identities or expressions that are culturally specific, or may not be conceptualised within Western gender frameworks. Numerous studies have demonstrated that the poor mental health outcomes experienced by many TGD people are associated with exposure to stigmatisation and marginalisation (Wilson et al., 2024). These negative experiences arise in the context of the dominant sociocultural narrative of cisnormativity; cisnormativity posits that there are only two genders (man and woman), and that a person's gender identity aligns with their presumed sex at birth (Vandenburg et al., 2022). There is some research outlining how TGD people's mental health is impacted by cisnormativity (England, 2022; Kcomt et al., 2020; Puckett et al., 2023), but none examining how cisnormativity disrupts the meeting of core emotional needs, which are foundational to psychological health (Young et al., 2003). Drawing on schema therapy (Young et al., 2003), a clinical model that specifically focuses on the role of unmet needs in the psychological well‐being of individuals, we take a qualitative approach in understanding how cisnormative sociocultural messaging can affect the extent that the needs of TGD individuals are met.

Cisnormativity and the devaluing of trans identities and needs

Cisnormativity contends that being cisgender (i.e., experiencing congruence between one's presumed sex and gender identity) is the norm or default, and therefore implies that TGD people are abnormal or defective. This ideology is deeply ingrained in societal structures and systems, perpetuating the marginalisation and stigmatisation of TGD individuals (also called minority stress; Hendricks & Testa, 2012; Meyer, 2003). For TGD people, exposure to minority stress increases the likelihood of experiencing poor mental health (Pellicane & Ciesla, 2022; Strauss et al., 2020).

The dominance of cisnormative beliefs in society influences how institutions, communities and individuals interact with TGD individuals, but also how TGD people view themselves, others and their place in the world. For example, both TGD and cisgender people reported that society views TGD individuals as ‘confused’, ‘mentally ill’, ‘monsters’, ‘deceptive’, ‘predatory’, ‘crazy’ and ‘freaks’ (Howansky et al., 2021; Rood et al., 2017). Such descriptors share much in common with the way other marginalised groups are dehumanised within society (Bruneau et al., 2018; Haslam & Stratemeyer, 2016). From a dehumanisation perspective, perceiving TGD individuals as ‘confused’ or ‘crazy’, denies them the fundamental qualities that make people human. Such qualities include rationality, intelligence, morality, agency, as well as the ability to experience emotions and form social bonds (Haslam, 2006; Karantzas et al., 2023). Groups viewed as lacking these human qualities can have their psychological needs demeaned or denied (Golossenko et al., 2023; Schroeder & Epley, 2020); recent research with marginalised groups highlights the association between experiencing needs as unmet and dehumanisation (Demoulin et al., 2021; Fontesse et al., 2024). Therefore, focusing on the degree to which sociocultural narratives influence how human needs are met or unmet for TGD people can provide important insights into the well‐being of this community.

The impacts of unmet needs: A schema therapy perspective

The schema therapy model (Young et al., 2003) provides a framework to understand how unmet or partially unmet needs by others (termed need frustration in the model) can lead to poor mental health outcomes. Within this model, humans are assumed to have five core emotional needs: secure attachments to others; autonomy, competence and a sense of identity; the freedom to express valid needs and emotions; spontaneity and play; and experiencing realistic limits and developing self‐control.

The core emotional need for secure attachments involves feeling safe, nurtured and accepted by close others who are sensitive and responsive to one's needs (Young et al., 2003). We may expect this need to be frustrated when TGD people are rejected or neglected by their caregivers, taught by others that their gender is shameful, or that they are fundamentally different to other people. The need for developing a sense of autonomy, competence and identity supports individuals to feel that they can function successfully and independently within the world. Narratives that TGD individuals are confused or mentally ill can mean institutions and individuals doubt TGD people's ability to know their gender or make decisions about gender affirmation, frustrating this need. To meet the need to freely express valid needs, opinions and emotions, an individual must expect that it is safe and acceptable for them to do so (Young et al., 2003). TGD people who are taught that their identity is unacceptable and unwanted may suppress their self‐expression to gain acceptance, love or approval. The fourth need is feeling able to be spontaneous and playful, rather than always being serious and goal‐directed. TGD people may feel a need to meet strict gender‐based rules and expectations and sacrifice their happiness, self‐expression or carefree nature to achieve this. The final need is about experiencing realistic limits over one's behaviour, allowing people to develop their own sense of self‐control, self‐discipline and take responsibility for their actions. This need may be frustrated when TGD people are aware of the harsh consequences of gender non‐conformity and exert high levels of self‐control and discipline to conform to societal expectations (Cardoso et al., 2022).

According to Young et al. (2003), when these needs are frustrated, it contributes to the development of early maladaptive schemas (EMSs). EMSs are defined as chronic negative mental representations that people maintain about themselves, their relationships with others, and the world. Empirical reviews demonstrate that greater endorsement of EMSs is positively associated with poor mental health outcomes (Bishop et al., 2021; Pilkington et al., 2021). For TGD individuals, cisnormativity may create an environment that repeatedly interferes with their core emotional needs being met, leading to the development of EMSs and mental health challenges (Radford et al., 2024). Indeed, two theoretical essays by Cardoso et al. (2024, 2022) proposed how adversity in the sociocultural environment could interfere with the meeting of core emotional needs for sexual and gender minority individuals and lead to the formation of EMSs. The current study seeks to corroborate their proposed theory by asking TGD individuals about such experiences.

Contextualising the meeting of needs: An ecological systems approach

Much of the schema literature to date has focused on the role of parents in meeting a person's core emotional needs during childhood and adolescence. However, Young et al. (2003) acknowledged that as a person develops across the lifespan, their needs are increasingly met or denied by factors beyond familial relations. With this in mind, we propose a theoretical extension to the schema therapy model, such that the meeting of needs is contextualised within an ecological systems perspective (Bronfenbrenner, 1977). Bronfenbrenner described individuals as being nested within multiple systems that shape human development. The innermost system surrounding the individual is the microsystem, which includes connections with family, friends and peers. Next is the mesosystem, which represents the interactions between entities in the microsystem. The exosystem encompasses broader elements like the media, government policies and systems. The macrosystem includes the broader sociocultural norms and beliefs. The influence of the more distal systems filters through to the more proximal systems, shaping the development of the individual.

The integration between schema therapy and an ecological systems perspective offers two advantages. First, it allows for an understanding of the ways in which needs may be frustrated across multiple levels of an individual's system. Second, it recognises that broader sociocultural beliefs and values (i.e., macrosystem) shape the ways in which more proximal systems attend (or not) to the needs of the individual. For example, cisnormative beliefs in the macrosystem can lead to transphobic media representations in the exosystem (Abbott, 2022). This representation directly influences TGD people but also shapes the way other people, communities and institutions view and interact with TGD people. When society teaches caregivers that gender non‐conformity is wrong, it shapes how they respond to their gender diverse child, and in turn, the child may learn to hide and be ashamed of those parts of themselves. This novel approach of contextualising the meeting of core emotional needs within the broader social ecology is particularly relevant for TGD individuals where macro‐level narratives like cisnormativity permeate throughout the ecological system, creating continuous opportunities for needs frustration. This integration sits alongside other research that contextualises TGD experiences of minority stress within an ecological systems perspective and recognises how health disparities among this community are driven by stigmatisation within their ecological system (Katz‐Wise et al., 2022; Puckett et al., 2022; White Hughto et al., 2015).

The current study

The dominance of cisnormativity and associated devaluation and demonisation of TGD identities may interfere with TGD people's core emotional needs being fulfilled by others and society at large. The schema therapy model states that unmet needs may be a catalyst for the development of mental ill health (Radford et al., 2024; Young et al., 2003). On this basis, understanding how cisnormativity influences TGD people's core emotional needs being met can provide critical insights to improve mental health outcomes for this community. As such, the aim of this study was to understand the ways in which TGD individuals felt their core emotional needs were shaped by cisnormativity and the associated anti‐trans stigmatisation and marginalisation.

METHODOLOGY

Theoretical framework

This research took a critical realist approach (Bhaskar, 1978), which asserts that while an objective reality exists, our knowledge of it is mediated by social, cultural and historical contexts (Danermark et al., 2019). Critical realism contends that the ‘real’ world can never be fully observed, because attempts to view and understand knowledge are coloured by the beliefs and perspectives of the researcher (Fletcher, 2016). In acknowledging that there is a ‘real’ social world, critical realism encourages an exploration of how and why phenomena occur, rather than merely observing them. In the current study, the analysis shifted between describing surface‐level observations from participants, to also looking more deeply to consider how existing theory may explain (or not) the social mechanisms shaping these experiences. In seeking to understand the underlying mechanisms of the social world, critical realism can therefore propose tangible solutions for social problems (Fletcher, 2016), an element the researchers believed to be important for this study.

Reflexivity statement

Building on the understanding that knowledge is inherently partial, situated and shaped by researchers' social, cultural and disciplinary perspectives, the research team actively engaged in reflexive practices to critically examine how their positionality influenced the research process and interpretation of findings (Braun & Clarke, 2013). The team included both insider (TGD) and outsider (cisgender) perspectives, with members varying in their levels of experience working alongside TGD individuals in peer and clinical spaces. All members are Australian and hold expertise in schema therapy (JB, GK), relationships and attachment (GK) and mental health (PS, JB, GK, GR). GR identifies as a white, transmasculine non‐binary person and was largely responsible for the study design, recruitment, coding, theme generation and write‐up. Throughout the research process, they reflected on how their positionality added benefits and potential risks to the study. GR documented these experiences in a reflexive journal and sought supervision with the team to discuss how their positionality may influence the analysis and to review their analytic decision making. These reflective conversations were particularly relevant when examining participant beliefs that differed from those of the research team, for instance, endorsing transmedicalist views.

Participant demographics

Participants were 101 TGD adults aged between 18 and 71 years (M = 27.60, SD = 8.97). Participants self‐described their gender identities; these are summarised in Table 1. Participants lived in 16 countries, most commonly Australia (44.55%), the United States (25.74%), the United Kingdom (5.94%) and Canada (5.94%). Participants lived in cities (47.53%), towns (37.62%) and rural areas (14.85%). On average, participants became aware of their TGD identity at age 17.92 years (range 3–43, SD = 8.71).

TABLE 1.

Summarised gender identities of participants.

Summarised descriptors	n
Agender, agender & non‐binary	3
Bigender, polygender	2
Genderfluid	7
Gender non‐conforming, gender non‐conforming & genderfluid	2
Genderqueer	2
Non‐binary	5
Trans	5
Transsexual	1
Man, trans man	18
Transmasculine	8
Transmasculine & non‐binary, demi guy, genderfluid, genderqueer	10
Woman, trans woman	29
Transfeminine	4
Transfeminine & non‐binary, demi girl, genderfluid	5

Data collection

Data was collected with an online qualitative survey. This approach (1) provided anonymity that may be important for members of a marginalised community and could encourage participants to share sensitive experiences or controversial opinions; (2) facilitated the recruitment of participants with varying identities, experiences and cultural and socioeconomic backgrounds; and (3) enabled us to engage a large sample (relative to conducting interviews).

The survey questions were piloted with a total of 13 TGD individuals. Questions were refined over three rounds of piloting, with new participants in increasingly larger samples for each round. Piloting ended when participant responses indicated that the questions were being understood as intended.

Upon receiving University ethics approval, participants were recruited online through the social media website Reddit between August and October 2023. Participants were eligible if they were TGD, aged 18 and above, and fluent in English. Participants could choose to enter a prize draw for one of six AUD$60 gift cards.

Participants read the plain language statement, confirmed eligibility, provided consent and completed demographic information. Directly above the survey questions we introduced the term ‘social messages’ to describe beliefs and attitudes that exist in society, then gave two examples of social messages about gender (e.g., ‘your gender is determined by your biology’) and suggested various ways people can be exposed to these messages (e.g., media, politics, family). Participants were asked to consider how social messages about TGD people and gender have impacted them and how people interacted with them across their life. Participants were then instructed to answer five questions (one corresponding to each of the core emotional needs; see Table 2). Question order was randomised to prevent question‐order bias and the final questions being repeatedly overlooked.

TABLE 2.

Survey questions about core emotional needs and social messages.

Need	Question
Secure attachments	How have social messages impacted the way that people close to you nurtured you and kept you safe? By close people we mean parent(s), partner(s) or best friends
Autonomy, competence and sense of identity	How has the extent to which you see yourself as an independent, competent and capable person been affected by social messages about gender or TGD people?
Freedom to express valid needs and emotions	Has your ability to freely express your needs, opinions and emotions been affected by social messages about gender or TGD people? Please describe your experiences
Realistic limits and self‐control	Have social messages about gender or TGD people shaped how you are expected to behave or manage your emotions? Please describe your experiences
Spontaneity and play	Have social messages about TGD people made it feel you must achieve high standards, or are unable to be playful or carefree? Please describe your experiences

From the 265 people who opened the plain language statement, 228 completed the demographic questions. Multiple strategies were employed to protect the quality of the data, including preventing respondents from making multiple submissions, assessing metadata to identify fraudulent respondents (Qualtrics' RelevantID), examining open text content and completion times, reCAPTCHA verifications, and a ‘honeypot’ question only visible to bots (Xu et al., 2022). Bot‐like responses and responses where most answers were shorter than a sentence (suggesting insufficient engagement) were removed (n = 127), leaving a final sample of 101. Median completion time was 33 min.

Analytic approach

Data were analysed using template thematic analysis (Brooks et al., 2015; King, 2004), with an emergent coding template used to identify, analyse and interpret patterns in the data. Following this approach, the analysis combined both deductive and inductive inquiry: it was primarily open‐ended with no a priori themes, allowing patterns to be generated from the data. However, where the researchers identified alignment with existing theories explaining the social world, they explored how these concepts might apply to the identified patterns. Template thematic analysis employs a coding framework that guides the analysis: developed early in the analysis, the template contains initial codes and patterns that is then continuously refined, expanded and adjusted as the analysis proceeds. Coding was completed using NVivo.

The analysis followed the six‐step process described by Brooks et al. (2015). (1) GR familiarised themselves with the data by reading the responses. (2) GR did a preliminary coding of the dataset. (3) GR organised these preliminary codes into clusters using a mindmap, which were then discussed among the research team alongside illustrative quotes. (4) GR developed a coding template. (5) GR re‐coded the data using the template, organised the codes into clusters using a mindmap, presented and discussed the developing patterns with the research team and then modified the template to better capture all sections of the data that were relevant to the research question. The data was re‐coded four times, with each iteration involving team discussions and refinements to the template and discussions of the boundaries between the clusters/early themes (6) a final code was performed with the template, and then the researchers reviewed and discussed the coded text to finalise the themes and subthemes.

ANALYSIS

Shown in Table 3, we identified four themes that capture the ways TGD individuals felt their core emotional needs were influenced by cisnormativity and the associated anti‐trans stigmatisation and marginalisation. Different needs were more commonly associated with different themes.

TABLE 3.

Themes, subthemes and commonly associated needs.

Theme	Subthemes	Dominant need/s
Losing security in close relationships: rejection, shame and concealment	Rejection	Secure attachment
	Identity concealment
	Shame
	Protection and acceptance
Representation and reputation	Being a perfect trans person	Spontaneity and play; Freedom to express valid needs and emotions; Realistic limits and self‐control
	Reputational damage
(Dis)empowered: cisnormativity as instilling strength and doubt	The two sides of independence	Autonomy, competence and sense of identity
	Doubt and incompetence
	Intersecting identities
Suppressing and performing gender	Suppression and stereotype threat	Spontaneity and play; Freedom to express valid needs and emotions; Realistic limits and self‐control
	Performing gender

Theme 1: Losing security in close relationships: Rejection, shame and concealment

This theme reports on how TGD people feel their close relationships have been impacted by the presence of anti‐trans ideology in their ecological system. Three subthemes report on the types of behaviours that led to relationship ruptures: being rejecting, encouraging identity concealment and casting shame. These various experiences frustrated the need for secure attachments, as this behaviour meant TGD individuals no longer felt safe, stable, accepted or respected in their close relationships (Young et al., 2003). The fourth subtheme highlights how the need for secure attachments was fulfilled when close others overcame their exposure to negative narratives and protected and accepted the individual.

Rejection

Several participants reported being disowned, experiencing conversion practices or having relationships soured because of anti‐trans messaging their family and friends had heard. Some are presented below:

My parents disowned me for being trans. This is directly because of the current antagonism towards trans people across the media in the UK. (22 yo, UK, Woman)

My mother chooses to believe the constant flood of messaging about ‘detransitioners’, ‘ROGD’ [rapid onset gender dysphoria] etc. over my explanations. She would rather throw me under the bus than experience any stigma herself, worrying that people will judge her for her ‘freak’ ‘nutter’ child, or perceive any support she shows as ‘following a trend’. She sees herself as a trans ally, but her constant undermining is the main reason we do not speak. (20 yo, Australia, Transmasc)

To my face my parent is accepting, but behind my back the opposite– condescending, naïve/ignorant, and upsetting. I find it hard to deal with because … their views on queerness have been completely marred by social messages so they almost see us as the butt of a joke rather than real people. (32 yo, UK, Enby, transmasc, genderfluid, genderqueer)

The ability of these caregivers to be supportive and accepting of the participant was impacted by their exposure to wider societal narratives that frame TGD people as ‘freaks’, something to be joked about, or as part of a moral panic (see Slothouber, 2020). Experiences like being disowned and having caregivers prioritise anti‐trans rhetoric likely fostered feelings of rejection and abandonment, frustrating the need for secure attachments. This need was likely further frustrated when participants experienced being ‘thrown under the bus’ by the parents speaking negatively about TGD identities behind their backs, perhaps to avoid vicarious stigma in their own ecological systems. The extracts above demonstrate how cisnormative beliefs in the wider ecological system shaped microlevel interactions and disrupted the meeting of needs for TGD individuals.

Identity concealment

Many TGD people must choose between experiencing the abuse and rejection described above or facing the negative psychological impacts of hiding their identity (Flynn & Smith, 2021). Both options mean individuals feel unsafe and insecure in their close relationships. They may learn that love and acceptance are conditional on being perceived as cisgender and heterosexual. Participants reported hearing people talking negatively about TGD people, which made them feel like they needed to conceal their gender identity or history to avoid experiencing negative outcomes:

The social messages I received from family (parents/siblings) regarding people who broke with gender expectations, queer people and trans people were in general quite negative and kept me in the closet for a long time. (27 yo, Norway, Genderqueer/non‐binary trans man)

I was raised by parents with casually homophobic and transphobic views that led me to hide the non‐conforming parts of myself until it became a habit, resulting in lots of anxiety and eventually severe depression that I have dealt with most of my life. (29 yo, Canada, Trans woman)

I feel as though that I have to hide the fact that I am transgender when I'm in public. […] I am exposed to unfiltered opinions and commentary from others about people like me. I never feel brave enough to tell people that I'm not actually a cis woman because I worry constantly about being judged differently or hated. (26 yo, Australia, Woman)

These participants described how hearing anti‐trans rhetoric impacted their sense of safety and security with close others and meant they monitored and modified their self‐expression to prevent experiencing potential harm and rejection. When close others endorsed and vocalised transphobic views, it frustrated the individual's needs for secure attachments, and the concealment also frustrated the needs for spontaneity and play and to freely express valid needs and emotions.

In addition, some participants' parents encouraged them to conceal their trans identities because of their exposure to narratives where TGD people are ‘crazy’ or ‘confused’. The caregivers likely thought they were helping the participant, but ignored the harm of not affirming their identity. The lack of attunement in these relationships was described as frustrating the need for safe, secure, nurturing attachments:

My relationship with my parents is more strained as a result of my being trans. This is very painful to me because we were always close before I came out and announced my intentions to pursue aspects of physical transition. I believe they think they are protecting me by asking me not to change my name or transition. They think I am confused or rushing into things, which is a very mainstream narrative around trans people, especially transmasculine people. But this has only made me feel more unsafe with them. (28 yo, Australia, Trans)

[My parents] have changed from being nurturing and keeping me safe in recent years, towards a more negative type of safety where they are trying to make me conform to binary ideas about sex and gender because they think this is better than being ‘crazy’. They believe this is the way to nurture me by forcing me to submit to a binary idea of femininity. (32 yo, Australia, Transmasculine, non‐binary, and gender diverse)

[My] parents have become more worried about my general wellbeing and safety. They have subtly encouraged me to detransition/be as gender conformant as possible as they worry the discrimination I will face will cause me to self‐harm or attempt suicide. I have explained I am much more likely to do such things if I were to stop taking HRT [hormone replacement therapy] and live as my AGAB [assumed gender at birth] at all times, but it does not seem to be heard. (29 yo, Australia, Trans woman)

Shame

A further way close relationships were ruptured was through humiliation and shaming. Some participants recalled being shamed for displays of gender non‐conformity, damaging their sense of safety and security with their caregivers:

I feel like growing up as an effeminate boy who wanted to be a girl gave the people close to me the impression that I should be precluded from nurturing or safety so that I could ‘toughen up’, due to messages about trans feminine behaviour being deviant and undesirable. (29 yo, Australia, Trans woman)

I was violently shamed when I presented myself as a 4‐year‐old to my dad wearing panties and proud of my acquisition from the laundry basket (my sister's). I was told if I wanted to dress in girl's clothes I would be put on the front step and all the neighbours would see– with the implication of course that this would be a humiliation and to be avoided at all costs. (72 yo, USA, Bigender)

I was told by my parents that I mustn't be a ‘sissy’, I was called a ‘big girl's blouse’ and I was taught about ‘tranvestites’ who were ‘weird’. On several occasions, my mum talked with me about transvestites. With hindsight, she must have realised that I had been wearing her clothes, hence the chats. […] Of course, all this meant that I hid. I didn't tell a soul about my feelings. (46 yo, UK, Female)

These participants learnt that deviating from gendered expectations resulted in punishment and exclusion from their family, but also society. They learnt that being themselves would jeopardise their safety and security in relationships, and that displaying femininity as a ‘boy’ would make you defective, socially isolated and deprived of emotional support. The enforcement of cisnormativity and strict gender norms on TGD people interferes with their ability to feel safe, accepted and respected by family and society more broadly.

Protection and acceptance

While the three subthemes above capture the ways in which cisnormative messages ruptured close relationships, participants also described how close others increased their support and care because they knew how anti‐trans narratives may be damaging to TGD individuals. Participants reported that their need for safety and security with close others was strengthened when friends and family dismissed transphobic narratives and provided support:

The constant barrage of hate on social media/news has actually made them [my friends] closer to me and more protective. (28 yo, USA, Trans woman)

I'm lucky to be surrounded by loving, open‐minded people who dismissed everything they thought they knew about trans people when I came out. (20 yo, Australia, trans man, transmasculine)

People close to me know the rhetoric in the media is nonsense. They try to help me get through it by chatting to me. (20 yo, Australia, transgender man)

Many long‐term friends have stepped up since my transition. I feel that they are much more protective of me now. […] They have stepped in when I have experienced transphobia and have called people out or even threatened them. (39 yo, Germany, binary trans man)

Participants also noted how shifts in representation about TGD people likely improved their coming out experiences. Greater access to positive representation meant friends and family could understand and support the participant. The increasing presence of positive messages and accurate resources about TGD identities meant friends and family were more accepting when the participant came out:

When I eventually came out to my parents as an adult, they quickly sought out and shared resources on parents of trans people with one another, providing me nothing but love, acceptance, understanding and assistance along the way. However, they have confided in me that if I had come out [earlier] they likely would have had significant trouble understanding and accepting me as who I was, not due to outright hatred but rather a complete lack of knowledge on trans people, other than as the subject of bad sitcom jokes and featured in ‘exotic’ pornography. (20 yo, Australia, Female)

I think if I had come out 10 years earlier, when social messaging about being trans was quite different, [my friends'] reactions wouldn't have been the same at all. The positive social messages around being trans have definitely improved my friendships. (39 yo, Germany, Binary trans man)

These positive experiences demonstrate that TGD people can have secure, attuned and supportive relationships with friends and family, despite the presence of anti‐trans narratives in society. Such relationships are known to improve the mental health outcomes of TGD individuals (Puckett et al., 2019). Shifting the tone of how TGD individuals are viewed through accurate resources and positive media representation can support close others to have nurturing relationships with TGD individuals, thereby meeting their need for secure attachments.

Theme 1 Conclusion

The theme describes the various ways cisnormative narratives impacted TGD people's close relationships and ultimately their need for secure attachments. Anti‐trans narratives in the broader culture impacted how important figures in the microsystem felt about TGD identities, which then impacted their ability to be responsive to the needs of the TGD individual, resulting in feelings of rejection, humiliation, fear and concealment. Such actions teach TGD individuals that they are not safe or supported in their close relationships or the broader society, frustrating the need for secure attachments. Those who concealed their identity to avoid rejection and abuse additionally experienced the frustration of the needs to freely express valid needs and emotions and for spontaneity and play. Conversely, these needs were strengthened when friends and family promoted affirmative narratives and supported the individual in their identity.

Theme 2: Representation and reputation

This theme describes the awareness many participants had about how they believed TGD people were viewed by the wider society, and the actions they took to try and improve this image. For some, this meant working hard to present as a ‘perfect human’, even if it meant foregoing their own wants and needs. A small number felt TGD people were being misrepresented by others within the community, and as such felt inhibited and restrained in their self‐expression. The two facets of this theme illustrate how TGD people's awareness of social messages impacted their ability to freely express their needs and emotions, be spontaneous and playful, and experience realistic limits on their behaviour.

Being a perfect trans person

Many participants described feeling a pressure to be seen as a ‘perfect trans person’ to offset negative stereotypes and prevent their behaviour being used against the TGD community. This pressure can mean people forfeit their own needs and wants, exert high levels of self‐control and hold high standards for themselves in various life domains. As such, this theme was identified most frequently in response to questions focusing on the needs for spontaneity and play, experiencing realistic limits, and to freely express valid needs and emotions. The following extracts present the ways participants felt these needs were disrupted:

There is a lot of negative propaganda regarding trans people, particularly when political agendas are involved. This has made me feel as though I need to be a shining, upstanding example of the community that I now represent. (41 yo, Australia, Female)

TGD people are usually not shown as high achievers or even just regular people in media. I feel that I have to reach the metaphorical top of life to prove others wrong and show that TGD people are just like anyone else and able to achieve the same things. (20 yo, Denmark, Woman)

The social messages put extra pressure on me to be a perfect human since any ‘negative’ behaviour would look bad on my community. (18 yo, trans, Australia)

I feel the pressure to be the ‘perfect trans person’. I feel as though any misstep on my behalf will reflect badly on the whole community, and possibly make people think badly of trans people in the future. (38 yo, Australia, Transmasculine non‐binary)

At the same time, this pressure created shame for those who felt their behaviour or experiences confirmed negative stereotypes, or did not meet high standards and could be used against the community. Participants described this as impacting their need for spontaneity and play:

I feel ashamed because I fit in the category of ‘childhood trauma’ as if that devalues every trans person (despite there being so many who had happy childhoods). (36 yo, Belgium, Binary trans man)

I feel like I am not allowed to actually be myself. I am not a good enough model of behaviour to be visible as a gender‐divergent person. (28 yo, USA, Closeted part‐time transfeminine person)

This subtheme captures the pressure of feeling you are a community representative, and fears about tarnishing the image of TGD people because of your experiences or behaviours. This resulted in TGD people monitoring and modifying their behaviours, and therefore not being able to fulfil the needs for spontaneity and play, experiencing realistic limits and freely expressing valid needs.

Reputational damage

A small minority of participants felt that their needs were impacted by messages originating from within the TGD community. These individuals felt that TGD representation from people they believed were ‘false’ trans people made it harder for them to have their needs met as ‘actual’ trans people. Their perspectives echo transnormative ideologies (Bradford & Syed, 2019; Johnson, 2015), where valid trans identities are those that conform to the gender binary, stereotypical gender norms and a medicalised model of transness (see also transmedicalism; Konnelly, 2021; Sutherland, 2023). Transnormativity prioritises trans identities that align with cisnormative ideals, and as evidenced by the following quotes, invalidates those that do not. The extracts below communicate the frustration and anger these participants felt in not being able to express themselves freely for fear of being associated with ‘false’ TGD people:

We are seen as jokes by most people now due to non‐dysphoric cis people* talking over actual trans people. I feel like I can't give my opinions or feelings on this topic without being seen as a horrible person, but this is an awful condition that I didn't choose to have—it's unfair that I'm being pushed back into the closet by what's considered ‘my community’ now. I used to be fine with the idea of being ‘out’, now I just mostly want to be stealth and left alone. My condition isn't political; it's something I was born with. I didn't ask to be seen as a zoo animal by the masses to debate over. (23 yo, USA, Female to male)

*This participant is likely referring to TGD people who do not experience gender dysphoria.

I am hesitant to reveal I am transgender due to the stereotypes surrounding it. […] As I move forward in my transition, my opinions have become more spiteful towards false ‘trans’ people who I feel are ruining the reputation of true transsexuals. (18 yo, USA, Male)

I can barely express myself as I am treated like a novelty. Unlike many, this isn't new to me. We need to stop encouraging transition without dysphoria, non‐binary trans masc who are literally teenage girls, and anyone else who causes us not to be taken seriously. (36 yo, Australia, Transgender)

The frustration of not being able to freely express oneself was directed towards those who were ‘ruining the reputation’ of TGD people by not meeting transnormative expectations. Transnormativity can create an illusion of safety for TGD people because it seeks to align trans experiences with the hegemonic cisnormative view of gender, making it easier to be tolerated by mainstream society (Colliver, 2021). These participants may have seen their safety as being threatened if they felt the group boundary of ‘trans’ was shifting and expanding to include those who challenge cisnormativity and ‘cause [TGD people] not to be taken seriously’. Here, the frustration of the need to freely express valid needs and emotions was frustrated in an attempt to protect their need for safety and security.

Theme 2 Conclusion

Together, these two subthemes demonstrate different ways TGD individuals are working to manage the reputation of their community in the face of negative social narratives. For many, this meant acting as a ‘shining, upstanding example’ of a TGD person, or feeling shame at not being able to meet this perceived expectation. A small number felt negative messages from other TGD people were harming the community's image, and modified and restricted their own behaviours to distance themselves from these unwanted narratives. Overall, this theme demonstrates how TGD people's awareness of sociocultural narratives about their community impacts their needs to freely express themselves, be spontaneous and playful and experience realistic limits.

Theme 3: (Dis)empowered: Cisnormativity as instilling strength and doubt

This theme explores the positive and negative impacts of social narratives on TGD people's sense of capability, independence and confidence. Two subthemes capture the tension that exists between needing to be strong and independent to resist anti‐trans attitudes and actions, while also recognising that being exposed to these attitudes at various levels of their ecological system can cast doubt in people's minds about their abilities and identities. The third recognises how ableism intersects with cisnormative narratives to create additional barriers to the need for autonomy among TGD individuals.

The two sides of independence

Schema therapy suggests that the need for autonomy, competence and a sense of identity is met when people are supported to complete age‐appropriate tasks, enabling them to function independently when appropriate (Young et al., 2003). The positive tone in the following extracts suggests that these participants were supported and had the skills to combat the challenges presented to them. As a result, they felt strong and competent in knowing they were overcoming the challenge of being TGD in a cisnormative society:

Most of the social messages about gender that I have heard have been about how it is hard to be transgender. Because of this, I think that by undertaking transition I have felt independent, competent and capable. (23 yo, Australia, Transfemme non‐binary)

In some ways, negative social messages about T&GD people are the reason I see myself as an independent, competent, capable person. With all the sh*t we have to put up with, and STILL be surviving and thriving is exactly what makes me feel this strength. (38 yo, Australia, Transmasculine non‐binary)

Other participants did not have adequate supports and needed to become independent to survive. This demonstrates how the frustration of one need (e.g., for secure attachment) can have repercussions with other needs (here, autonomy). This may be more likely among TGD people, where cisnormativity places them at increased risk of experiencing rejection and social isolation (Fuller & Riggs, 2018). A protective mechanism to cope with rejection and isolation can be hyper‐independence. Independence is often viewed positively in Western societies, but when done out of necessity, this excessive self‐reliance can create issues with trust, perfectionism and forming and maintaining relationships. Participants describe this self‐reliance forming in response to a lack of support:

I actually feel more independent. My family disowned me after I came out because they were brainwashed into thinking I am evil. This has meant I have had to fend for myself more, and therefore have become more independent. (22 yo, UK, Woman)

I feel more independent because I feel like I would have to do everything on my own. (18 yo, Austria, Non‐binary transmasc)

I see myself as a very independent person as I feel like I'm going through this journey alone. While I think it's good that I can consider myself extensively independent, because of how isolated I feel I get depressed quite quickly. This is because I feel like I can't depend on people to help me, yet I also feel like I'm not capable enough for this. (18 yo, Australia, Transmasc genderfluid)

These participants highlighted feeling more independent because of isolation, not because they have been adequately supported and scaffolded. The final extract captures the bind of not having others to depend on, but also feeling that they have not yet developed the skills to be fully independent. Despite feeling independent, without appropriate scaffolding it can be challenging to develop a sense of competency in managing age‐appropriate tasks, frustrating the need for autonomy.

Doubt and incompetence

In contrast to those who felt empowered by knowing they were surviving despite the presence of anti‐trans narratives, some participants described internalising transphobic narratives that paint TGD people as mentally ill, confused or having been brainwashed into being trans. These messages undermined the participants' knowledge of their identities and capabilities, frustrating the need for autonomy:

Sometimes negative attitudes towards TGD people left me wondering if I am right about who I am, if I am really the insane and brainwashed one. At these moments I felt incapable of being able to say who I actually am. (19 yo, Russia, Non‐binary)

[Social messages] give me doubt that I am not capable, that I am insane or mentally ill. Surrounding myself with other queer/trans people helps a lot, but that little voice of doubt is hard to shut up at times. (36 yo, Belgium, Binary trans man)

Additionally, TGD people's knowledge of their identities and abilities can also be disempowered by the institutions that determine who access medical and legal affirmation. Needing to ‘prove’ one's TGD identity to a professional reinforces ideas that TGD people may be confused about themselves and need a professional to authorise their decision making (cf informed consent models, self‐identification laws; Jacobsen, 2024). Participants described the impact of this disempowerment on their sense of autonomy:

I feel I am expected to defer to cis people, doctors, everyone who is positioned as knowing more about myself than I do, and it has been hard not to internalise. (29 yo, Australia, Trans woman)

I have had increased personal doubt about transitioning because of anti‐trans social messaging. These messages sometimes lead me to feel that I am not able to make my own decisions, despite being an adult who has lived independently for 8 years with nearly no oversight from a ‘real’ adult. (26 yo, Australia, Transmasc)

Intersecting identities

Some participants described how being Autistic or disabled compounded with anti‐trans stigma, frustrating their need for autonomy. Problematic narratives can frame gender as being too complex for TGD Autistic and disabled people to comprehend, a standard not applied to their cisgender peers (Neumeier, 2021). This assumption interferes with families, carers and professionals supporting them to make autonomous decisions about their gender and how they wish to affirm it (Strauss et al., 2021). Autistic participants describe being impacted by transphobic and ableist arguments used to discredit both aspects of their identities:

My autism makes people assume I am too naïve or stupid to know my own gender. (20 yo, Australia, Trans man, transmasculine)

I have to be cautious about revealing that I am both autistic and transgender, due to the stereotypes about both communities, and cruel theories about the connection between these identities, such as autistic people ‘being easily manipulated into being trans’. (20 yo, Australia, Transmasc)

Another participant who identifies as disabled stated how the health care system denied their autonomy and how they felt ‘under constant pressure to defend myself and having to prove competence’. They described a sense of struggling to feel independent and competent in areas related to disability, but this being conflated with their ability to understand and make decisions about their gender. Cruel assumptions about Autistic and disabled people's capabilities are often used to undermine their knowledge of who they are and ability to make autonomous decisions.

Theme 3 Conclusion

While some participants reflected on anti‐trans narratives as reminding them of their strength and resilience, for others these narratives forced them to become hyper‐independent, doubtful of their gender or feeling as if they should be deferring to others for gender‐related decisions. Those additionally impacted by ableist assumptions felt that their competence and knowledge of their gender were questioned or debatable. Overall, this theme communicates how cisnormative narratives interfere with TGD people's need for autonomy, competence and their sense of identity.

Theme 4: Suppressing and performing gender

This theme explores the way cisnormativity made TGD people feel that they could not freely express themselves. The two subthemes report on the ways participants tried to gain acceptance and avoid harm by (1) self‐censoring their emotions and opinions and (2) performing gender and transness in specific ways. This monitoring and modifying of behaviour was viewed as an attempt to gain (conditional) acceptance, thereby supporting the need for secure attachment. However, this theme illustrates that the cost of this conditional acceptance is the frustration of the needs to freely express valid needs and emotions, for spontaneity and play, and to experience realistic limits and self‐control.

Suppression and stereotype threat

Participants described self‐censoring their emotions, opinions and behaviours because of stereotype threat (Steele & Aronson, 1995), where there is a fear about confirming negative stereotypes about one's minority group. This subtheme reports on participants' self‐suppression in response to various stereotypes about TGD people being unstable social justice warriors, predators or angry. This self‐suppression was reported to frustrate the needs for spontaneity and play, to freely express valid needs and emotions, and experience realistic limits and self‐control. The frustration of all three needs likely reflects each of these needs constructs containing an aspect of needing to monitor and suppress oneself to align with external (or internalised) expectations.

First, participants reported being conflict avoidant and not expressing their opinions or emotions because of beliefs that TGD people are ‘easily triggered’ or ‘crazy’:

When a transgender person stands up for themselves, they are thought to be unstable. It pretty much teaches me to never stand up for myself, to let people misgender me and ridicule me if I want to have a chance at being taken seriously. (36 yo, Belgium Binary trans man)

I feel like I'm supposed to be stoic all the time […] because if I don't I play into the ‘trans people are all crazy’ myth. (38 yo, Australia, Trans man)

I was in a class once that was debating the validity of rapid onset gender dysphoria, and I had a very hard time hiding how I felt. I had to pretend to agree with some of the points they made against my existence just so that I did not sound like an irrational trans person who freaks out and has a meltdown over something. I regret some things I said in that class to this day. […] But I was weak and afraid of being a crazy social justice warrior trans stereotype. (24 yo, USA, Trans man, male)

Next, TGD adults working with children expressed concerns that their behaviour might be misinterpreted due to the moral panic portraying TGD individuals as predators or groomers. In particular, the second respondent describes being hypervigilant and suppressing any behaviours that could be misinterpreted as ‘indoctrination’.

I work in childcare and worry people will think I am a predator for my love of children. (20 yo, Australia, Trans man)

I worry that showing support to trans students will be seen as indoctrination or predation. Multiple queer students have become attached to me over the years as an out educator, and I am terrified one of their parents will accuse me of being inappropriate with them for doing things like using their chosen name/pronouns or providing a listening ear. I very much feel unable to be carefree due to the social messages around trans adults and children. My cis coworkers joke around with students far more than I do because I am always scared that if I make a joke, it will be used as proof I am unfit to be around children. (28 yo, Australia, Trans)

Finally, many participants—especially trans women and femmes—talked about suppressing their emotions and exerting high levels of self‐control to protect themselves against the potential negative outcomes of being painted as an ‘angry man’. The extracts below show how they self‐censored their emotions to avoid confirming negative stereotypes about transfeminine people:

I am scared of being perceived as an angry man if I get angry, and perceived as hysterical if I get sad. Make no mistake, my emotions still flow more freely than before; I just think a whole lot more about what I express. (23 yo, Denmark, Trans woman)

I feel like I have to repress anger and be polite and passive to mistreatment to avoid scrutiny and not be perceived as a man. I feel repressed and worthless. (23 yo, Australia, Trans woman)

I think as a trans woman that I am not allowed to show emotions like anger or desire lest I'm accused of adopting male behaviour, but I also don't think I am afforded the kind of ability to show sadness and doubt so have to just try not to feel much of any emotion. (29 yo, Australia, Trans woman)

Taken together, the extracts in this subtheme illustrate the high levels of hypervigilance and self‐censorship TGD people are using to prevent their behaviours confirming negative stereotypes used against the TGD community. Participants felt unable to stand up for themselves, express emotionality or work closely with children to ‘avoid scrutiny’. This suppression comes at the cost of frustrating the needs to be spontaneous and carefree, freely express valid needs and emotions, or experience realistic limits on one's behaviour.

Performing gender

Alongside feeling a pressure to suppress behaviours associated with negative stereotypes, participants also felt a pressure to perform gender and transness in specific ways. Many binary trans people described expectations to pass/blend and be ‘gorgeous’, otherwise their identities could be invalidated. Passing/blending is important to many trans people (especially those at risk of marginalisation); however, it should not be an expectation or requirement for a person's gender to be affirmed. Participants described societal acceptance as being conditional on meeting specific standards in appearance:

I don't like how we have to flawlessly pass and be drop dead gorgeous to be accepted as ‘real’ men or women. And if you don't pass then you are a delusional little girl playing dress up in daddy's clothes or a hulking predatory man in a dress trespassing into women's spaces. (20 yo, Australia, Trans man, transmasculine)

I feel like I have to be performatively hyperfeminine all the time to be taken seriously as a woman. (21 yo, Australia, Woman)

As a passing trans woman, I feel like the standards for my womanhood tend to be much more rigid and harsh than they are for cis women, and I glean from various conversations that I have been used as the ‘model’ trans woman to belittle non‐passing trans women. (34 yo, USA, Woman)

In addition to feeling pressures around passing/blending, many trans women felt there were limited ways in which they could perform gender without being invalidated or mocked, and this resulted in feeling as if they had to ‘walk a tightrope’ in displaying the appropriate level of femininity:

If I don't live up to standards of cis women, my identity will be invalidated. On the other hand, I can't overdo it since I will then be deemed to be performing a caricature of women. (20 yo, Denmark, Woman)

I feel like if I don't pass perfectly then I am seen as just a false mimicry of a woman that is making a mockery and not putting in real effort, but if I don't pass effortlessly or put too much effort in then I am seen as trying to parody femininity or believing womanhood is all about aesthetics or even accused of having a fetish for dressing as a woman. (29 yo, Australia, Trans woman)

If I am too masculine or queerly feminine I feel like I will get misread as the wrong gender. If I am not attractive or passing enough I will get push back. However if I lean too heavily into femininity I will be berated. (34 yo, USA, Woman)

Some reported experiencing or fearing the invalidation of their identity because their experiences of gender expression did not align with transnormative narratives or stereotypical representations of trans identities, impacting the need to freely express valid needs, emotions and opinions:

[My parents] said to me ‘You're not trans; you can't even cut your hair short’. That's when I decided to be more strict with my presentation, as I didn't want people to assume that I was comfortable with my gender. I shaved my hair off despite being deeply attached to my long hair; I refused to wear skirts to my private school; and I tried hiding my chest with sport bras. (20 yo, Canada, transgender (FTM))

I feel like I can't dress like my AGAB [assumed gender at birth] because I'm genderfluid. I'm worried it would influence people to look past my identity and invalidate it. I feel like if I don't look more masculine all the time, then I'm not being nonbinary correctly. (19 yo, USA, Genderfluid/gender non‐conforming)

For the longest time I didn't buy myself a binder and still wore ‘women's’ clothing because the typical image of a trans guy I saw online was of these punkish very young looking guys with piercings who were on tumblr all day and I did not see myself in them at all. (21 yo, Germany, Trans man)

These extracts capture how cis‐ and transnormative narratives create unrealistic expectations for how TGD people should look and behave, and how not meeting these expectations could result in identity invalidation. They described performing gender and transness in specific ways to create conditional acceptance; however, this hypervigilance and the modification of their expression impacted the needs for realistic limits and self‐control, spontaneity and play, and to freely express valid needs, opinions and emotions.

Theme 4 Conclusion

This theme highlights how cisnormative narratives constrained participants' ability to express themselves authentically. Participants suppressed behaviours that could mean they were aligning with stereotypes painting TGD people as predatory, angry or easily triggered, and additionally worked to perform gender and transness in certain ways to prevent mockery and the invalidation of their identity. Experiences of both suppression and performance in this theme arise with TGD people seeking (conditional) acceptance in society: these behaviours support them wanting to meet the need for secure attachment. However, this disrupted participants' ability to freely express valid needs and emotions, engage in spontaneity and play and experience realistic limits. These pressures were felt across multiple contexts, including workplaces, family dynamics, schools and peer relationships.

DISCUSSION

This research found that for TGD people the meeting of core emotional needs, as outlined within the schema therapy model, is greatly influenced by manifestations of cisnormativity. First, exposure to anti‐trans narratives shaped the ability of friends and family to be supportive, safe and accepting of the participant. Descriptions of TGD people being rejected, shamed and encouraged to conceal their identity demonstrated how such narratives led to the frustration of the need for secure attachments. Alternatively, some felt this need was met when friends and family were supportive of their TGD identity, despite exposure to transphobic rhetoric. Second, TGD people reported feeling a pressure to be a perfect representative of the TGD community, and sacrificing self‐expression and happiness to meet high standards in behaviour and performance. Others did not want to be aligned with ‘false’ TGD people they believe misrepresent the community, and similarly modified their behaviour to distance themselves from this perceived misrepresentation. This altering of behaviour to cultivate a certain reputation or image interfered with the needs to freely express valid needs and emotions, be spontaneous and playful and experience realistic limits. Next, cisnormative narratives created additional barriers for TGD people that left them feeling incompetent or doubtful and needing to become hyper‐independent to survive. This frustrated the need for autonomy, competence and a sense of identity. Autistic and disabled TGD people felt ableist assumptions further compounded this sense of incompetence and doubt. However, some felt this need was fulfilled because of the strength they felt in overcoming societal challenges. Finally, TGD people attempted to avoid mockery and invalidation by (1) suppressing their emotions, opinions and behaviours to avoid confirming negative stereotypes and (2) performing their gender and transness in specific ways that align with gender norms and transnormative narratives. This monitoring and modifying of behaviour was an attempt to maintain secure attachments with others and the world, but ultimately frustrated the needs to freely express valid needs and emotions, be spontaneous and playful and experience realistic limits. Overall, these findings demonstrate that cisnormativity is detrimental to the meeting of TGD people's core emotional needs.

This research positioned the meeting of needs as outlined within the schema therapy model within an ecological systems perspective. In doing so, we reported how TGD people's needs are shaped by manifestations of cisnormativity from the macro to individual levels. This included feeling constrained by the gender binary, patronised by medical institutions, suppressed and hypervigilant in education and work settings, rejected by caregivers, and internalising dehumanising and disempowering messages. Our findings sit alongside a growing body of research highlighting how the individual experiences of TGD people must be contextualised within their sociocultural context (Puckett et al., 2022; White Hughto et al., 2015). For example, Katz‐Wise et al. (2022) illustrated how the experiences of TGD youth are shaped by individual, family, community and societal factors. By additionally considering how an ecological systems lens can be applied within the schema therapy model, our findings provide two important implications for the schema therapy model to expand its understanding of needs frustration. First, we highlighted how microlevel interactions do not exist in a vacuum: the way a caregiver meets the needs of their child is shaped by the broader societal context. In a cisnormative society this can result in caregivers failing to meet needs for TGD individuals. For example, a child's needs can be unmet when they feel ashamed and rejected by their parent for displays of gender non‐conformity, which arises because the parent is exposed to narratives that frame TGD people as abnormal from their friends, family, media, religious community and government policies. Second, TGD people's needs can be met and frustrated by sources at all levels of their social ecology, not just their close relationships. For example, TGD people felt hypervigilant and suppressed because of moral panics framing TGD people as predators, and lacking autonomy when professional assessments are required to access affirmative health care. The potential for needs to be frustrated across multiple levels of the ecological system may be particularly relevant for minority groups whose identities can be disparaged and devalued by society, which appears to have downstream effects on the meeting of core emotional needs.

The schema literature typically describes the frustration of the need for realistic limits and self‐control as experiencing insufficient boundaries and expectations around behaviour, leading to a failure to develop appropriate self‐discipline and consideration for others (Young et al., 2003). In this study, participants related strongly to the opposing idea of experiencing excessive limitations, rigid expectations and needing to exert high levels of self‐control. This may reflect the question wording, but it is also probable that the original description of this need is not applicable in understanding the impacts of cisnormativity on TGD people. Other needs, like autonomy, can be frustrated bidirectionally when there is too much or too little scaffolding around independence (Young et al., 2003); however, it is unclear if this similarly applies to the realistic limits need. If the need for realistic limits can be frustrated bidirectionally, it is unclear how the experiences described in response to this need differ from the descriptions of extreme monitoring and suppression of behaviour provided in response to the needs for spontaneity and play and the freedom to express valid needs, opinions and emotions. Indeed, participants described the same experiences of hypervigilance and suppression as frustrating these three needs, which reflects broader questions about the orthogonality of the five core emotional needs.

There is limited research into the core emotional needs (Pilkington et al., 2023); however, recent analyses have proposed four core emotional needs, with the needs for spontaneity and play and the freedom to express valid needs and emotions largely collapsed into a unitary need (termed excessive responsibility and standards; Bach et al., 2018; Louis et al., 2020). More recently, the integration of aspects of Dweck's (2017) theory of needs within schema therapy (Arntz et al., 2021) highlights that at its foundation, basic human needs may be as few as three needs (i.e., acceptance, competence and optimal predictability), with other more complex needs emerging as a function of development. Thus, our findings may point to the existence of fewer needs than first espoused with the schema therapy model. However, highlighting how our findings do not quite map onto all five core emotional needs is not with the intention of seeking to redefine these existing needs. But our findings provide important initial empirical insights that may speak to possibly revisiting the needs that underpin the model in the future, or at the very least, to encourage further empirical work into this aspect of the schema therapy model.

Although the overall findings of our study are consistent with research into the negative effects of TGD marginalisation, such as research on minority stress theory, focusing on core emotional needs from a schema therapy perspective provides a new lens to understand the influence of cisnormativity on TGD individuals. Many of the reported experiences relating to the need for secure attachment, like experiencing rejection, non‐acceptance of identity and being made to feel shameful, are consistent with experiences of interpersonal difficulties described in existing literature and frameworks of TGD mental health (Testa et al., 2015). However, by examining the spectrum of core emotional needs, we identified additional ways that TGD people are impacted by cisnormativity that are not captured in the minority stress model. Some of the experiences reported by our participants are consistent with ways in which Cardoso et al. (2024, 2022) theorised sexual and gender minority people's needs would be frustrated by societal oppression, for instance feeling limited in one's emotional expression. Other experiences are yet to be reported in the literature; for example, descriptions of hyper‐independence following social isolation and feeling a pressure to be a positive community representative are unexamined ways in which TGD people's well‐being is influenced by cisnormativity. The well‐being of TGD people is impacted by a multitude of experiences, more far‐reaching than the typically described experiences of rejection and discrimination. Furthermore, employing an ecological systems approach highlighted how many interpersonal experiences are related to societal influences; for example, feeling rejected when parents endorse anti‐trans rhetoric (e.g., ROGD). This research sits alongside an emerging body of work that highlights gaps in the existing conceptualisation of the factors impacting TGD mental health (Puckett et al., 2023; Tebbe & Budge, 2022); new approaches should include experiences like those reported in this study and take an ecological systems approach.

Implications

This research has important implications to improve the mental health of TGD individuals. Given cisnormativity can frustrate core emotional needs at all levels of the ecological system, recommendations must similarly target the macro to individual levels. First, at the macrosystem and exosystem, promoting accurate and diverse representations of trans narratives in the media will reduce the stigmatisation of the community, dispel myths (e.g., TGD people as predators, mentally ill), reduce the burden TGD individuals feel to be a positive representative for their community, and broaden society's understanding of the diversity of experience and expression within the TGD community (Gillig et al., 2017; Pham et al., 2020). Better understandings of the diversity in the community may mean TGD people feel less pressured to conform to rigid gender norms or follow transnormative expectations. TGD people's feelings of competency can be bolstered with structural changes that promote autonomy and self‐determination (e.g., informed consent models, self‐identification laws; Coleman et al., 2022). Legal protections can ensure TGD people feel safe and supported in their communities, workplaces and schools (Blosnich et al., 2016; Reisner et al., 2015), supporting their core emotional needs.

These changes can work to change how those in an individual's microsystem view TGD individuals; however, there are also changes that can be enacted in the microsystem itself. Participants reflected on the positive impact of accurate and affirming resources their friends and family had accessed; ensuring friends and family have access to such resources in various formats (e.g., online resources, peer support networks) may improve their ability to meet the need for secure attachments (Thornburgh et al., 2020).

At the individual level, clinicians working alongside TGD people should consider ways that needs frustration may have occurred, and continues to occur, at all levels of the ecological system, and tailor interventions designed to support the individual in adaptively meeting their unmet needs accordingly. For instance, imagery rescripting (a technique used in schema therapy) can be used to alter the narrative and meaning of an existing memory by re‐imagining the memory in a different way whereby a particular core emotional need is met rather than unmet. Within the context of the sociocultural issues surrounding cisnormativity, an imagery rescripting could involve a memory where the individual is now supported to wear the school uniform that affirms their gender by their family, school and broader community. In this way, the imagery rescripting can help in the reformulation of the meaning of the original memory from ‘people don't accept me’ to ‘I have people who will advocate and support me’. Clinicians should also ensure their practice does not perpetuate cisnormativity (e.g., by expecting or promoting transnormative narratives). TGD individuals may also benefit from peer support and connection with the TGD community: such connections can normalise the diversity of TGD experiences, and bolster feelings of empowerment, acceptance and support (Johnson & Rogers, 2020). Working to support the meeting of TGD people's core emotional needs across multiple levels of their ecological system is especially important given previous research has shown frustrated needs are implicated in poor mental health outcomes (Radford et al., 2024).

Strengths and limitations

A key strength of this research is the application of a clinical model in understanding the impacts of cisnormativity on TGD individuals. This allows for a direct translation of the findings into strategies to improve mental health outcomes for the TGD community. Applying a schema therapy lens to this research also revealed distinct ways in which TGD people are being harmed by cisnormativity not yet discussed in the literature, providing clinicians and researchers with new insights and areas for further investigation.

This study is centred around the experiences of TGD people, and using an online qualitative survey allowed us to connect with a large sample (n = 101) of TGD people from many countries and with various gender identities. This allowed us to report on common experiences specific to subgroups within the community (e.g., Autistic individuals, transfemmes). Most participants were from the Anglosphere; future studies should examine how needs are met/unmet in other contexts where sociocultural beliefs about TGD people differ (e.g., in Samoa; Vasey & VanderLaan, 2021). A challenge of this data collection method was that we were unable to ask follow‐up questions to clarify responses, which can be done through interview and focus‐group methodologies; yet, the anonymity of our data collection approach may have encouraged greater disclosure of controversial views.

CONCLUSION

Cisnormativity and associated devaluation of TGD identities greatly interfered with the meeting of core emotional needs in the schema therapy model for TGD people. The multitude of ways cisnormativity infiltrated TGD people's ecological systems demonstrated that needs can be frustrated at a structural, community, interpersonal and individual level. Given the impact of unmet needs on the development of schemas and mental health outcomes, targeting manifestations of cisnormativity across society is integral to improving the well‐being of TGD individuals.

AUTHOR CONTRIBUTIONS

George Radford: Conceptualization; methodology; data curation; formal analysis; writing – review and editing; writing – original draft; investigation; project administration. Jamie E. M. Byrne: Conceptualization; writing – review and editing; supervision. Petra K. Staiger: Writing – review and editing; supervision. Gery C. Karantzas: Conceptualization; methodology; supervision; writing – review and editing; project administration.

FUNDING INFORMATION

The first author was supported by a scholarship through the Australian government's Research Training Program.

CONFLICT OF INTEREST STATEMENT

There are no competing interests to declare.

Radford, G. , Byrne, J. E. M. , Staiger, P. K. , & Karantzas, G. C. (2025). Cisnormativity and the frustration of core emotional needs among transgender and gender diverse individuals. Psychology and Psychotherapy: Theory, Research and Practice, 98, 934–959. 10.1111/papt.12596

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.