Nonbinary in a Binary World: The Impact of Identity Concealment and Blending on Nonbinary People’s Mental Health

Background: Nonbinary people identify as a gender or genders outside of the binary of man and woman. Nonbinary people experience mental health disparities related to gender minority stress and discrimination within the United States and other societies that espouse gender binarism. Purpose: The nonbinary community is an understudied population who may experience key differences in protective and risk factors when compared to more widely-studied binary transgender and cisgender LGB communities. Understanding the relationships between distress, blending into the gendered environment, and concealing gender identity may assist clinicians in helping nonbinary clients. Methods: Study 1, a published article (Flynn & Smith, 2021), served as the springboard for Study 2 and Study 3 by investigating interactions between blending and identity concealment using data from the 2015 United States Transgender Survey. A MANCOVA analysis was performed with blending and identity concealment as independent variables and distress and victimization as dependent variables. For studies 2 and 3, an online survey was administered, comprised of questions about blending (adapted from the 2015 United States Transgender Survey: James et al., 2016) and several subscales from the Nonbinary Minority Stress Scale (including Identity Concealment, Invalidation, and Burdening subscales; Matsuno et al., 2024), the Transgender Congruence scale (Kozee et al., 2012), and the Depression, Anxiety and Stress Scale (Lovibond & Lovibond, 1995). In study 2, the relationship between blending into the binary gendered environment and mental health was explored through a moderation model. It was hypothesized that congruence between gender identity and expression would moderate the relationship between blending and depression, anxiety, and stress. Multiple regression analyses were conducted in SPSS using the PROCESS macro Model 1. In study 3, a path analysis was conducted in MPlus to investigate invalidation and burdening as mediators of the relationship between identity concealment and negative mental health outcomes. An indirect path from identity concealment through iv invalidation to the mental health outcomes, and another indirect path from identity concealment through burdening to the mental health outcomes were hypothesized. Results: Study 1 found a significant positive relationship between blending and distress, as well as a significant negative relationship between identity concealment and distress, with no interaction effects. In Study 2, the moderation models for each dependent variable of depression, anxiety, and stress reached significance, revealing gender congruence as a protective factor against negative mental health outcomes. Additionally, not blending was significantly associated with higher anxiety scores. Study 3 revealed a significant relationship between identity concealment and higher anxiety. Additionally, higher invalidation scores predicted higher scores on all three mental health dependent variables. Conclusions: Study 1 yielded results that suggested identity concealment and blending might impact nonbinary people’s mental health in unique ways compared to other groups in the LGBTQ+ community. Study 2 revealed that participants who blended less had higher anxiety scores, while gender congruence is a protective factor. Study 3 revealed that invalidation experiences may cause depression, anxiety, and stress, although the relationship between these variables and identity concealment is more complex than a simple mediation model. Taken together, the three studies add to the growing literature on nonbinary people’s mental health, as well as illuminating nuances in experience that can inform clinicians who work with this population.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Counseling Psychology

Grantor

University of Houston

Year dc:date.issued

2025

Author dc:creator

• Flynn, Sana

Advisor dc:contributor.advisor

• Smith, Nathan Grant

Committee members dc:contributor.committeemember

• Matsuno, Em
• Kim, Han Joe
• De Dios, Marcel

• Counseling psychology

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/10657/20713

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/20713