Healing from Child and Adolescent Sexual Violence Among Gender Expansive Populations: An Integrative Review

Background and Purpose: Child and Adolescent Sexual Violence (CASV) encompasses a range of nonconsensual sexual experiences (abuse, assault, harassment) with significant impacts on mental health, relationships, and future victimization risk. Research often overlooks gender expansive individuals (GEI), who face heightened risks and distinct challenges. Among studies exploring CASV, few address healing or post-traumatic growth, especially among GEI populations. Understanding the unique healing processes across diverse identities of survivors is crucial for designing effective interventions. Addressing these gaps can enhance support and promote healing among gender expansive CASV survivors.

Methods: An integrative review explored healing among GEI after CASV. Six databases (PsychInfo, CINAHL, MEDLINE, SocIndex, Scopus, PubMed) were systematically searched in February 2024. Search terms included GEI, CASV, and healing. Two researchers independently coded for inclusion/exclusion. Studies were evaluated using the 2018 Mixed Methods Appraisal Tool (MMAT) and summary study information was uploaded into ATLAS.ti for coding of patterns and themes using an iterative and constant comparison approach.

Results: Seven studies met inclusion criteria. All included studies were empirical and quasi-experimental, with five employing quantitative and two qualitative approaches. Participants were high school students (n=5) or transgender adults (n=2). Two studies specifically examined racial/ethnic experiences, focusing on transgender people of color and Latinx LGBTQ youth. The quality of the studies ranged from moderate to strong, with most studies employing rigor appropriate to research with underrepresented populations. Theoretical frameworks varied, and one study utilized two approaches. Theories included minority stress theory (n=3), intersectionality (n=2), ecological model of peer victimization (n=1), and bully-sexual violence pathway (n=1). One study did not specify a theoretical approach. The themes of healing identified were protective factors (social support, self-esteem, supportive school environments, and hope for the future), contextual factors (access to mental health services, medical care, and gender neutral spaces), and resistance (negotiating oppression and feeling pride in identity). Overwhelmingly, studies identified healing through supportive parental and family relationships, and the need for these relationships to evolve after “coming out” and throughout the lifespan. Studies also highlighted healing through other forms of social support, such as school environments, secure adult attachments, and GEI community.

Conclusions and Implications: Mechanisms of healing in the included studies spanned protective factors, contextual factors, and internal resistance. Supportive individuals and supportive environments were specified across nearly all studies. Internal factors, such as hoping for the future, navigating oppression, and feeling pride in identity may be linked to resilience, but may also suggest unique resistance factors related to gender expression. It is important to note that a large number of studies were excluded due to sexual and gender minorities being collapsed into one category, resulting in a small sample size for the current review. Understanding the unique healing experiences of GEI, separately from cisgender sexual minorities, is critical. These results suggest healing from CASV occurs in multiple contexts, ranging from internal resources to external supportive networks. Removing barriers to accessing services and improving social support can promote healing from CASV among this population.