Background
Gender identity is defined as being male or female, which corresponds to one’s gender [
1]. There is usually a harmony between sex and gender identity, but sometimes these two items are incompatible [
2]. According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), “the incongruity between a person’s experienced gender and the gender assigned to him or her at birth” leads to “Gender Dysphoria,” a term that replaced the previous “Gender Identity Disorder” in order to avoid stigma [
1,
3]. The prevalence of diagnosis of trans women ranges from 5 to 14 in 100,000 and trans men from 2 to 3 per 100,000. Since not all adults seek hormonal and surgical treatment at specialized clinics, this rate is probably underestimated [
3].
Transgender people face many problems include lack of social support, community rejection, physical and family violence. Among these problems, family violence is a common issue [
1,
4‐
7]. Family violence defines as violence between family members, including violence between current or former intimate partners and acts of violence between a parent and a child, between siblings, or elder abuse [
8]. Some families do not accept transgender youth because of the religious atmosphere and fear of disgrace and harassment of neighbors and other members of society, and they continuously treat their children with violence [
9]. A report in 2010 showed that 60% of transgender people are subject to family violence [
10]. According to a report in 2014 in Iran, only 20% of parents support their transgender youth; 10% do not care about this issue and choose to ignore it, and 70% of parents deal with anger when their child’s demand gender reassignment. These parents usually do not accept their child’s problems or respond with inhumanity, anger, and resentment [
2]. In qualitative studies conducted by the research team (under submission), many of the transgender’s problems in society stem from family violence and lack of family support [
11].
Several studies reported a high level of family violence against transgender youth, which can be lead to suicidal thoughts, drug abuse, running away from home, and high-risk behaviors; but very few if any interventions have conducted to reduce violence against these youths by working with potential perpetrators of violence [
10,
12].
Some researches support CBT as an effective intervention for decreasing family violence against children [
13‐
15]. CBT researches conducted on violent perpetrator parents showed decreased anger and anxiety levels, improved parenting, family interaction, and problem-solving behaviors. Despite the effectiveness of CBT in decreasing child abuse, more new studies need due to the outdated nature of existing studies [
15]. Even when children do not participate directly in cognitive-behavioral therapy (sessions are for parents only), they will benefit from improving parents’ skills and reducing their violent behaviors [
16]. Based on some studies’ results, parents’ physical punishment after cognitive-behavioral therapy has decreased; and children’s post-traumatic stress symptoms, depression, and behavioral problems reduced significantly [
17]. This study is one of the first RCT on family violence against transgender youth globally and in Iran.
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