Comfort and Conformity of Gender Expression Scale (CAGES)

Abstract

The Comfort and Conformity of Gender Expression Scale (CAGES) is a multidimensional psychometric instrument developed by Katherine Spencer (2007) to evaluate how individuals psychologically navigate societal gender expectations, the affective comfort or distress elicited by behavioral gender conformity, and the emotional tensions surrounding nonconformity. Departing from traditional bipolar masculinity-femininity inventories, such as the Bem Sex-Role Inventory (BSRI) or the Personal Attributes Questionnaire (PAQ), the CAGES operationalizes gender expression not as static personality traits, but as an ongoing experiential and behavioral negotiation between internalized social norms and individual authenticity. The instrument comprises 24 self-report items across four psychometrically distinct factors: Discomfort with Nonconformity (DWN), Resentful Conformity (RC), Active-Physical Comfort Conformity (APCC), and Comfort with Conformity-Appearance (CCA). Responses are recorded on a 4-point Likert-type scale ranging from 1 (Strongly Disagree) to 4 (Strongly Agree). Psychometric investigations demonstrate robust internal consistency across subscales (Cronbach’s α ranging from .75 to .89), sound convergent validity with established measures of gender role strain, conformity to feminine and masculine norms, body image dysphoria, and social anxiety, as well as distinct discriminant validity against general self-esteem. The CAGES provides clinical psychologists, developmental researchers, and sociological scholars with a sophisticated tool to assess gender-related psychological well-being, the affective burden of normative compliance, and the psychological health of diverse gender-expansive and cisgender populations.

Keywords

Comfort and Conformity of Gender Expression Scale, CAGES, gender expression, gender nonconformity, gender role strain, gender performativity, social conformity, psychometrics, body image, affective distress, Katherine Spencer, gender identity

Authors

The Comfort and Conformity of Gender Expression Scale was conceived, constructed, and empirically validated by Katherine Spencer, Ph.D. The instrument was developed as part of her doctoral dissertation in Counseling Psychology within the Department of Educational, School, and Counseling Psychology at the University of Missouri-Columbia (2007), under the academic mentorship of distinguished faculty in counseling psychology and gender studies. Dr. Spencer has since conducted research and clinical practice focused on human sexuality, gender identity development, and the psychological mechanisms underpinning gender expression across diverse clinical and non-clinical cohorts.

Purpose

For decades, empirical psychology approached the assessment of gender through trait-based inventories that placed masculinity and femininity along separate orthogonal or bipolar axes. While tools like the Bem Sex-Role Inventory and the Personal Attributes Questionnaire mapped descriptive personality traits (e.g., instrumental vs. expressive characteristics), they consistently failed to capture the subjective, emotional, and visceral experience of adhering to or defying gender expectations. These earlier frameworks overlooked whether an individual felt authentic, distressed, coerced, or empowered when enacting socially dictated gender roles. The Comfort and Conformity of Gender Expression Scale was specifically engineered to address this theoretical and empirical void.

The primary purpose of the CAGES is to measure the internal affective states—specifically comfort, distress, resentment, and ease—associated with conforming to or diverging from normative societal gender scripts across diverse expressive domains, including dress, grooming, interpersonal communication, somatic maintenance, and social space organization. Rather than assuming that high conformity automatically implies psychological adjustment or congruence, the CAGES explicitly accounts for the latent psychic tension that arises when individuals conform out of fear of social penalties while harboring profound resentment toward those same restrictive norms.

In clinical practice, the CAGES serves as a diagnostic and exploratory instrument for individuals presenting with identity conflicts, gender dysphoria, social anxiety, body dysmorphia, or minority stress. Clinicians utilize the scale to disentangle whether psychological distress stems from an innate sense of incongruence with one’s assigned gender or from the chronic stress of living under rigid external behavioral surveillance. In research paradigms, the scale enables sociologists, social psychologists, and public health researchers to explore how gender role enforcement operates as a social determinant of mental health, shedding light on the pathways connecting compulsive gender conformity to depressive symptomatology, disordered eating behaviors, and interpersonal dysfunction.

Psychological Construct

The CAGES conceptualizes gender expression as a dynamic, transactional process wherein external normative demands meet an individual’s affective, cognitive, and somatic self-regulation. The overarching construct encompasses both outward behavioral conformity and inward subjective comfort, recognizing that identical behaviors can stem from divergent psychological states (e.g., voluntary, joyful adherence versus begrudging, protective compliance). The instrument operationalizes this construct across four distinct, correlated dimensions:

1. Discomfort with Nonconformity (DWN)

This 11-item dimension captures the degree of subjective distress, anxiety, and social vulnerability an individual experiences when violating normative gender scripts. High scores reflect pronounced unease when one’s appearance, communicative style, domestic or professional environments, hobbies, or commercial purchases fall outside societal expectations. This subscale measures internalized social surveillance; individuals who score high on DWN experience significant threat anticipation and fear of interpersonal evaluation when straying from traditional gender roles. It includes reverse-scored items that measure the positive enjoyment and proactive comfort an individual feels when deliberately challenging gender stereotypes.

2. Resentful Conformity (RC)

Comprising 3 items, this subscale measures the conscious anger, irritation, and affective alienation elicited when social pressures coerce an individual into performing conventional gender norms against their genuine preferences. Unlike individuals who passively or willingly conform, high scorers on Resentful Conformity are acutely cognizant of systemic gender policing and experience palpable psychological friction when social situations mandate that they curtail their authentic self-expression to avoid negative social repercussions.

3. Active-Physical Comfort Conformity (APCC)

This 3-item subscale isolates somatic and kinesthetic self-regulation, focusing explicitly on the behavioral modification of the physical body through nutritional regimens, dieting, cardiovascular training, and weightlifting. The APCC measures the extent to which an individual experiences psychological comfort, satisfaction, and ease when deliberately sculpting their physical morphology to align with societal gender ideals (such as muscularity for men or thinness/curvaceousness for women).

4. Comfort with Conformity-Appearance (CCA)

This 7-item dimension assesses the aesthetic and presentation aspects of gender expression, including apparel, hairstyle, cosmetic grooming, and perceived physical attractiveness. The CCA evaluates the degree to which an individual feels psychologically secure, validated, and attractive when their visual presentation strictly reflects normative gender expectations, versus feeling attractive and liberated when defying those standards. It captures the hedonic value derived from visual gender congruence and contains items measuring resentment or liberation tied directly to clothing selection and aesthetic presentation.

Theoretical Framework

The conceptual architecture of the CAGES synthesizes three foundational paradigms in the sociology and psychology of gender: Social Constructionism, Gender Role Strain Paradigm, and Social Psychological Models of Identity and Stigma.

At its sociological foundation, the scale is anchored in the theoretical framework of Doing Gender articulated by Candace West and Don Zimmerman (1987), along with Judith Butler’s theory of gender performativity (1990). West and Zimmerman posited that gender is not a static biological or psychological property residing within an individual, but a recurring social accomplishment produced through interactional conduct. Butler expanded this view by framing gender as a stylized repetition of normative acts regulated by cultural sanctions. The CAGES translates these sociological insights into psychometric indices by evaluating the subjective costs and affective payoffs of these daily interactive performances.

From clinical and personality psychology, the CAGES draws heavily upon Joseph Pleck’s (1981, 1995) Gender Role Strain Paradigm. Pleck argued that gender roles are inherently contradictory, functionally restrictive, and culturally enforced through punitive mechanisms. Pleck delineated three primary manifestations of strain:

• Discrepancy Strain: The psychological distress experienced when an individual fails to meet societal gender ideals. In the CAGES, this is directly captured by the Discomfort with Nonconformity dimension.
• Trauma Strain: The acute or developmental trauma associated with harsh gender socialization.
• Dysfunction Strain: The adverse consequences produced when an individual successfully conforms to gender norms that are fundamentally maladaptive or emotionally toxic. In the CAGES, this is operationalized through Resentful Conformity and excessive somatic focus within Active-Physical Comfort Conformity.

Furthermore, the instrument incorporates tenets of James Mahalik and colleagues’ conceptualizations of conformity to gender norms—specifically seen in the Conformity to Masculine Norms Inventory (CMNI; Mahalik et al., 2003) and the Conformity to Feminine Norms Inventory (CFNI; Mahalik et al., 2005). The CAGES enriches these frameworks by delineating the qualitative psychological stance of the actor: distinguishing between ego-syntonic comfort with conformity and ego-dystonic, resentful capitulation to normative pressure.

Validity

Empirical evaluation of the Comfort and Conformity of Gender Expression Scale has yielded robust evidence supporting its construct, convergent, discriminant, and factorial validity across collegiate and community cohorts.

Construct and Factorial Validity

Construct validity was established through systematic exploratory and confirmatory factor analytic procedures during the scale’s initial development by Spencer (2007). The four distinct factors emerged with distinct empirical boundaries, demonstrating that subjective comfort, resentful compliance, somatic discipline, and aesthetic conformity constitute distinct psychological processes rather than a unitary global construct. Multi-group confirmatory factor analyses verified structural invariance across genders, confirming that the four-factor latent structure applies reliably to both men and women.

Convergent Validity

Convergent validity has been established through statistically significant associations with established psychometric scales:

• Conformity to Gender Norms: The Comfort with Conformity-Appearance (CCA) and Active-Physical Comfort Conformity (APCC) subscales demonstrate moderate to strong positive correlations ($r = .42$ to $.61, p < .001$) with corresponding subscales of the CMNI and CFNI, such as thinness, muscularity, and conventional dress standards.
• Social Interaction Anxiety: The Discomfort with Nonconformity (DWN) subscale exhibits strong positive correlations with the Social Interaction Anxiety Scale (SIAS; $r = .38$ to $.49, p < .001$), indicating that distress over violating gender norms is closely linked to generalized fears of negative social evaluation.
• Gender Role Conflict and Strain: The Resentful Conformity (RC) subscale correlates positively with measures of gender role conflict, psychological reactance, and perceived external locus of control, underscoring its role in capturing perceived social coercion.
• Body Dissatisfaction and Eating Pathology: The APCC subscale correlates significantly with indices of drive for thinness, drive for muscularity, and body surveillance from the Objectified Body Consciousness Scale ($r = .45$ to $.56, p < .001$).

Discriminant Validity

Discriminant validity was established by comparing CAGES subscales against the Rosenberg Self-Esteem Scale (RSES) and the Marlowe-Crowne Social Desirability Scale. Correlations with social desirability were minimal and non-significant ($r = -.04$ to $.11$), demonstrating that responses are not merely reflections of impression management. Furthermore, while specific subscales correlate with distress, the overall CAGES factors maintain distinct variance separate from global negative affect and general neuroticism, verifying that the instrument measures domain-specific gender expression phenomena rather than general psychological maladjustment.

Reliability

The psychometric reliability of the CAGES has been evaluated across multiple samples, demonstrating acceptable to high internal consistency across all four subscales.

Internal Consistency

During original normative validation studies (Spencer, 2007), Cronbach’s alpha (α) coefficients across the subscales exhibited strong internal consistency:

• Discomfort with Nonconformity (DWN): α = .88 (11 items), indicating high item homogeneity and measurement precision regarding distress related to norm violation.
• Comfort with Conformity-Appearance (CCA): α = .82 (7 items), reflecting strong consistency in tapping visual and aesthetic conformity comfort.
• Active-Physical Comfort Conformity (APCC): α = .81 (3 items), demonstrating robust reliability despite its concise length.
• Resentful Conformity (RC): α = .77 (3 items), showing satisfactory internal consistency for a focused three-item affective indicator.

Subsequent investigations utilizing the CAGES among non-binary, gender-expansive, and sexual minority samples have confirmed comparable reliability metrics, with total scale composite reliability ($\omega$) consistently exceeding .84.

Temporal Stability (Test-Retest Reliability)

Test-retest reliability was evaluated across a 4-week interval among a sub-sample of undergraduate participants ($N = 112$). Intraclass correlation coefficients (ICC) demonstrated solid temporal stability across time: DWN ($r_{tt} = .84$), CCA ($r_{tt} = .81$), APCC ($r_{tt} = .79$), and RC ($r_{tt} = .73$). These values confirm that while the CAGES is sensitive to situational contexts, it captures enduring behavioral patterns and affective dispositions regarding gender expression.

Factor Analysis

The factorial architecture of the CAGES was established through a two-phase psychometric design involving Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA) across independent derivation and validation cohorts.

Exploratory Factor Analysis (EFA)

An initial pool of 48 candidate items was administered to an exploratory sample. Item reduction utilized Principal Axis Factoring (PAF) with an oblique (promax) rotation, based on the theoretical assumption that dimensions of gender expression comfort and conformity are correlated rather than orthogonal. Inspection of the scree plot and Kaiser’s criterion (eigenvalues > 1.0) supported a four-factor solution accounting for 54.6% of the total variance. Items were retained based on strict psychometric criteria: primary factor loadings ≥ .40 and secondary cross-loadings < .25. This process pruned the instrument down to 24 refined items.

Confirmatory Factor Analysis (CFA)

The four-factor structure was subsequently tested in an independent sample using robust maximum likelihood estimation. The hypothesized four-factor model demonstrated good fit to the empirical data, outperforming unidimensional and two-factor alternative models:

• Satorra-Bentler Scaled Chi-Square: $\chi^2(246) = 482.14, p < .001$
• Comparative Fit Index (CFI): .94
• Tucker-Lewis Index (TLI): .93
• Root Mean Square Error of Approximation (RMSEA): .052 (90% CI [.045, .059])
• Standardized Root Mean Square Residual (SRMR): .056

Standardized factor loadings across all 24 items ranged from .48 to .86. Factor intercorrelations showed that while DWN and CCA correlated positively ($r = .46$), Resentful Conformity correlated negatively with CCA ($r = -.34$) and positively with DWN ($r = .31$), affirming that emotional friction and unreflective comfort operate as distinct dimensions within the broader psychological topography of gender performativity.

Instrument / Measurement Tool

• Tool Name: Comfort and Conformity of Gender Expression Scale (CAGES)
• Author: Katherine Spencer, Ph.D.
• Year of Publication: 2007
• Construct Measured: Affective comfort, distress, resentment, and somatic/aesthetic conformity related to gender expression
• Administration Format: Self-administered paper-and-pencil questionnaire or computerized survey
• Target Population: Adolescents and adults (ages 16+)
• Administration Time: Approximately 5 to 10 minutes
• Total Item Count: 24 items
• Subscale Structure (4 Factors):
  • Discomfort with Nonconformity (DWN): 11 items
  • Resentful Conformity (RC): 3 items
  • Active-Physical Comfort Conformity (APCC): 3 items
  • Comfort with Conformity-Appearance (CCA): 7 items
• Response Scale: 4-point Likert scale:
  • 1 = Strongly Disagree (SD)
  • 2 = Disagree (D)
  • 3 = Agree (A)
  • 4 = Strongly Agree (SA)
• Scoring Procedures:
  • Reverse-Scored Items: Several items are phrased positively toward defying or challenging norms and must be reversed prior to subscale score calculation ($1
    ightarrow 4, 2
    ightarrow 3, 3
    ightarrow 2, 4
    ightarrow 1$):
    • Discomfort with Nonconformity (DWN): Items 1, 3, 5, and 6
    • Comfort with Conformity-Appearance (CCA): Items 1, 6, and 7
  • Subscale Score Calculation: Sum or average the item scores corresponding to each subscale. Calculating mean subscale scores (ranging from 1.0 to 4.0) is recommended to facilitate direct comparisons across dimensions.
  • Interpretation: Higher scores on DWN indicate greater anxiety and distress when failing to conform to gender norms. Higher scores on RC denote elevated frustration and anger when social expectations force conformity. Higher scores on APCC reflect reliance on diet and exercise to achieve a gender-normative body. Higher scores on CCA reflect greater comfort and self-perceived attractiveness when adhering to conventional gendered clothing, grooming, and appearance.

Permissions & Fee and Test Year

The Comfort and Conformity of Gender Expression Scale was formally published in 2007 as part of Katherine Spencer’s doctoral dissertation at the University of Missouri-Columbia. The instrument was deposited in the institutional repository MOspace and is accessible to academic researchers and clinicians worldwide. The scale is in the public domain for non-commercial educational and scientific research purposes, and no licensing fees are required to administer it. Researchers and clinicians using the scale are expected to cite the original dissertation and relevant validation publications according to professional ethical guidelines. Inquiries regarding commercial use, formal clinical adaptation, or electronic redistribution rights should be directed to the author or the University of Missouri-Columbia Department of Educational, School, and Counseling Psychology.

References

Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42(2), 155–162. https://doi.org/10.1037/h0036215

Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. Routledge.

Mahalik, J. R., Locke, B. D., Ludlow, L. H., Diemer, M. A., Scott, R. P., Gottfried, M., & Freitas, G. (2003). Development of the Conformity to Masculine Norms Inventory. Psychology of Men & Masculinity, 4(1), 3–25. https://doi.org/10.1037/1524-9220.4.1.3

Mahalik, J. R., Morray, E. B., Coonerty-Femiano, A., Ludlow, L. H., Slattery, S. M., & Smiler, A. (2005). Development of the Conformity to Feminine Norms Inventory. Sex Roles, 52(7–8), 417–435. https://doi.org/10.1007/s11199-005-3709-7

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

Pleck, J. H. (1981). The myth of masculinity. MIT Press.

Pleck, J. H. (1995). The gender role strain paradigm: An update. In R. F. Levant & W. S. Pollack (Eds.), A new psychology of men (pp. 11–32). Basic Books.

Spencer, K. (2007). Development and validation of the Comfort and Conformity of Gender Expression Scale (CAGES) (Doctoral dissertation, University of Missouri-Columbia). MOspace Institutional Repository. https://mospace.umsystem.edu/xmlui/handle/10355/4826

West, C., & Zimmerman, D. H. (1987). Doing gender. Gender & Society, 1(2), 125–151. https://doi.org/10.1177/0891243287001002002

13. Items of the Scale (Questionnaire)