Posttraumatic stress in the trans community: The roles of anti-transgender bias, non-affirmation, and internalized transphobia.

Abstract

Transgender people have higher rates of posttraumatic stress disorder (PTSD) than the general population. This risk can be partially understood by conceptualizing day-to-day bias-related stressors and nonaffirmation as potentially traumatic, but there is currently limited empirical evidence to support such a framework. This study aimed to explore this framework by testing the hypothesis that exposure to antitransgender bias and non-affirmation are related to PTSD symptom severity, even after controlling for exposure to traditionally defined potentially traumatic events. Drawing upon shame-based models of PTSD, this study also tested the hypothesis that internalized transphobia partially mediates the relationships between both bias and non-affirmation and PTSD symptom severity. Cross-sectional data were collected online from 575 individuals who identified as having a gender different from their sex assigned at birth. Data were analyzed utilizing structural equation modeling. As hypothesized, participants with greater exposure to anti-transgender bias and higher levels of non-affirmation experiences had increased PTSD symptom severity, even after controlling for exposure to other trauma. These relationships were partially explained by internalized transphobia. These findings document meaningful relationships between anti-transgender bias, non-affirmation, internalized transphobia, and posttraumatic stress. They provide initial support for conceptualizing anti-transgender bias and non-affirmation experiences as potentially traumatic themselves and/or as trauma response triggers and highlight a potential role of internalized transphobia in PTSD symptoms. Clinical implications for working with trans populations are discussed. Public Significance StatementThis study found that anti-transgender bias, non-affirmation of gender, and internalized transphobia were related to PTSD symptom severity. When psychologists or the general public make efforts to understand trans people's increased rates of PTSD symptoms and diagnoses-or participate in efforts to improve mental health in the trans community-they should attend to anti-transgender bias, non-affirmation, and internalized transphobia.

Factors that drive mental health disparities and promote well-being in transgender and nonbinary people

“…Although internal stressors have been positioned as mediators between external stressors and adverse mental health outcomes 30 , evidence for such mediation is mixed. More frequently, internal stressors either occur concomitantly with external stressors 31 , 32 or partially but do not fully mediate the relationship of external stressors with adverse health outcomes 33 , 34 . Stressors drive mental health concerns among stigmatized populations such as sexual-minority populations (individuals who identify as queer, lesbian or gay, bisexual, pansexual and other identities) 27 – 29 and individuals with disabilities 35 , 36 .…”

“… 87 ). In a 2021 USA-based study, 44% of transgender or nonbinary participants met DSM-5 criteria for PTSD 33 . Some of the symptoms of PTSD can be debilitating 88 and increase risk for substance use, depression and additional post-traumatic stress in TNB populations 77 , 84 , 85 , 89 – 93 .…”

“…Linking these disparities to minority-stress theory, exposure to discrimination in various forms (such as in housing, employment and healthcare) has been positively associated with depression and anxiety in samples of TNB adults in the USA, Canada, Pakistan and China 31 , 32 , 99 , 106 – 111 . Similarly, anti-trans bias and non-affirmation, such as being misgendered by others, have been associated with a diagnosis of PTSD 33 , 84 . Harassment, trauma and sexual assault have been positively associated with self-harming behaviours in TNB individuals in the USA 97 .…”

Minority stressors and their associations with severe psychological distress among gender-diverse people.

“…Family rejection (Delozier et al, 2020; McGuire et al, 2016; Pariseau et al, 2019) and physical forms of victimization (Beckman et al, 2018; dickey et al, 2017; Kolp et al, 2020; Reisner et al, 2016; White Hughto et al, 2017) due to one’s gender identity contributes to mental health concerns, such as anxiety and depressive symptoms. Further, identity invalidation (e.g., misgendering, deadnaming, being referred to with language not aligned with one’s gender identity) is noted in past research as an especially prevalent distal minority stressor that can impact body image and eating behaviors (Mitchell et al, 2021), substance use (Ehlinger et al, 2022), posttraumatic stress symptoms (Barr et al, 2021), suicidality (Pollitt et al, 2021), and other mental health (James et al, 2016; Pollitt et al, 2021; Testa et al, 2015). These studies highlight how independent distal minority stress experiences have the potential to influence the mental health of transgender and other gender-diverse people.…”

Considering Spiritual Care for Religiously Involved LGBTQI Migrants and Refugees: A Tentative Map

“…Establishing trust needs to be followed by assessing risks for PTSD, suicide, depression, substance abuse, and making proper referrals where necessary. Extending care to transgender people also requires additional levels of care given the pronounced presence of post-traumatic stress due to anti-transgender bias, non-affirmation, and internalised transphobia (Barr et al 2021). Because the new freedom around sexual practice in the receiving country may lead to sexual health risks, the caregiver will also need to assess and build trust to ensure that the client has access to sexual health information appropriate to their orientation and information about accessing sexual health care, testing, and disease prevention.…”