Mental Health

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Mental Health in the Trans* and Gender Non-Conforming community is not an easy topic of discussion.  Individuals who identify as transgender tend to experience higher rates of mental health issues than the general population.

While approximately 6.7 percent of the general U.S. population suffers from depression and 18 percent grapple with some iteration of an anxiety disorder, nearly half of all individuals who identify as transgender experience these issues. What's more, over 41 percent of trans men and women are estimated to have attempted suicide — a rate that's nearly nine times as high as the rate of cisgender Americans. 

What underlies this astonishingly elevated rate of mental health issues? According to a study published in the July 2016 edition of The Lancet offers significant evidence that the "distress and impairment, considered essential characteristics of mental disorders" among transgender individuals primarily arises in response to the discrimination, stigma, lack of acceptance, and abuse they face on an unfortunately regular basis.

Mental Health and Gender Dysphoria

Mental illness in transgender people first needs to be understood as separate from the diagnosis of gender dysphoria, which refers to the discomfort or stress caused by a discrepancy between a person’s
gender identity and sex assigned at birth.

 

Many, but not all transgender people, experience gender dysphoria at some point in their lives. It is important to highlight that while gender dysphoria is a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), transgender identity is not in the DSM-5, and should not be considered a form of psychopathology.

 

For most transgender people with or without SMI (Severe Mental Illness), their gender dysphoria is alleviated by achieving a satisfactory level of affirmation of their gender identity through social, legal, and/or evidence-informed gender-affirming health services.

 

Many transgender people will require both hormone therapy and surgery to alleviate gender dysphoria, while
some may need only one of these options or neither. Mental health clinicians should take the opportunity to provide information regarding both medical and non-medical options for gender affirmation, including psychotherapy.

Effective psychotherapy that addresses gender dysphoria and gender identity exploration may involve focusing on:

  • Gender identity, expression, and role

  • Adverse effects of minority stress and stigma on psychological health

  • Reducing internalized transphobia

  • Building peer and social supports

  • Improving body image

  • Enhancing resilience

  • Considering the “coming out” process (physical, psychological, social, sexual, reproductive, economic, and legal implications).


Gender-affirming interventions should be initiated for patients who meet diagnostic criteria for gender dysphoria if co-occurring mental health conditions are reasonably well-controlled and the patient is able to make an informed decision about treatment with clear and realistic expectations. In many cases, gender-affirming health care will help stabilize or resolve co-occurring psychiatric problems.

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Why are mental health challenges more common among trans individuals?


When a person decides to transition, some of the time it’s obvious. And unfortunately, not everyone is understanding.

The individual may be bullied and not accepted by their loved ones as they transition, and after. And they may face medical insurance issues, too. The anticipation of these barriers might even cause someone to believe that they have no realistic path to transition.

There is a high level of emotional pain that can come with transitioning. And there is a high level of emotional pain that can come with continuing to live with gender dysphoria.

 

This pain (just like the pain that comes from living with any chronic disease) is what can lead to depression and anxiety. And it is these mental illnesses that can make a person feel like they have no way out and have thoughts of ending their life.

Trans* and Gender Non-Conforming people also, at times, must deal with the ongoing day to day discrimination faced in their everyday lives, in the community they live, or how the general society treat them. From politics to social interactions, it can be a walking mine field just to get through the day.

Transgender people are more likely than the general population to experience discrimination in housing, employment, and healthcare. Many are verbally and physically victimized starting at a young age. Abuse related to gender
minority status has a dose-response relationship with major depressive disorder and suicidality among transgender adolescents. Daily experiences of anti-transgender stigma, prejudice, and discrimination become internalized and ultimately affect psychological health. An estimated 40% of all transgender people have attempted suicide in their lifetimes.

Though research on transgender behavioral health is limited, studies have found a higher risk for mood disorders, posttraumatic stress disorder (PTSD), and substance use disorders, but not psychotic disorders compared to the rest of the population.

 

When risk profiles based on transgender status and SMI intersect, patients are liable to experience a particularly dangerous array of vulnerabilities that require attentive, specialized care.

These reasons above and so much more can contribute to the ongoing mental health challenges a person in the Trans* community can face.

How can someone help a loved one or someone you know who is transgender or gender non-conforming?


Be really supportive. Help them get into seeing a mental health professional – especially someone who is confident in helping their clients work through gender identity issues.

 

Go to our Area Resources page to find out some of those who offer transgender specific services. These services include mental health providers who specialize in LGBTQ help. But they also cover the wide range of what someone might need.

Knowing what to say or not to say is a common concern I hear from loved ones. If you accidentally use the wrong pronoun, apologize. But don’t dwell. Keep in mind that being transgender is not their entire identity. Really, just treat them like any other friend. Ask the questions that you would ask anyone else, like, “How are you doing?” Or if they are in distress, ask, “How can I help?” You would never pry into the details of someone’s gastric bypass, colonoscopy or pap smear. In the same way, don’t ask trans people about their transition surgery.

You can find more tools and resources for helping a loved one on MakeItOK.org. This campaign works to end the stigma that surrounds mental illnesses. That’s a big part of what prevents people from getting the help that they need. If you are not sure what terminology to use when speaking to the person needing help, you can refer to our definitions page or contact our Trans Health Advocate here at OutReach by calling 608.255.8582, Monday-Friday from Noon to 5pm. You can also reach her at gingerb@lgbtoutreach.org. You may also get some hints by click HERE.

For further sources of information on this subject, check out the links below!

World Professional Association for Transgender Health

www.wpath.org

 

National LGBT Health Education Center – Transgender Health

www.lgbthealtheducation.org/topic/transgender-health

 

SAMHSA-Behavioral Health Treatments and Services

https://www.samhsa.gov/treatment

 

SAMHSA-HRSA Center for Integrated Health Solutions

www.integration.samhsa.gov

NAMI - National Alliance on Mental Illness

https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI

Mental Health America

https://www.mhanational.org/issues/lgbtq-communities-and-mental-health

National LGBTQIA+ Health Education Center

www.lgbtqiahealtheducation.org

*Note - Excerpts for this page were taken from the "Caring for Transgender People with Severe Mental Illness" Manual Edition MAY 2018; published by the The National LGBTQIA+ Health Education Center and the "Understanding mental health in the transgender community" Blog by Dr Deb Thorp MD for healthpartners.com.