Ever since the revision to the Diagnostic and Statistical Manual of Mental Disorders in 2013, transgender people have begin to feel a bit of relief from the stigma of mental illness.
Prior to 2013, transgender individuals were diagnosed by mental health professionals as having Gender Identity Disorder–an illness which was considered something akin to multiple personality disorder.
Thankfully, as medicine has progressed in recent years, doctors have learned that gender identity itself is not a disorder, and have instead started treating the real problem–gender dysphoria.
The word “dysphoria” means a sense of restlessness, anxiety, dissonance, or distress, and is the linguistic opposite of a sense of euphoria.
Trans people experience this sense of distress when they contemplate the difference between the reality of their body or their social presentation, and the way they believe their body or presentation should be in order to accurately align with their sense of self.
This change in terminology has been, for the most part, incredibly helpful for transgender communities, and it has allowed trans people to proudly claim their own stories, and their own lives.
Despite being able to separate essential parts of identity from illness, however, many transgender folks do struggle with other mental health issues like anxiety, depression, and eating disorders. Sometimes these issues are a direct result of the stress trans folks experience in their day-to-day life because of discrimination and transphobia, underlining the real necessity of legal protections for trans individuals.
Sometimes these illnesses are the mind’s way of dealing with gender dysphoria prior to coming out and transitioning. Fortunately, it’s been found time and time again that as trans people become more at home in their bodies, and as they begin presenting in a way that accurately reflects their gender identity, overall mental health does improve.
Trans People May Suffer from Social Anxiety
Social anxiety is possibly the most prevalent disorder found among transgender people, with studies in 2005 and 2010 showing that 55% of transgender people experience high levels of anxiety, compared to only 6.8% of the cisgender (non-transgender) population.
The American Psychiatric Association’s 2012 recommendation for access to care for transgender people helps us understand this huge disparity:
“Being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression. Transgender and gender variant persons are frequently harassed and discriminated against when seeking housing or applying to jobs or schools, are often victims of violent hate crimes, and face challenges in marriage, adoption and parenting rights. Discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals.”
Transgender people may find themselves living in constant fear of verbal or physical harassment. While a healthy mind can deal with this kind of pressure for short periods, over time this perpetual sense of danger is likely to develop into a debilitating form of social anxiety.
Trans People May Suffer from Depression
Depending on personality and genetics, some people are more prone to either depression or anxiety, or may suffer from a combination of the two.
A 2015 study from the Harvard School of Public Health found that in a group of transgender people between the ages of twelve and twenty-nine, 50.6% were diagnosed with depression and 17.2% had attempted suicide. As we come to understand depression in the transgender community more accurately, it’s become clear that the major cause is what’s referred to as “minority stress;” that is, “stressors induced by a hostile, homophobic culture, which often results in a lifetime of harassment, maltreatment, discrimination and victimization.”
The good news, then, is that as social relations and culture change, negative attitudes toward transgender people may be reduced, which will then reduce the stressors which trigger anxiety and depression.
Trans People May Suffer from Eating Disorders
Another fairly common disorder found in the transgender community revolves around food. In a 2015 study of students at 223 different universities, it was found that “Transgender students were more than four times as likely to report an eating disorder diagnosis as cisgender heterosexual women,” who are generally the focus of eating disorder studies.
The reasoning behind this discrepancy is fairly straightforward–transgender women feel the same pressure to stay thin that cisgender women feel, while transgender men often realize that keeping a low body weight represses secondary sex characteristics and menstruation.
For many trans teens who aren’t allowed to transition, it may feel like disordered eating and excessive exercise are the only ways to make their body more masculine or feminine.
If you have a friend or family member who struggles with an eating disorder, read up on what they’re going through over at the National Eating Disorder Association website, and talk with them about seeking clinical help. If you have a friend or family member who deals with gender dysphoria, the best thing you can do is affirm their identity and use their correct name and pronouns.
The difference between gender dysphoria (which transgender people experience), and body dysmorphia (which is the condition associated with eating disorders), is that body dysmorphia can be successfully treated with medication. Gender dysphoria, on the other hand, only effectively disappears once a trans person is allowed to physically and/or socially transition.
Hormone Therapy Helps
Alongside trans-inclusive mental healthcare, the ability to physically transition has had the most positive effect on trans folks suffering from anxiety, depression, and eating disorders. Study after study has confirmed that access to hormone therapy has had a positive effect on the mental health of transgender patients.
One 2012 study looked at a sample population wherein about two thirds had undergone hormone therapy, while the remaining third had not, and found that individuals who had not begun hormones experienced approximately 30% higher levels of anxiety and depression.
Two more recent studies, one from 2013 and one from 2014, looked at a representative population of transgender people before hormone therapy, at one year on hormones, and then after any desired gender confirmation surgery.
The results found an even greater reduction in disordered symptoms, especially in symptoms of anxiety, after the start of hormone therapy, and what’s more, after twelve months on a hormone regimen, transgender patient’s scores on symptom checklists resembled the scores of the general population!
Additional studies focusing on levels of cortisol, a stress hormone, found that prior to hormone therapy trans people experienced higher perceived stress, while after twelve months of cross-sex hormones their cortisol levels came down and fell within the normal range.
So while it is true that the transgender community suffers from mental illness at a higher rate than their cisgender peers, we can take comfort from the knowledge that these disorders are understood, treatable, and above all, that they do not undermine our gender identities.
Just because you may deal with depression does not mean your dysphoria is a moot point
Just because you struggle with anxiety doesn’t mean that your fear of harassment isn’t real
Just because you’re recovering from an eating disorder doesn’t mean you’re not allowed to ask for help when it comes to gendered expectations surrounding body image.
If we take nothing else from these studies–if we ignore the positive effects of trans-inclusive mental health care and access to hormone therapy–we must at least recognize that mental illnesses don’t render gender identities insignificant.
Let’s hope that as more research is done we’ll see positive advances in trans-inclusive treatment in the medical community, and continued movement towards legislation to protect LGBTQ folks from the social stigma that triggers these disorders.
This post was originally published on Austen Hartke‘s blog as When Worlds Collide – Mental Illness Within the Trans Community and Dysphoria and Dysmorphia: Understanding Identity and Mental Illness.