Trauma-Informed Approaches in Trans Mental Health

Trauma in psychology refers to an emotional response to a highly distressing event or a situation that overwhelms an individual’s ability to cope, which can lead to long-term negative effects. It can affect one’s sense of self and emotional range, resulting in psychological impairment. The responses, however, vary from person to person, as not only is the way a person will respond affected by neurodiversity and culture, but personal experience.

If trauma is severe, it may be identified as a type of Post-Traumatic Stress Disorder, or PTSD.  Treatment approaches include cognitive behavioural therapy or CBT, eye movement desensitisation and reprocessing, as well as non-traditional options, like meditation and dance therapy. If a trauma-informed response focuses on responding to ‘what’s wrong with you?’ with a shift to responding to ‘what happened to you?’, it highlights the importance of understanding the individual’s circumstances in the journey of recovery. 

Read More: Trauma: Types, Symptoms and Treatment

Types of Trauma

The types of trauma identified in the literature are many and varied: 

• Violence and abuse: These can be events including sexual violence, war/terror, slavery, and ACEs. Gun violence, etc. 
• Discrimination: The harmful beliefs of others regarding one’s sex, race, disability, age, sexuality, gender orientation and/ or religion. 
• Social Determinants of Health: Homelessness, food insecurity, economic opportunities, and substance use. 
• Natural disasters: e.g. hurricanes or earthquakes. 
• Medical trauma: Including early specialisation, grieving, medical error, procedures, etc.

Read More: Addiction Psychology and Relapse Prevention: Trauma-Informed Approaches to Substance Use Disorders

Trauma and Trans Individuals 

Trans individuals experience greater levels of discrimination, minority stress, aggression, and trauma consisting including physical or sexual violence. These experiences, driven by a lack of safety and acceptance, lead Trans individuals to not seek important healthcare. Many Trans people have traumatic experiences while navigating the healthcare system. Some of these experiences include being misgendered, being denied informed consent, and being subjected to inappropriate questioning.

Healthcare providers are often not trained to adequately respond to the unique needs of Trans populations. Trans individuals may have a lot of resiliency in their lives, but can equally experience trauma. Trans individuals who have trauma-related disorders will subsequently have surface memory of the traumatic event(s) repeatedly and unwanted, scattered throughout their lives as if the event(s) were occurring again. The memories of this event are often accompanied by feelings of intense fear or horror.

Read More: How Chosen Families Support Trans Mental Health

Trauma-Informed Care

According to the US Substance Abuse and Mental Health Services Administration, the definition of trauma-informed care is “A program, organisation, or system that is trauma-informed: 

• Realises the widespread impact of trauma and understands potential paths for recovery.
• Recognises the signs and symptoms of trauma in clients, families, staff, and others involved with the system. 
• Responds by fully integrating knowledge about trauma into policies, procedures, and practices. 

Essentially, Trauma-informed care (TIC) is a model of working with vulnerable individuals. TIC recognises and responds to trauma. When mental health providers are striving to resist all re-traumatisation factors, they should concentrate on making the Trans patient feel listened to, understood, respected, and trusted. It can take time to develop. 

Read More: A Guide to Trauma Response

SAMHSA’s Six Principles of Trauma-Informed Care

The core principles of trauma-informed care are as follows: 

1. Safety: Whether physical or psychological, clients, partners, families and friends must feel safe. 
2. Trustworthiness & Transparency: Explaining clear instructions, making decisions or doing tasks with transparency creates trust. 
3. Peer support: Peer and community support can enhance and also play into the avoidance of the re-traumatisation process. 
4. Collaboration and Mutuality: Collaboration and mutuality assist in working through and healing the power differential. 
5. Empowerment, Voice and Choice: Empowerment, voice and choice entail building the client’s strengths to help them feel heard and involved and making them a valued collaborator in the process of choice-making. 
6. Cultural, Historic & Gender Issues: Implementing protocols and processes that acknowledge the individuality of need of each client without regard to cultural or historical, or gender position. 

Read More: The Courageous Path of Trans Identity and Self-Acceptance

Client–Patient Relationship

Primary healthcare focuses on trauma-informed care; the relationships between patients and providers are predicated on trust. Trauma-informed care acknowledges overwhelming early adversity and how it influences and shapes clients’ beliefs and functioning, including the gender identity of transgender clients. Trauma-informed care very often can involve modifying the length of consultations; providing crucial trauma therapy within a physical healthcare visit; and building, potentially, long-term and safe relationships with the staff at the practice, clinic, or organisation. 

Research shows that people generally appreciate it when they are asked about how trauma might affect them; as well as it also helps to improve relationships between doctors and patients and improves health outcomes, including those related to trauma. The implementation of trauma-informed care may help to prevent and manage the long-term health impacts of adversity and trauma, particularly for vulnerable populations, such as trans individuals. 

Read More: The Quiet Inheritance: Gender Lessons We Didn’t Know We Learned

Suggestive Symptoms of Trauma

Symptoms include anxiety, depression, and PTSD. Other symptoms include fatigue, headaches, jaw pain related to teeth grinding, palpitations, GI symptoms, sexual dysfunction, sleep disturbance and chronic pain. Dysphoria when examining body parts that do not match someone’s gender are included with dysphoria whenever a provider uses triggering terminology to name body parts. 

Read More: Is Gender Dysphoria Associated With Paranoia in Patients?

Application of Trauma-Informed Care Principles

It is significant to respect patients’ gender during the encounter. One must pay attention to power dynamics during the encounter. It is significant to collect history in a patient-led way. One must be cognizant of asking about trauma in a way that avoids traumatisation. One must also appropriately respond to trauma disclosure. It is also essential to identify symptoms and exam findings throughout the encounter that might be suggestive of a history of trauma. 

Recognising and responding in a constructive manner when a patient becomes dysregulated is also important. It is important to ensure that the care plan involves co-development, securing mutual respect, safety and ongoing engagement. Also, very importantly, it is important to recognise, affirm and build on the patient’s strengths over time. 

Higher Levels of Care for Suicidal Trans Patients

Practitioners need to approach this with a very structural mindset. Preparing the client by providing clear information can include communicating about what is going to happen next. You need to do this in a very calm, step-by-step way. Although the process must be normalised, the experiences should never be minimised. Use calm, non-threatening, reassuring language to describe what clients can expect.

You can also offer emotional or social support literally by offering to inform a loved one. Try to build trust through transparency and the intention to call in advance. It is also critical to give the client space before adding anything else they might have thought to add. TIC could meet the needs of Trans people and has some benefits in their care as well. Mental health care providers must understand the implications of being a gender minority for this group, as only through frameworks that take account of their lived experiences can we truly improve the care we provide.

Read More: Power of Self-Care in Trauma Recovery

FAQs

1. What is trauma in psychological terms? 

Trauma refers to an emotional response to a deeply distressing or overwhelming experience that exceeds an individual’s ability to cope. It can lead to lasting negative effects on one’s mental, emotional, and physical well-being. 

2. How does trauma affect transgender individuals uniquely? 

Trans individuals often face higher rates of discrimination, minority stress, and violence, both in society and within healthcare systems. These experiences can result in complex trauma, especially when compounded by medical trauma such as misgendering or being denied informed consent. 

3. What is Trauma-Informed Care (TIC)? 

Trauma-Informed Care is an approach that acknowledges the widespread impact of trauma and integrates this understanding into every aspect of service delivery, ensuring individuals feel safe, respected, and empowered. 

4. What should healthcare providers do during a trauma-informed consultation? Providers should: 

• Respect the patient’s name and pronouns 
• Avoid invasive or non-essential questions about gender or transition 
• Ask about trauma gently and only when appropriate 
• Co-develop care plans with patient input 
• Provide safe, affirming environments 

5. Why do trans individuals often avoid healthcare? 

Due to past experiences of being misgendered, dismissed, or invalidated, many trans people may distrust or avoid healthcare altogether. Fear of discrimination and retraumatization can be significant barriers to access. 

6. What role does peer support play in TIC for trans individuals? 

Peer support offers validation, shared understanding, and community connection. For trans individuals, support from others with lived experience can be vital in healing and navigating systems that may feel unsafe. 

References +

Hordvik, E. (2019). What is Psychological Trauma? In Routledge eBooks (pp. 23–30). https://doi.org/10.4324/9780429461637-3 

Levenson, J. (2017). Trauma-Informed Social Work practice. Social Work. https://doi.org/10.1093/sw/swx001

Levenson, J. S., Craig, S. L., & Austin, A. (2021). Trauma-informed and affirmative mental health practices with LGBTQ+ clients. Psychological Services, 20(Suppl 1), 134–144. https://doi.org/10.1037/ser0000540 

Oseldman. (2018, May 25). Trauma types. The National Child Traumatic Stress Network. https://www.nctsn.org/what-is-child-trauma/trauma-types 

Potter, J., Harvard Medical School, The Fenway Institute, Grossman, S., Berman, S., Harvard Medical School’s Trauma-Informed Care Curricular Theme Steering Committee, & The National Trauma Informed Care Education and Research Group (TIHCER). (n.d.). Trauma-Informed care for trans and Gender-Diverse individuals. https://www.lgbtqiahealtheducation.org/wp content/uploads/2020/06/9e.-Trauma-Informed-Care.pptx.min_.pdf 

Starcevic, A. (2019). Introductory Chapter: Psychological Trauma. IntechOpen eBooks. https://doi.org/10.5772/intechopen.89519 

The 4 R’s of trauma. (n.d.). Cornell Cooperative Extension. https://cceorangecounty.org/community resilience/the-4-rs-of-trauma 

Trauma-informed care — TransHub. (n.d.). TransHub. https://www.transhub.org.au/clinicians/trauma-informed-care