Back to top Open menu arrow
Download Reprints
Sections
METHODS RESULTS DISCUSSION Clinical Points
The Journal of Clinical Psychiatry The Journal of Clinical Psychiatry

The Journal of
Clinical Psychiatry
Access icon

Original Research September 26, 2022

Psychiatric Diagnoses Among Transgender and Gender Diverse Patients Compared to Cisgender Patients

Mark Zimmerman, MD; Isabel Benjamin, BA; Craig Seijas-Rodriguez, PhD

J Clin Psychiatry 2022;83(6):21m14062

ABSTRACT

Background: Sexual and gender minority persons (ie, those reporting sexual orientation other than heterosexual and gender identity other than cisgender, respectively) experience high rates of various forms of psychopathology. However, discussions of sexual minority populations are often focused on aspects of mental health associated with sexual orientation, with relatively less emphasis placed on transgender and gender diverse (TGD) individuals’ mental health. No prior studies have compared psychiatric diagnoses between TGD and cisgender patients presenting for psychiatric treatment in a systematic way using semistructured diagnostic interviews assessing a broad range of disorders.

Methods: Between April 2014 and January 2021, we administered semistructured diagnostic interviews for DSM-IV disorders to 2,212 psychiatric patients, 69 of whom reported TGD identity (ie, gender identity other than cisgender such as transgender, genderqueer, or nonbinary identity). The patients completed a demographic questionnaire on which they indicated their assigned sex at birth and their current gender identity.

Results: TGD patients had on average more diagnoses than cisgender patients (3.54 ± 1.88 vs 3.04 ± 1.72, t = 2.37, P = .02). After controlling for age, TGD patients were significantly more likely to be diagnosed with posttraumatic stress disorder and borderline personality disorder than cisgender patients (P < .05).

Conclusions: To the best of our knowledge, this is the first study of psychiatric patients using semistructured diagnostic interviews to compare the frequency of psychiatric disorders between cisgender and TGD patients. These results bear implications for creating gender-inclusive treatment facilities. Psychiatry programs interested in qualifying as Safe Zones and treating TGD patients should have or develop expertise in treating posttraumatic stress disorder and borderline personality disorder.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

  1. Beckwith N, McDowell MJ, Reisner SL, et al. Psychiatric epidemiology of transgender and nonbinary adult patients at an urban health center. LGBT Health. 2019;6(2):51–61. PubMed CrossRef
  2. Clements-Nolle K, Marx R, Guzman R, et al. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915–921. PubMed CrossRef
  3. Coulter RW, Blosnich JR, Bukowski LA, et al. Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug Alcohol Depend. 2015;154:251–259. PubMed CrossRef
  4. Reisner SL, White JM, Bradford JB, et al. Transgender health disparities: comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health. 2014;1(3):177–184. PubMed CrossRef
  5. Rodriguez-Seijas C, Eaton NR, Pachankis JE. Prevalence of psychiatric disorders at the intersection of race and sexual orientation: results from the National Epidemiologic Survey of Alcohol and Related Conditions-III. J Consult Clin Psychol. 2019;87(4):321–331. PubMed CrossRef
  6. Rodriguez-Seijas C, Fields EC, Bottary R, et al. Comparing the impact of COVID-19-related social distancing on mood and psychiatric indicators in sexual and gender minority (SGM) and non-SGM individuals. Front Psychiatry. 2020;11:590318. PubMed CrossRef
  7. Millet N, Longworth J, Arcelus J. Prevalence of anxiety symptoms and disorders in the transgender population: a systemic review of the literature. Int J Transgenderism. 2017;18(1):27–38. CrossRef
  8. Dhejne C, Van Vlerken R, Heylens G, et al. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. 2016;28(1):44–57. PubMed CrossRef
  9. Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev. 2018;66:24–38. PubMed CrossRef
  10. Reisner SL, Biello KB, White Hughto JM, et al. Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: Baseline findings from Project LifeSkills. JAMA Pediatr. 2016;170(5):481–486. PubMed CrossRef
  11. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–33, quiz 34–57. PubMed
  12. Nuttbrock L, Hwahng S, Bockting W, et al. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res. 2010;47(1):12–23. PubMed CrossRef
  13. Nuttbrock L, Bockting W, Rosenblum A, et al. Gender abuse and major depression among transgender women: a prospective study of vulnerability and resilience. Am J Public Health. 2014;104(11):2191–2198. PubMed CrossRef
  14. Bazargan M, Galvan F. Perceived discrimination and depression among low-income Latina male-to-female transgender women. BMC Public Health. 2012;12(1):663. PubMed CrossRef
  15. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69. PubMed CrossRef
  16. Dubois LZ. Associations between transition-specific stress experience, nocturnal decline in ambulatory blood pressure, and C-reactive protein levels among transgender men. Am J Hum Biol. 2012;24(1):52–61. PubMed CrossRef
  17. Durwood L, McLaughlin KA, Olson KR. Mental health and self-worth in socially transitioned transgender youth. J Am Acad Child Adolesc Psychiatry. 2017;56(2):116–123.e2. PubMed CrossRef
  18. Jefferson K, Neilands TB, Sevelius J. Transgender women of color: discrimination and depression symptoms. Ethn Inequal Health Soc Care. 2013;6(4):121–136. PubMed CrossRef
  19. Olson KR, Durwood L, DeMeules M, et al. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137(3):e20153223. PubMed CrossRef
  20. Spack NP, Edwards-Leeper L, Feldman HA, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics. 2012;129(3):418–425. PubMed CrossRef
  21. Nemoto T, Cruz TM, Iwamoto M, et al. A tale of two cities: access to care and services among African-American transgender women in Oakland and San Francisco. LGBT Health. 2015;2(3):235–242. PubMed CrossRef
  22. Brennan J, Kuhns LM, Johnson AK, et al; Adolescent Medicine Trials Network for HIV/AIDS Interventions. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–1757. PubMed CrossRef
  23. Meyer IH, Brown TN, Herman JL, et al. Demographic characteristics and health status of transgender adults in select US regions: Behavioral Risk Factor Surveillance System, 2014. Am J Public Health. 2017;107(4):582–589. PubMed CrossRef
  24. Salazar LF, Crosby RA, Jones J, et al. Contextual, experiential, and behavioral risk factors associated with HIV status: a descriptive analysis of transgender women residing in Atlanta, Georgia. Int J STD AIDS. 2017;28(11):1059–1066. PubMed CrossRef
  25. Warrier V, Greenberg DM, Weir E, et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun. 2020;11(1):3959. PubMed CrossRef
  26. Zimmerman M, Mattia JI. Psychiatric diagnosis in clinical practice: is comorbidity being missed? Compr Psychiatry. 1999;40(3):182–191. PubMed CrossRef
  27. Shear MK, Greeno C, Kang J, et al. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. 2000;157(4):581–587. PubMed CrossRef
  28. First MB, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-I/P, Version 2.0). New York, NY: Biometrics Research, New York State Psychiatric Institute; 1995.
  29. Pfohl B, Blum N, Zimmerman M. Structured Interview for DSM-IV Personality. American Psychiatric Press, Inc.; 1997.
  30. Ruxton GD, Neuhauser M. Review of alternative approaches to calculation of a confidence interval for the odds ratio of a 2 x 2 contingency table. Methods Ecol Evol. 2013;4(1):9–13. CrossRef
  31. Hyde Z, Doherty M, Tilley P, et al. The First Australian National Trans Mental Health Study: Summary of Results. School of Public Health; 2013.
  32. Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016;388(10042):412–436. PubMed CrossRef
  33. Zimmerman M, McGlinchey JB, Chelminski I, et al. Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview. Psychol Med. 2008;38(2):199–210. PubMed CrossRef
  34. Hendricks ML, Testa RJ. Roberts. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pr. 2012;43(5):460–467. CrossRef
  35. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–697. PubMed CrossRef
  36. Tan KKH, Treharne GJ, Ellis SJ, et al. Gender minority stress: a critical review. J Homosex. 2020;67(10):1471–1489. PubMed CrossRef
  37. White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–231. PubMed CrossRef
  38. Hatzenbuehler ML. How does sexual minority stigma “get under the skin”? a psychological mediation framework. Psychol Bull. 2009;135(5):707–730. PubMed CrossRef
  39. Bradford J, Reisner SL, Honnold JA, et al. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10):1820–1829. PubMed CrossRef
  40. Mizock L, Lewis TK. Trauma in transgender populations: risk, resilience, and clinical care. J Emotional Abuse. 2008;8(3):335–354. CrossRef
  41. Anzani A, Panfilis C, Scandurra C, et al. Personality disorders and personality profiles in a sample of transgender individuals requesting gender-affirming treatments. Int J Environ Res Public Health. 2020;17(5):1521. PubMed CrossRef
  42. Madeddu F, Prunas A, Hartmann D. Prevalence of Axis II disorders in a sample of clients undertaking psychiatric evaluation for sex reassignment surgery. Psychiatr Q. 2009;80(4):261–267. PubMed CrossRef
  43. Sansone RA, Lam C, Wiederman MW. Being bullied in childhood: correlations with borderline personality in adulthood. Compr Psychiatry. 2010;51(5):458–461. PubMed CrossRef
  44. Ball JS, Links PS. Borderline personality disorder and childhood trauma: evidence for a causal relationship. Curr Psychiatry Rep. 2009;11(1):63–68. PubMed CrossRef
  45. de Aquino Ferreira LF, Queiroz Pereira FH, Neri Benevides AML, et al. Borderline personality disorder and sexual abuse: a systematic review. Psychiatry Res. 2018;262:70–77. PubMed CrossRef
  46. Ogata SN, Silk KR, Goodrich S, et al. Childhood sexual and physical abuse in adult patients with borderline personality disorder. Am J Psychiatry. 1990;147(8):1008–1013. PubMed CrossRef
  47. Kavanaugh JG Jr, Volkan VD. Transsexualism and a new type of psychosurgery. Int J Psychoanal Psychother. 1978-1979;7:366–372. PubMed
  48. Meyer JK. The theory of gender identity disorders. J Am Psychoanal Assoc. 1982;30(2):381–418. PubMed CrossRef
  49. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10–51. PubMed CrossRef
  50. Rodriguez-Seijas C, Morgan TA, Zimmerman M. Is there a bias in the diagnosis of borderline personality disorder among lesbian, gay, and bisexual patients? Assessment. 2021;28(3):724–738. PubMed CrossRef
  51. Eaton N, Rodriguez-Seijas C, Pachankis JE. Transdiagnostic approaches to sexual and gender minority mental health. Psychol Sci. 2021;30(6):510–518. CrossRef
Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

Save Save

Share Share

Cite Cite

Vol 85 • 2024 • Number 3

Read the Current Issue

Editorial

Focus on Women’s Mental Health: Twenty Years and Counting

Original Research

Esmethadone in Patients With Major Depressive Disorder and Inadequate Response to Standard Antidepressants

Commentary

Can Our Collective Experiences As Clinicians Improve Mental Health Care?

Original Research

Prescription Opioid Use Disorder in US Adults Reporting Prescription Opioid Use

Original Research

Symptomatic Disorders Comorbid with Borderline Personality Disorder Over Time

Original Research

Aripiprazole Lauroxil Initiation Regimens
View current Issue

Celebrating
85 Years

Read the Journal of Clinical Psychiatry

Subscribe to read
more articles

Subscribe