The frequency of potentially traumatic events (PTEs) and associated symptoms were examined in a cross-sectional study of 97 transgender participants who had been classified as male at birth. A total of 98% reported at least one PTE and 91% endorsed multiple events. Of those with PTE exposures, 42% reported that at least one event was transgender bias-related. Among those with PTEs, 17.8% endorsed clinically significant symptoms of PTSD and 64% reported clinically significant depressive symptoms. The percentage of transgender individuals in this sample reporting clinically significant symptoms was higher than in trauma-exposed samples of men in the general population, but roughly similar to rates of female trauma survivors. Amount of time spent dressed consistent with gender identity was associated with increased risk for PTE exposure and was positively associated with mental health symptoms. No differences in symptoms were observed when comparing those with and without transgender bias-related PTEs. Overall, transgender individuals endorsed high prevalence of PTE exposure along with elevated PTSD and depressive symptoms, when compared to other traumatized populations.

References

American Psychiatric Association . ( 2000 ). Diagnostic and statistical manual of mental disorders ( 4th ed. , text revision). Washington, DC : Author .

Google Scholar

American Public Health Association . ( 2009 , February 13 ). Retrieved from http://www.apha.org/

Google Scholar

Balsam, K. F., Rothblum, E. D., Beauchaine, T. P. ( 2005 ). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings . Journal of Consulting and Clinical Psychology, 73, 477 - 487 .

Google Scholar Crossref | Medline | ISI

Berrill, K. T. ( 1990 ). Anti-gay violence and victimization in the United States: An overview . Journal of Interpersonal Violence, 5, 274 - 294 .

Google Scholar SAGE Journals

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., Forneris, C. A. ( 1996 ). Psychometric properties of the PTSD Checklist (PCL) . Behaviour Research and Therapy, 34, 669 - 673 .

Google Scholar Crossref | Medline | ISI

Bradley, S. J., Zucker, K. J. ( 1997 ). Gender identity disorder: A review of the past 10 years . Journal of the American Academy of Child and Adolescent Psychiatry, 36, 872 - 880 .

Google Scholar Crossref | Medline | ISI

Breslau, N., Kessler, R., Chilcoat, H. D., Schultz, L. R., Davis, G. C., Andreski, P. ( 1998 ). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma . Archives of General Psychiatry, 55, 626 - 632 .

Google Scholar Crossref | Medline

Brewin, C. R., Andrews, B., Valentine, J. D. ( 2000 ). Meta-Analysis of risk factors for posttraumatic stress disorder in trauma- exposed adults . Journal of Consulting and Clinical Psychology, 68, 748 - 766 .

Google Scholar Crossref | Medline | ISI

Clements-Nolle, K., Marx, R., Katz, M. ( 2006 ). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization . Journal of Homosexuality, 51, 53 - 69 .

Google Scholar Crossref | Medline | ISI

Cohen-Kettenis, P. T., Owen, A., Kaijser, V. G., Bradley, S. J., Zucker, K. J. ( 2003 ). Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis . Journal of Abnormal Child Psychology, 31, 41 - 53 .

Google Scholar Crossref | Medline | ISI

Cole, C. M., O’Boyle, M., Emory, L. E., Meyer, W. J.. ( 1997 ). Comorbidity of gender dysphoria and other major psychiatric diagnoses . Archives of Sexual Behavior, 26, 13 - 26 .

Google Scholar Crossref | Medline | ISI

Comstock, G. D. ( 1991 ). Violence against lesbian and gay men. New York, NY : Colombia University Press .

Google Scholar Crossref

Dean, L., Meyer, I. H., Robinson, K., Sell, R. L., Sember, R., Silenzio, V. M. B., . . . Dunn, P. ( 2000 ). Lesbian, gay, bisexual and transgender health: Findings and concerns.: Retrieved from Gay and Lesbian Medical Association & Columbia University Joseph L. Mailman School of Public Health Center for Lesbian, Gay, Bisexual, and Transgender Health.

Google Scholar

Dobie, D. J., Kivlahan, D. R., Maynard, C., Bush, K. R., Davis, T. M., Bradley, K. A. ( 2004 ). Posttraumatic stress disorder in female veterans: Association with self-reported health problems and functional impairment . Archives of Internal Medicine, 164, 394 - 400 .

Google Scholar Crossref | Medline

Dohrenwend, B. P., Turner, J. B., Turse, N. A., Adams, B. G., Koenen, K. C., Marshall, R. ( 2006 ). The psychological risks of Vietnam for U.S. veterans: A revisit with new data and methods . Science, 313, 979 - 982 .

Google Scholar Crossref | Medline | ISI

Drummond, K. D., Bradley, S. J., Peterson-Badali, M., Zucker, K. J. ( 2008 ). A follow-up study of girls with gender identity disorder . Developmental Psychology, 44, 34 - 45 .

Google Scholar Crossref | Medline | ISI

Ehlers, A., Clark, D. M. ( 2000 ). A cognitive model of posttraumatic stress disorder . Behaviour Research and Therapy, 38, 319 - 345 .

Google Scholar Crossref | Medline | ISI

Ehlers, A., Hackmann, A., Steil, R., Clohessy, S., Wenninger, K., Winter, H. ( 2002 ). The nature of intrusive memories after trauma: The warning signal hypothesis . Behaviour Research and Therapy, 40, 995 - 1002 .

Google Scholar Crossref | Medline | ISI

FBI Uniform Crime Reports . ( 2005-2007 ). Hate crime statistics. Retrieved from http://www.fbi.gov/ucr/ucr.htm

Google Scholar

Foa, E. B., Rothbaum, B. O. ( 1998 ). Treating the trauma of rape: Cognitive behavioral therapy for PTSD. New York, NY : Guildford Press .

Google Scholar

Fontana, A., Rosenheck, R. ( 1998 ). Duty- related and sexual stress in the etiology of PTSD among women veterans who seek treatment . Psychiatric Services, 49, 658 - 662 .

Google Scholar Crossref | Medline | ISI

Garnets, L., Herek, G. M., Levy, B. ( 1990 ). Violence and victimization of lesbians and gay men: Mental health consequences . Journal of Interpersonal Violence, 5, 366 - 383 .

Google Scholar SAGE Journals

Garnets, L., Herek, G. M., Levy, B. ( 1992 ). Violence and victimization of lesbians and gay men: Mental health consequences . In Herek, G. M., Berrill, K. T. (Eds.), Hate crimes: Confronting violence against lesbians and gay men (pp. 207 - 226 ). Newbury Park, CA : Sage .

Google Scholar

Gehring, D., Knudson, G. ( 2005 ). Prevalence of childhood trauma in a clinical population of transsexual people . International Journal of Transgenderism, 8, 23 - 80 .

Google Scholar Crossref

Green, B. L., Goodman, L. A., Krupnick, J. L., Corcoran, C. B., Petty, R. M., Stockton, P., Stern, N. M. ( 2000 ). Outcomes of single versus multiple trauma exposure in a screening sample . Journal of Traumatic Stress, 13, 271 - 286 .

Google Scholar Crossref | Medline | ISI

Heidt, J. M., Marx, B. P., Gold, S. D. ( 2005 ). Sexual revictimization among sexual minorities: A preliminary study . Journal of Traumatic Stress, 18, 533 - 540 .

Google Scholar Crossref | Medline | ISI

Herek, G. M. ( 1991 ). Stigma, prejudice and violence against lesbians and gay men . In Gonsiorek, J. C., Weinrich, J. D. (Eds.), Homosexuality: Research implications for public policy (pp. 60 - 80 ). Newbury Park, CA : Sage .

Google Scholar Crossref

Herek, G. M., Berrill, K. T. (Eds.). ( 1992 ). Hate crimes: Confronting violence against lesbians and gay men. Newbery Park, CA : Sage .

Google Scholar

Herek, G. M., Gillis, J. R., Cogan, J. C. ( 1999 ). Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults . Journal of Consulting and Clinical Psychology, 67, 945 - 951 .

Google Scholar Crossref | Medline | ISI

Herek, G. M., Gillis, J. R., Cogan, J. C., Glunt, E. K. ( 1997 ). Hate crime victimization among lesbian, gay, and bisexual adults: Prevalence, psychological correlates, and methodological issues . Journal of Interpersonal Violence, 12, 195 - 217 .

Google Scholar SAGE Journals | ISI

Hershberger, S. L., D’Augelli, A. R. ( 1995 ). The impact of victimization on mental health and suicidality of lesbian, gay and bisexual youths . Developmental Psychology, 31, 65 - 74 .

Google Scholar Crossref | ISI

Horowitz, M. J. ( 1986 ). Stress response syndromes: A review of posttraumatic and adjustment disorders . Hospital and Community Psychiatry, 37, 241 - 249 .

Google Scholar Medline

Janoff-Bulman, R. ( 1996 ). Psychometric review of World Assumption Scale . In Stamm, B. H. (Ed.), Measurement of stress, trauma and adaptation. Lutherville, MD : Sidran Press .

Google Scholar

Kaysen, D., Lostutter, T. W., Goines, M. A. ( 2005 ). Cognitive processing therapy for acute stress disorder resulting from an anti-gay assault . Cognitive and Behavioral Practice, 12, 278 - 289 .

Google Scholar Crossref | Medline | ISI

Kenagy, G. P. ( 2005 ). Transgender health: Findings from two needs assessment studies in Philadelphia . Health and Social Work, 30, 19 - 26 .

Google Scholar Crossref | Medline | ISI

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., Nelson, C. B. ( 1995 ). Posttraumatic stress disorder in the National Comorbidity Survey . Archives of General Psychiatry, 52, 1048 - 1060 .

Google Scholar Crossref | Medline

Kim, T. S., Cheon, Y. H., Pae, C. U., Kim, J. J., Lee, C. U., Lee, S. J., . . . Lee, C. ( 2006 ). Psychological burdens are associated with young male transsexuals in Korea . Psychiatry and Clinical Neurosciences, 60, 417 - 421 .

Google Scholar Crossref | Medline | ISI

Kosciw, J., Cullen, M. K. ( 2001 ). The GLSEN 2001 National School Climate Survey: The school-related experiences of our nation’s lesbian, gay, bisexual and transgender youth. New York, NY : GLSEN .

Google Scholar

Kubany, E. S., Haynes, S. N., Leisen, M. B., Owens, J. A., Kaplan, A. S., Watson, S. B., Burns, K. ( 2000 ). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire . Psychological Assessment, 12, 210 - 224 .

Google Scholar Crossref | Medline | ISI

Litz, B. T., Miller, M. W., Ruef, A. M., McTeague, L. M. ( 2002 ). Exposure to trauma in adults . In Antony, M. M., Barlow, D. H. (Eds.), Handbook of assessment and treatment planning for psychological disorders (pp. 215 - 258 ). New York, NY : Guilford .

Google Scholar

Lombardi, E. L., Wilchins, R. A., Priesing, D., Malouf, D. ( 2001 ). Gender violence: Transgender experiences with violence and discrimination . Journal of Homosexuality, 42, 89 - 101 .

Google Scholar Crossref | Medline | ISI

Maguen, S., Shipherd, J. C., Harris, H. N. ( 2005 ). Providing culturally sensitive care for transgender patients . Cognitive and Behavioral Practice, 12, 479 - 490 .

Google Scholar Crossref | ISI

Maguen, S., Shipherd, J. C., Harris, H. N., Welch, L. P. ( 2007 ). Prevalence and predictors of disclosure of transgendered identity . International Journal of Sexual Health, 19, 3 - 13 .

Google Scholar Crossref

Mays, V. M., Cochran, S. D. ( 2001 ). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States . American Journal of Public Health, 91, 1869 - 1876 .

Google Scholar Crossref | Medline | ISI

McDevitt, J., Balboni, J., Garcia, L., Gu, J. ( 2001 ). Consequences for victims: A comparison of bias- and non- bias- motivated assaults . American Behavioral Scientist, 45, 697 - 713 .

Google Scholar Abstract | ISI

Meyer, I. H. ( 1995 ). Minority stress and mental health in gay men . Journal of Health and Social Behavior, 36, 38 - 56 .

Google Scholar Crossref | Medline | ISI

Monson, C. M., Gradus, J. L., Young-Xu, Y., Schnurr, P. P., Price, J. L. ( 2008 ). Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree? Psychological Assessment, 20, 131 - 138 .

Google Scholar Crossref | Medline | ISI

Morrow, K. B. ( 1991 ). Attributions of female adolescent incest victims regarding their molestation . Child Abuse and Neglect, 15, 477 - 483 .

Google Scholar Crossref | Medline | ISI

National Coalition of Anti-Violence Programs and Horizons . ( 1995 ). Anti-lesbian/gay violence in 1995. Chicago, IL : Horizons .

Google Scholar

Newman, E., Riggs, D. S., Roth, S. ( 1997 ). Thematic resolution, PTSD, and complex PTSD: The relationship between meaning and trauma-related diagnoses . Journal of Traumatic Stress, 10, 197 - 213 .

Google Scholar Crossref | Medline | ISI

Noelle, M. ( 2002 ). The ripple effect of the Matthew Shepard murder . American Behavioral Scientist, 46, 27 - 50 .

Google Scholar SAGE Journals | ISI

Olff, M., Langeland, W., Draijer, N., Gersons, B. P. ( 2007 ). Gender differences in posttraumatic stress disorder . Psychological Bulletin, 133, 183 - 204 .

Google Scholar Crossref | Medline | ISI

Ozer, E. J., Best, S. R., Lipsey, T. L., Weiss, D. S. ( 2003 ). Predictors of posttraumatic stress disorder and symptoms in adults: A meta- analysis . Psychological Bulletin, 129, 52 - 73 .

Google Scholar Crossref | Medline | ISI

Pineles, S. L., Shipherd, J., Mostoufi, S. M., Abramovitz, S. M., Yovel, I. ( 2009 ). Attentional biases in PTSD: More evidence for interference . Behaviour Research and Therapy, 47, 1050 - 1057 .

Google Scholar Crossref | Medline | ISI

Radloff, L. S. ( 1977 ). The CES-D Scale: A self-report depression scale for research in the general population . Applied Psychological Measurement, 1, 385 - 401 .

Google Scholar SAGE Journals

Resick, P. A., Schnicke, M. K. ( 1992 ). Cognitive processing therapy for sexual assault victims . Journal of Consulting and Clinical Psychology, 60, 748 - 756 .

Google Scholar Crossref | Medline | ISI

Rose, S. M., Mechanic, M. B. ( 2002 ). Psychological distress, crime features, and help-seeking behaviors related to homophobic bias incidents . American Behavioral Scientist, 46, 14 - 26 .

Google Scholar SAGE Journals | ISI

Sattler, D. N., de Alvarado, A. M., de Castro, N. B., Male, R. V., Zetino, A. M., Vega, R. ( 2006 ). El Salvador earthquakes: relationships among acute stress disorder symptoms, depression, traumatic event exposure, and resource loss . Journal of Traumatic Stress, 19, 879 - 893 .

Google Scholar Crossref | Medline | ISI

Schnurr, P. P., Green, B. L. ( 2004 ). Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes . Advances in Mind-Body Medicine, 20, 18 - 29 .

Google Scholar Medline

Schnurr, P. P., Jankowski, M. K. ( 1999 ). Physical health and Post-traumatic stress disorder: Review and synthesis . Seminars in Clinical Neuropsychiatry , 4, 295 - 304 .

Google Scholar

Schumm, J. A., Briggs-Phillips, M., Hobfoll, S. E. ( 2006 ). Cumulative interpersonal traumas and social support as risk and resiliency factors in predicting PTSD and depression among inner-city women . Journal of Traumatic Stress, 19, 825 - 836 .

Google Scholar Crossref | Medline | ISI

Shalev, A. Y., Freedman, S., Peri, T., Brandes, D., Sahar, T., Orr, S. P., Pitman, R. K. ( 1998 ). Prospective study of posttraumatic stress disorder and depression following trauma . American Journal of Psychiatry, 155, 630 - 637 .

Google Scholar Crossref | Medline | ISI

Tak, S., Driscoll, R., Bernard, B., West, C. ( 2007 ). Depressive symptoms among firefighters and related factors after the response to Hurricane Katrina . Journal of Urban Health, 84, 153 - 161 .

Google Scholar Crossref | Medline | ISI

Terhakopian, A., Sinaii, N., Engel, C. C., Schnurr, P. P., Hoge, C. W. ( 2008 ). Estimating population prevalence of posttraumatic stress disorder: An example using the PTSD checklist . Journal of Traumatic Stress, 21, 290 - 300 .

Google Scholar Crossref | Medline | ISI

Tolin, D. F., Foa, E. B. ( 2006 ). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research . Psychological Bulletin, 132, 959 - 992 .

Google Scholar Crossref | Medline | ISI

Ventureyra, V. A., Yao, S. N., Cottraux, J., Note, I., De Mey-Guillard, C. ( 2002 ). The validation of the Posttraumatic Stress Disorder Checklist Scale in posttraumatic stress disorder and nonclinical subjects . Psychotherapy and Psychosomatics, 71, 47 - 53 .

Google Scholar Crossref | Medline | ISI

Vogt, D. S., Pless, A. P., King, L. A., King, D. W. ( 2005 ). Deployment stressors, gender and mental health outcomes among Gulf War I veterans . Journal of Traumatic Stress, 18, 115 - 127 .

Google Scholar Crossref | Medline | ISI

Ware, J. E., Kosinski, M., Keller, S. D. ( 1995 ). SF-12: How to score the SF-12 physical and mental health summary scales. Boston, MA : The Health Institute, New England Medical Center .

Google Scholar

Ware, J. E., Kosinski, M., Keller, S. D. ( 1996 ). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity . Medical Care, 34, 220 - 233 .

Google Scholar Crossref | Medline | ISI

Weathers, F., Litz, B. T., Herman, D. S., Huska, J. A., Keane, T. M. ( 1993 ). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Presentation at the International Society for Traumatic Stress Studies , San Antonio, Texas .

Google Scholar

Wolfe, J., Sharkansky, E. J., Read, J. P., Dawson, R., Martin, J. A., Ouimette, P. C. ( 1998 ). Sexual harassment and assault as predictors of PTSD symptomatology among U.S. female Persian Gulf War military personnel . Journal of Interpersonal Violence, 13, 40 - 57 .

Google Scholar SAGE Journals | ISI

Xavier, J. M. ( 2000 ). The Washington Transgender Needs Assessment Survey (WTNAS) . Retrieved from http://www.gender.org/vaults/wtnas.html

Google Scholar