I spent last weekend at the Colorado Gold Rush conference, an event sponsored by the Healthcare Guild and the GIC.  The conference was originally designed as a resource for transgender folks who needed a safe space to find common ground and provide mutual support for each other.  Once upon a time, the conference was one of the few places where people in the trans community could get the information they need to live their lives.  Since more resources exist, the conference has become less necessary…but still very useful.  Now, the conference has expanded its purpose to include presentations that are geared toward mental health workers.  That works out great for me, of course.  It helps me stay updated on the latest information and provides opportunities to participate in interesting discussions.

One of the most engaging presentations was “Intersections of Trauma and Gender Variant/Transgender Identity:  Treatment Considerations for Compassionate, High-Quality care.  This was presented by Erin Jacklin and Kendra Doukas from the Catalyst Center.  One major issue discussed was the prevalence of complex PTSD in gender-variant people.

“Complex” PTSD may not fit the pattern of symptoms that plague victims of single-incident trauma. Single-incident “shock” trauma often results in flashbacks to the event, often leading to avoidance of situations that trigger memories.  While untreated shock trauma can be devastating, victims are granted one saving grace…at least they know where their symptoms come from.

Complex trauma is a whole different animal.  It is often misdiagnosed, and people can go for years without receiving proper treatment.  Fortunately, this is changing, largely thanks to Judith Hermann and her seminal book “Trauma and Recovery.”  We’ve still got a long way to go.  One complication with cPTSD is that clients (and often, therapists) can’t pin down one “Big T” trauma that caused the symptoms…and yet the client may be chronically anxious, depressed and hyper-vigilent.  They may struggle with maintaining stable relationships or employment, despite their best efforts.  Or, they may walk around in a constant state of feeling disconnected, without knowing why.

There is always a reason for symptoms.  People do not choose to live this way.  cPTSD can be the result of physical or sexual abuse…but sometimes, it’s not.  Sadly, the impact of emotional abuse is often underestimated.

Trauma is often defined as a reaction to an event perceived as life-threatening.  That definition seems simple enough.  But let’s look at what we perceive as life-threatening.  Threat-perception is a tricky thing.  It’s subjective, based on circumstances and individual characteristics.

Let’s look at one example of stress, which may or may not be traumatic:  rejection.  If a mature adult is rejected or treated coldly, they may be hurt, but not traumatized.  If a small child is raised by cold or emotionally rejecting parents, trauma will almost certainly occur.  Even if the child’s physical needs are met, the absence of emotional nurturing can be perceived as life-threatening.  A child depends utterly on parents.  They will not trust parents who are emotionally distant, and they will grow up perceiving the world as unsafe.  Likely result?  cPTSD.

Now, what about adults?  Can they experience complex emotional trauma?  Again this depends on the circumstances.

If an adult experiences a single incident of being rejected or treated coldly, they may be hurt, but not traumatized.

If an adult experiences chronic, repetitive instances of rejection from their community, even if the person’s physical needs are met, the absence of emotional nurturing can be perceived as life-threatening.  A person depends very much on community.  They will not trust a community that is emotionally distant, rejecting or cold.  They may live their life perceiving that the world is unsafe.  Possible result?

Complex trauma.  Because, even if we live with abundant food, clothing and shelter…what happens in a crisis?  Can we count on the support of family, friends and even complete strangers?  Would our neighbors loan us their phone to dial 911?   Hopefully…but do we know for sure?

If we are living our lives as straight, white cisgender folks, we may take our community’s support for granted.  We may lose sight of the fact that some people can’t presume to have that safety net.  I celebrate the fact that the Affordable Care Act contains non-discrimination policies for Transgender people (Thanks, Obama). I lament the fact that the polices had to be there in the first place.  About one in 5 trans people have been denied basic medical care, simply because of their gender identity. It is possible, then, for some people to live in a chronically unsafe, potentially traumatizing situation simply by living in America.  Small rejections or microaggressions can be painful reminders of this lack of safety.

While it is small-minded for therapists to assume all transgender clients (or clients belonging to any marginalized group) have complex PTSD, it is vitally important to be aware of how discrimination might affect a client’s way of being in the world.  This often requires us cis therapists to look at our own privilege, and commit to ongoing self-examination regarding any microaggressions we may inadvertently commit.  We are (sorry to say) part of the healthcare system that has been guilty of discrimination.  Let’s keep looking at our position with critical analysis, courage and compassion for ourselves.  This will allow us to change the system, one therapist at a time.