++
I believe that telling our stories, first to ourselves and then to one another and the world, is a revolutionary act. It is an act that can be met with hostility, exclusion, and violence. It can also lead to love, understanding, transcendence, and community. I hope that my being real with you will help empower you to step into who you are and encourage you to share yourself with those around you.
++
Janet Mock, Redefining Realness: My Path to Womanhood, Identity, Love & So Much More1
++
This chapter begins reviewing the high prevalence of trauma and adversity among transgender and gender diverse (TGD) people and explaining the potential effects of trauma on their overall health and well-being. The chapter then describes how clinicians can support the healing and recovery of their TGD patients by incorporating principles of trauma-informed care during health care encounters and by advocating for trauma-informed changes at both institutional and systems levels.
+++
TRAUMA AND ITS EFFECTS
++
The concept of trauma has evolved over time; currently, it describes events that overwhelm ordinary human stress responses and “involve threats to life or bodily integrity, or a close personal encounter with violence or death.”2 For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as resulting from “an event, series of events, or set of circumstances that is experienced by an individual as physical or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”3 Traumatic events include violence (e.g., sexual, physical, and emotional abuse and other violent crimes), political acts (e.g., war, genocide, and torture), natural disasters and accidents (e.g., car crashes, house fires), and experiences with illness and disease (e.g., intensive care stays, birth trauma). Discrimination and structural violence, defined as social structures that stop individuals, groups, and societies from reaching their full potential, can also be experienced as traumatic.4 Studies estimate that approximately 90% of American adults will experience at least one traumatic event in their lifetime according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria.5 More than one-half of Americans have reported a traumatic experience related to interpersonal violence (child abuse, physical assault, and sexual violence).5
++
Adverse childhood experiences (ACEs), as defined by the landmark ACE study conducted by researchers at Kaiser Permanente, are specific types of trauma that occur before age 18. These include abuse (physical, emotional, or sexual), neglect (physical or emotional), and household dysfunction (exposure to divorce; a member of the household with mental illness, a substance use disorder, or who is incarcerated; or witnessing violence in the home).6 ACEs are common: over one-half of participants in the original Kaiser study reported at least one ACE. Moreover, ACEs were associated with increased health risk behaviors; mental illness; substance use ...