Are trans people more prone to personality disorders than the general population, and if so, so what?
This research, published in March 2020, is trans friendly. It introduced me to the term “medicalised trans people”, that is, trans people who seek out diagnosis, hormones, or surgery, as trans people may simply be, without seeking these things. It finds a cause for personality disorders: as it says, we suffer stressful reactions from others because of our gender nonconformity, and that stress, and internalised transphobia, may cause anxiety or substance misuse.
It recommends that mental health professionals should affirm not pathologize our identity, but take account of these associated mental health disorders and personality disorders when establishing treatment plans. That will help us navigate the transition process, improve our quality of life, and reduce gender dysphoria.
We show a higher rate of anxiety and depression, and other psychiatric disorders, than the general population. They use the Minority Stress theory to suggest that exposure to minority stress may cause personality disorders, and ways of being with other people that mimic personality disorders. Hit me enough, and you make me expect to be hit. Repeated messages that our identity and core selves are unacceptable, which we receive from discrimination, may cause maladaptive personality traits.
Personality disorders might make it difficult to adapt to transition, and reduce our well-being and satisfaction after. They might influence how our gender dysphoria is demonstrated to others.
The researchers found that trans women’s personality profile was closer to that of cis women than cis men, and trans men’s resembled cis men’s.
The DSM V Alternative model for personality disorders (AMPD) diagnoses by moderate or severe impairment in personality functioning, and one or more pathological personality traits- negative affect, detachment, antagonism, disinhibition, and psychoticism. Well, if I have to fight for my rights I may come across as antagonistic. I have been seen as detached: I don’t show appropriate sadness at bad things happening, because it’s just one more thing on top of all the rest.
This could be seen as an adaptive strategy to reduce the effect of stigma on my health, produce resilience, and improve my social adjustment.
And then, I am afraid I do not understand the study. It says,
First, the AMPD dimensional assessment of personality traits indicated that the transgender sample presented, overall, a healthier and less maladaptive personality profile than their cisgender counterparts matched by gender identity. Second, the categorical approach to PDs diagnoses by means of structured clinical interviewing pointed out a considerable prevalence of PDs in our sample: almost half of the included transgender clients exhibited at least one PD diagnosis.
I don’t know if that says we are more disordered, or less. However, the study says the trans sample they assessed 50% had PDs, and that fits previous research. In the general population, large epidemiological studies show a prevalence of 15%. That might show we are more likely to develop PDs.
They suggest we develop personality disorders as a maladaptive way of coping with dysphoria. We develop social isolation, self harm, anger outbursts, and envy of others. Other minorities also have higher rates of PDs.
They found that we showed lower rates of PDs when assessed by questionnaire than when assessed by interview. They consider this shows that we still distrust the treatment process, treating doctors as gatekeepers even if they intend an affirming model of trans care. We want the hormones sooner than they will give them.
The research is here: Personality Disorders and Personality Profiles in a Sample of Transgender Individuals Requesting Gender-Affirming Treatments, by Annalisa Anzani and others.