Different aspects of dissociative symptoms in practice with transgender clients

Abstract

Objectives Dissociation is a psychological defense mechanism against traumatic experiences, acute or long-term stressful events. Dissociation can affect self-concept, identity, memory, or perception of the external world. There is emerging evidence of a link between trauma and dissociation, and different mental health conditions other than trauma-related conditions. A wide range of defense mechanisms can be used in coping with painful, stressful, and traumatic life events. Dissociation is one of the defense mechanisms that transgender people who struggle with gender dysphoria may use. The goal of this case presentation is to recognize the importance of trauma history and dissociative symptoms during the assessment process of transgender clients. It is important to be aware of mental health issues to ensure a safer individualized process of transition (gender affirmation through desired medical interventions). Methods Three transgender participants that are presented were assessed by a multidisciplinary team of mental health professionals. Diagnostic procedures included quantitative and qualitative methodology. Informed consent was obtained. We focused on the plethora of dissociative symptoms presented by transgender clients with depression, borderline and schizoid personality structure. Results Various manifestations of dissociation which emerged during assessment led us to probe for traumatic events of different origins and address them through the psychotherapy process. Addressing dissociative symptoms in psychotherapy treatment resulted in better clinical outcomes, improved quality of life, better functioning, and satisfaction with partnership and sexuality for transgender clients who present dissociative symptoms. Conclusions Results comply with the concept of dissociation as a coping mechanism to overwhelming stressors. Focusing on childhood and adult trauma history and consequent dissociative symptoms should be included in differential diagnostic procedures and assessment with transgender clients with mental health issues. It is important to distinguish between those dissociative symptoms related to trauma or other mental health conditions and those that are used to cope with gender dysphoria. Conflicts of Interest The authors declare no conflict of interest. Dissociation is a psychological defense mechanism against traumatic experiences, acute or long-term stressful events. Dissociation can affect self-concept, identity, memory, or perception of the external world. There is emerging evidence of a link between trauma and dissociation, and different mental health conditions other than trauma-related conditions. A wide range of defense mechanisms can be used in coping with painful, stressful, and traumatic life events. Dissociation is one of the defense mechanisms that transgender people who struggle with gender dysphoria may use. The goal of this case presentation is to recognize the importance of trauma history and dissociative symptoms during the assessment process of transgender clients. It is important to be aware of mental health issues to ensure a safer individualized process of transition (gender affirmation through desired medical interventions). Three transgender participants that are presented were assessed by a multidisciplinary team of mental health professionals. Diagnostic procedures included quantitative and qualitative methodology. Informed consent was obtained. We focused on the plethora of dissociative symptoms presented by transgender clients with depression, borderline and schizoid personality structure. Various manifestations of dissociation which emerged during assessment led us to probe for traumatic events of different origins and address them through the psychotherapy process. Addressing dissociative symptoms in psychotherapy treatment resulted in better clinical outcomes, improved quality of life, better functioning, and satisfaction with partnership and sexuality for transgender clients who present dissociative symptoms. Results comply with the concept of dissociation as a coping mechanism to overwhelming stressors. Focusing on childhood and adult trauma history and consequent dissociative symptoms should be included in differential diagnostic procedures and assessment with transgender clients with mental health issues. It is important to distinguish between those dissociative symptoms related to trauma or other mental health conditions and those that are used to cope with gender dysphoria.