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5 Myths About Transgender Mental Health—and Why They’re Harmful

Dispelling these pervasive misconceptions can help boost mental well-being for gender-diverse people.

5 Myths About Transgender Mental Health—and Why They’re Harmful

Medically reviewed in November 2021

Updated on November 12, 2021

With the increasing visibility of the transgender, gender nonconforming, and nonbinary community, misconceptions about the mental health of gender-diverse people have proliferated in recent years. Not only are these myths incorrect, but they are harmful, as they often suggest that being transgender is inherently a mental health disorder rather than a valid identity and experience.

Sand Chang, PhD is a psychologist based in Oakland, California who specializes in working with gender-diverse clients. We spoke with Chang to gain insight into some of the most persistent myths transgender people often confront and what can be done to combat them.

MYTH: Being transgender is a mental illness.
Transgender identity is not classified as mental health disorder in the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, which is used by providers to diagnose individuals with mental health challenges. In recent years, leading health organizations, including the World Health Organization and the American Psychological Association, have also issued statements forcefully emphasizing that being transgender is not a mental disorder.

"Rather than classifying transgender identity as a mental illness," Chang says, "it's important to recognize that being transgender is an expression of human diversity and often an important cultural identity."

A mental illness is a health condition that impacts emotion, thinking, and/or behavior in a way that is distressing and impairing to the individual. Gender expression, meanwhile, is not inherently distressing or impairing, nor is gender considered a health condition. What may be distressing, however, is the environment in which gender-diverse people often find themselves.

“Many trans people suffer from mental health challenges because of anti-trans bias and ciscentrism in the world, but they are not inherently mentally ill,” Chang explains. (Cisgender refers to a person whose gender identity corresponds with the sex they were identified as having at birth. A ciscentric outlook suggests that transgender people’s needs or identities are less valid than those of cisgender people.)

While transgender identity is not in the DSM-5, gender dysphoria is, though this classification is contested by many practitioners who specialize in caring for transgender patients.

Dysphoria refers to the distress someone might experience when they feel their gender identity doesn’t align with their physical or physiological characteristics. It’s important to note that not all transgender, gender nonconforming, or nonbinary people experience gender dysphoria, but it remains a requirement for obtaining many gender-affirming treatments.

Because dysphoria, distress, and impairment are not inevitable consequences of being transgender, it’s not accurate to equate being transgender with mental illness.

MYTH: Higher rates of mental illness in transgender people can only be remedied through therapy.
While therapy—whether provided by a psychiatrist, psychologist, social worker, or a counselor—can be a valuable tool in addressing and improving the mental well-being of transgender people, it’s far from the only source of support that transgender people need.

“For some people, medical interventions to affirm gender are crucial,” Chang says. “Seeking out a healthcare provider who can support someone in feeling more affirmed in their gender can certainly be helpful, as well. Feeling affirmed by the external environment through different means of social transition is also important.”

In fact, the National LGBT Health Education Center makes a number of recommendations for improving mental health in transgender people who are struggling with mental illness. These can work at individual and societal levels, and include:

MYTH: Believing you aren’t the gender you were assigned at birth is a delusion.
Beliefs about one’s own gender, and what constitutes someone’s gender identity, are not delusions, but are rooted in and determined by one’s self-identification.

Nowhere in the DSM-5 is gender identity considered a diagnosable delusion. Gender is a feature of culture and its definition is not fixed or universal. Rather, gender describes one’s sense of self. The fact that people disagree on how gender is determined is evidence of its subjective nature.

“The problem exists in the external environment, which makes mistaken assumptions based on people’s appearance,” Chang says. The misconceptions of others—rather than the way an individual relates in their own life to the concept of gender—can therefore lead to distress.

MYTH: If transgender people did enough therapy, they would no longer be transgender.
Simply put, therapy is not designed to change someone’s self-identification, but to enable them to thrive, however they identify. No legitimate studies prove that any therapeutic approach can alter someone’s intrinsic sense of self.

In fact, research has shown that psychological interventions that attempt to change one’s gender identity (known as “conversion therapy” or “gender identity conversion efforts”) contribute to psychological distress and increase one's likelihood of attempting suicide.

MYTH: The rate of suicidality among transgender people is greatly exaggerated.
While research on transgender mental health is limited, available evidence indicates a strong risk of suicide.

According to the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, upwards of 40 percent of transgender people have attempted suicide in their lifetimes, compared to 4.6 percent of Americans overall. This is consistent with findings from the 2019 Trevor Project National Survey, which notes that more than half of transgender respondents had considered suicide.

Research suggests that transgender people are four times more likely than their cisgender counterparts to have a mental health diagnosis, which is a notable risk factor for suicidal and self-harm behaviors. This includes a nearly four times higher risk of depression in transgender people who have not received mental health support.

Additional risk factors abound, especially in less supportive environments. “The barriers to accessing affirming treatment and medical care heighten the risk for transgender individuals,” Chang notes. “In particular, transgender youth have a greater need to feel that their social environment is supporting them. A lack of that support increases distress.”

While further research is needed, there is no compelling reason to believe that suicide rates among transgender people are an exaggeration. It’s a real problem that requires concerted attention and effort to remedy. (If you or someone you know is considering suicide or having thoughts of suicide, call the National Suicide Prevention Lifeline at 800-273-8255.)

Transgender people deserve better
Transgender people need to have their experiences believed and validated and to have an opportunity to occupy affirming environments. By perpetuating myths about mental health, we ignore the real challenges that transgender and gender-diverse people face in their daily lives. Pushing back against false notions can create room for more honest, empowering conversations about the needs of the transgender community.

Sources:

American Psychological Association. APA Resolution on Gender Identity Change Efforts. February 2021.
National LGBT Health Education Center, a Program of the Fenway Institute. Caring for Transgender People with Severe Mental Illness. May 2018.
Turban JL, Beckwith N, Reisner SL, Keuroghlian AS. Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry. 2020;77(1):68-76.
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M.. Executive Summary of the Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. 2016.
The Trevor Project National Survey on LGBTQ Youth Mental Health. 2019.
Wanta JW, Niforatos JD, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgend Health. 2019;4(1):313-315.
Witcomb GL, Bouman WP, Claes L, Brewin N, Crawford JR, Arcelus J. Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. J Affect Disord. 2018;235:308-315.

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