Understanding PTSD Assessment Challenges in Transgender and Gender Diverse Communities

A recent study was published on the complexities of assessment of PTSD among transgender and gender diverse (TGD) adults. TGD people face high rates of violence across the lifespan, including within families and relationships. TGD people also experience stress related to societal mistreatment and marginalization, for example stress related to discrimination and exclusion, gender non-affirmation, identity concealment, and misgendering. 

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is considered the 'gold standard' for PTSD. Dr. Valentine conducted the first study to administer the CAPS-5 to TGD adults. The study is a qualitative analysis of the process of administering the CAPS-5, which documented complexities and challenges unique to TGD adults.  

Half of the study participants met diagnostic criteria for PTSD. Example complexities include that participants had difficulty differentiating whether current distress was linked to discrete events called index trauma (traumas that involved life threat, serious injury, or sexual violence) or chronic, pervasive discrimination. This makes assessment more difficult as the presence of a symptom is only marked “yes” when the participant is able to link the current symptom to the index event. Finally, the level of impairment associated with PTSD symptoms, suggesting that TGD people experience greater impairment in response to trauma. Greater impairment may be evidence of the impact of trauma, discrimination, and marginalization on emotional, social, and occupational functioning.   

Key findings suggest, given the complex intersections of chronic trauma and discrimination experienced by TGD communities, using CAPS-5 without specialized training on TGD populations could lead to inaccurate diagnoses. Some recommendations include validating stressful experiences (even if not classified as an index trauma) and understanding that vigilance in the face of actual threats differs from PTSD hypervigilance.  

There is a need for more research to address clinical, conceptual, and assessment challenges and knowledge gaps in TGD populations.