Leading the Way in Trauma Therapy

Does being a transgender child entail being doomed to a life of posttraumatic stress and misery? At first glance it doesn’t look so good. Let’s start with the 41% attempted suicide rate. Yes, 41% – nearly half of transgender individuals have tried to kill themselves. Other research indicates that compared to cisgender children, transgender children have substantially higher rates of anxiety and depression (a fair estimate of post-traumatic stress when the latter is not directly assessed).

The obvious question is whether the transgender child’s terrible fate is somehow inherent to being transgender, or rather the result of the shaming, bullying, and discrimination that has been visited upon the child. Fortunately, the answer, as per a recent landmark study, is the latter.

For the first time, many transgender children are living openly as such, and enjoying social acceptance and support in their identities, so these “socially transitioned” transgender children can now be studied. Olsen and colleagues (2016) compared 73 socially transitioned transgender children (ages 3-12) to 73 matched controls and 49 cisgender siblings. Parents completed depression and anxiety measures regarding their children. The primary finding: “Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group.”

I observed this dynamic in action with a child I know well, “Andy.” From age two or so he insisted on wearing dresses – “He wants to be like his older sister,” the parents explained to me. But the dress-wearing persisted into preschool. And he played “family” with the other girls, rather than playing cars with the boys. At age three he persistently said he was she, and to call her Ariel (presumably after the character in the Disney movie). Finally the parents got it: “We thought we had a boy, but we have a girl. At least for now, maybe it’ll change again, maybe not. But for now, we’ll respect and support her as a girl.”

Ariel did not like going to “school” where several of the children routinely challenged her identity. “You’re really a boy, right?” Finally Ariel’s mother met with the preschool teacher and gave her several books about boys who wear dresses and/or who say they are girls. The teacher started reading these books aloud to Ariel’s class, and guided the post-book discussions. The conclusion was that people get to say who they are, themselves. The children ran with this. One child proclaimed, “I’m Superman!” Another shouted, “Call me French Fry!” And Ariel got to be Ariel without further challenge.

Within days, Ariel’s parents noticed a dramatic change. She no longer protested going to school. In school, she went from being quiet and withdrawn to talkative and social. And at home she became happy – not every minute, but generally – for the first time in many months.

As time went on, Ariel’s community accepted her gender identity as a fact, and her parents’ concerns more closely matched other parents’ concerns about their children: “Does she have enough friends? How can we help her learn to tolerate frustration better?” Ariel’s transgender status was also a focus; for example, they made an effort to socialize with a couple of other families who also had a transgender child, to further normalize Ariel’s experience.

One day in Ariel’s fourth year, she announced that she didn’t want to be Ariel anymore; she wanted to be Andy again. Still a girl, but with her own name. Apparently she no longer needed that other girl name to establish that she was a girl. Following some discussion with her parents, though, the new spelling was Andie.

At this writing, Andie is four and a half, and basically a “normal kid” with various interests, strengths and challenges. She wears dresses often, because they’re pretty, and wears pants sometimes but not as often as her older sister. She has friends, mostly girls. Recently when an older cousin (who should have known better) said that Andie was really a boy, she became deflated: sad, quiet, withdrawn, for the rest of the day. Other times she is able to stand up for herself and correct the person without any apparent negative impact.

The clear conclusion is that the anxiety, depression, and suicidality that has long been associated with a child being transgender (previously called gender identity disorder) is not inherent, but rather is the result of bullying, rejection, disrespect, and discrimination. When the maltreatment is not present, transgender children have about the same range of mental health issues as other children. The slightly elevated anxiety may reflect the extra challenges associated with being a transgender child, that can persist even in a supportive environment.

Note: Andie’s name and details have been altered for confidentiality, despite the fact that Andie and her parents requested that her real name and details be used. My rationale is that Andie is not old enough to make a choice that could impact her as a teen and adult. As a socially transitioned transgender child, her preference for openness is appropriate. Even so, in an only partially transitioned society, I chose to exercise caution on her behalf. When she is older, she can write her own blog posts if she wants to.

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