The antecedents of gender dysphoria and the associated thoughts, emotions, and ways of coping: a qualitative analysis and clinical implications

ABSTRACT

Despite recent trans-affirming research centering experiences of gender dysphoria and its relation to psychological outcomes, there is a dearth of research studying the components of experiences of gender dysphoria. This has limited the ability of clinicians to intervene and reduce the distress caused by gender dysphoria. The current study utilized an online qualitative approach based on cognitive-behavioral therapy thought trackers to ask 108 transgender and nonbinary participants four prompts: a) antecedents of gender dysphoria, b) associated thoughts, c) emotions, and e) ways of coping. Analyses of these prompts revealed that gender dysphoria is frequently triggered by body, social, and intrapersonal experiences and is associated with a range of thoughts (e.g. body, gender presentation, medical transition, and self-harm focused) and emotions (e.g. anger, sadness, fear, and suppression) related to experiences of gender dysphoria. Participants noted engaging in both facilitative coping strategies (e.g. mindfulness, gender affirmation, medical transition, social interactions, and cognitive reframes) as well as avoidant strategies (e.g. distraction; suppression; avoid viewing body/self, social interactions, and voice; and identity concealment) to deal with gender dysphoria. Considering the lack of published therapeutic interventions targeting gender dysphoria, the discussion focuses on the ways the current findings can inform clinical practice with TNB individuals.

KEYWORDS:

• Cognitive behavioral theory
• gender dysphoria
• nonbinary
• therapeutic interventions
• transgender

Practical Implications

Asking open-ended questions about what gender dysphoria means for the client and not assuming the experiences is solely body focused. It seems important to allow clients space to experience their sadness, anger, and fear that are associated with gender dysphoria. Clinicians can assist clients to integrate mindfulness-based practices to cope with gender dysphoria as well as understand the positive role some avoidant coping strategies can have when dealing with intense experiences of gender dysphoria.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and material

The authors have not deposited the data in a publicly accessible data base.

Notes

1. A transgender history refers to individuals who are living in their affirmed gender identity and no longer utilize the trans identity label

2. We utilize the term passing to reflect the language used by our participants; however, it should be noted that this term carries with it a connotation that the individual is deceiving others by presenting as their affirmed gender and the use of this phrase is contested within academic writing (see Billard, 2019 for a review).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial,or not-for-profit sectors.

Notes on contributors

Louis Lindley

Louis Lindley (he/him) is currently a doctoral student at the University of Wisconsin-Madison studying counseling psychology. His research interests broadly include gender minority stress, trans and nonbinary individuals’ sexual well-being, and substance use.

Lex Pulice-Farrow

Lex Pulice-Farrow (they/them) currently works at the Department of Psychology, University of Tennessee - Knoxville. They take a strengths-based approach to focus on the lived experiences of gender and sexual minorities. Currently, they are working on research that centers the lived experiences of trans and nonbinary individuals in the context of gender dysphoria and trans joy.

Stephanie Budge

Stephanie Budge (she/her) is an associate professor in the Department of Counseling Psychology and is also the Director of the Advancing Health Equity and Diversity program in the School of Medicine and Public Health at the University of Wisconsin-Madison. She founded the Trans CARE Collaborative in 2014—the collaborative is a group of scholars and community advocates who work together to improve research focused on Two-spirit, transgender, and nonbinary people. Stephanie’s research focuses on improving of medical and psychotherapy treatments (and access to care) for Two-spirit, trans, and nonbinary (2STNB) clients. She provides clinical trainings nationally and internationally related to LGBTQ issues, focusing on practitioners’ self-efficacy, knowledge, awareness, and skills. At the University of Wisconsin-Madison, she promotes 2STNB advocacy on campus by providing workshops to students, faculty, and staff related to navigating gender identity within a university environment. As a licensed psychologist, she provides pro-bono psychological services to 2STNB youth and adults. Stephanie is currently an Associate Editor of two journals: Psychotherapy and Psychology of Sexual Orientation and Gender Diversity. She is also on the editorial board of the International Journal of Transgender Health.