Finding one's identity is a topic that has probably occupied every human being from birth until his/her death: "Who am I, how do I see myself and how do my fellow human beings perceive me?” are the crucial questions to the self in finding one's identity.
The definition of the self is as follows: "It is a conceptual system consisting of one's thoughts and attitudes about oneself."1 But what does the term identity actually mean? The perception of one's own person as something constant and at the same time changeable in the course of life is at the centre of the definition of identity here. The inner uniformity remains in essence despite possible external changes that can be traced back to life history or the respective environmental situation. One's own identity lies in the perception of the individual, because only the individual himself/herself knows who he/she is. The inner uniformity and the knowledge of one's own identity are opposed to the outer appearance. For the human being as a social being, it is important how he/she is perceived by the outside world. Do fellow human beings see the same identity that the individual perceives inside as his/her identity? Is there a congruence or a discongruence between one's own perception and perception by the outside world?
A person has a need for her/his perceived gender identity to be in congruence with the external gender. This is not primarily about sexuality, but about the gender self-experience of one's own person. Scientific studies have shown that gender incongruence can lead to psychological and physical illnesses. If the outside world's perception of oneself and one's own perception diverge too much, this can be accompanied by enormous psychological stress and the promotion of certain harmful behavioural patterns. In the US, half of the people with a transgender, multi-gender or gender fluid identity suffer from depression or anxiety disorders.2,3 The lifetime prevalence for suicidality among trans women and trans men is 46%. They outnumber cisgender persons by a factor of 11.4 According to an American study from Ontario, medical underuse is present in about 44% of persons with a *trans or *inter lifestyle. In the cisgender control group of the same age, this was the case for only about 11%. Often, people with a *trans or *inter lifestyle face a very specific problem: The attending physician lacks expertise regarding transgender medical issues.5-7
A study published in the renowned journal The Lancet looked for reasons for the psychological situation of persons with transgender, multi-gender or gender fluid identity. The focus is on the state of subjective distress and impairment. This arises as a reaction to the discrimination, stigmatisation, lack of acceptance, rejection and mistreatment of the persons concerned, which they regularly experience in their everyday lives. Discrimination against a person changes their behavioural patterns. The inter* and trans* persons are in a state of heightened vigilance and physical stress reactions. This encourages risky behaviour and a rejection of their own person. This psychological stress also manifests itself on a physical level: cortisol levels can rise, vascular resistance can increase, cardiac and memory performance can decrease. There is a risk of premature onset of Alzheimer's disease. In the US, 26% of people with *trans or *inter lifestyles consume harmful substances. 33% suffer from anxiety disorders.8,9
It is our responsibility as medical professionals to ensure that people with *trans and *inter lifestyles are protected from discrimination and stigmatisation in the health care system. Also, some professional competence in transgender medical issues should be acquired through regular training. If we all actively address discrimination and stigma and the path to transition is made easier, one day the prevalence for depression, anxiety disorder and suicidality among persons with a *trans or *inter lifestyle may decrease in response.
References:
1. https://www.psy.lmu.de/epp/studium_lehre/lehrmaterialien/lehrmaterial_ss10/wintersemester1011/krimmel_vuori/seminar1/sitzung_8.pdf.
2. Budge S. L. et al. (2013). Anxiety and Depression in Transgender Individuals: The Roles of Transition Status, Loss, Social Support, and Coping. J. Consult. Clin. Psychol. 2013;81(3):545-557.
3. Nota N. M. et al. (2019). Evaluation and Treatment of Gender-Dysphoric/Gender Incongruent Adults. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc; 2000-.
4. Weissman M. M. et al. (1999). Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 1999;29(1):9-17.
5. Bauer G. R. et al. (2013). Suicidality among trans people in Ontario: implications for social work and social justice. Serv Soc Que 2013;59(1):35-62.
6. Bell J. et al. (2019). Trans individuals' experiences in primary care. Can Fam Physician. 2019;65(4):e147-e154.
7. Vermeir E. et al. (2018). Improving Healthcare Providers' Interactions with Trans Patients: Recommendations to Promote Cultural Competence. Healthc Policy. 2018;14(1):11-18.
8. The Lancet Public Health. (2020). Transgender health, identity, and dignity. Editorial, Vol. 5, Issue 4, E117.
9. Jamieson J. P. et al. (2012). Experiencing Discrimination Increases Risk-Taking, Anger, and Vigilance. Psychological Science 24 (2) (December 20): 131-139.