Psychiatric Diagnoses Among Transgender and Gender Diverse Patients Compared to Cisgender Patients

ABSTRACT

Background: Sexual and gender minority persons (ie, those reporting sexual orientation other than heterosexual and gender identity other than cisgender, respectively) experience high rates of various forms of psychopathology. However, discussions of sexual minority populations are often focused on aspects of mental health associated with sexual orientation, with relatively less emphasis placed on transgender and gender diverse (TGD) individuals’ mental health. No prior studies have compared psychiatric diagnoses between TGD and cisgender patients presenting for psychiatric treatment in a systematic way using semistructured diagnostic interviews assessing a broad range of disorders.

Methods: Between April 2014 and January 2021, we administered semistructured diagnostic interviews for DSM-IV disorders to 2,212 psychiatric patients, 69 of whom reported TGD identity (ie, gender identity other than cisgender such as transgender, genderqueer, or nonbinary identity). The patients completed a demographic questionnaire on which they indicated their assigned sex at birth and their current gender identity.

Results: TGD patients had on average more diagnoses than cisgender patients (3.54 ± 1.88 vs 3.04 ± 1.72, t = 2.37, P = .02). After controlling for age, TGD patients were significantly more likely to be diagnosed with posttraumatic stress disorder and borderline personality disorder than cisgender patients (P < .05).

Conclusions: To the best of our knowledge, this is the first study of psychiatric patients using semistructured diagnostic interviews to compare the frequency of psychiatric disorders between cisgender and TGD patients. These results bear implications for creating gender-inclusive treatment facilities. Psychiatry programs interested in qualifying as Safe Zones and treating TGD patients should have or develop expertise in treating posttraumatic stress disorder and borderline personality disorder.