Shattered

Grinding Glass: Understanding dysphoria

I have a form of PTSD.

I don’t hide the fact that I’m a pacifist, so I definitely never served in the military, even though I was born into a military family, and most people think that that’s where you get PTSD. In reality, at least 1 in 20 people in America have PTSD at any given time, and overwhelmingly, that’s people like me—civilians who never served in the military.

We pick it up because life comes at you hard sometimes. Some of us get it from being in a really bad car crash. Some get it from seeing something horrible happen to other people—there was a huge surge in cases of PTSD from people who saw the 9/11 attacks, for instance. Basically, if you see or have to live through a terrible, horrific event, there’s about a 20% chance you’ll develop PTSD afterward.

By the way: if you ever find yourself in that sort of situation? Play some Tetris (or whatever simple puzzle game) as soon as it’s safe. Just download it on your phone and play for twenty minutes. It can reduce the likelihood of developing PTSD by over 60%.

People are usually really surprised to hear that I have PTSD when I tell them. Like, really surprised. If you’ve ever met me in person, I’m a pretty vibrant person, big and cheerful, with smiles for days and lots of laughter and a wide-open heart. If you peek in on my Mastodon or Reddit posts, you’ll see a lot of the same. People get confused, because what they don’t see from me is someone with a short temper, flashbacks, risk-taking—all the stuff you’ve been told PTSD is about.

I don’t have that kind of PTSD, though. What I have is called cPTSD, and it works differently.

And if you’re reading this, you’re trans, and especially if you transitioned later in life, I think you probably do too.

Hang in there with me for a moment. I promise it’s worth the walk.

Putting the C in cPTSD

The big difference between PTSD and cPTSD is that PTSD comes from a single, horrific event, like that car crash. Something monstrous happened to you, and the memory of that event drags on you like a stone that you can’t quite get away from.

CPTSD, meanwhile, happens when someone experiences low-level, long-term trauma. Say, for example, that you had a deeply neglectful parent. They had you because they wanted an accessory for their life, or because they felt like they were obligated—the reasons don’t really matter. But, now you’re here, and instead of giving you the close love, care, and attention that growing and developing children need in order to become happy, healthy adults, they kind of just… moved on with their life. Like, they were still there in the house with you. But they just weren’t there for you. So you grew up learning, instead, day by day, that you were not and would never be as important to them as whatever was occupying the bulk of their attention. It doesn’t even need to be intentional.

I have a friend who lived this life. She was born into a regular family, like any other, but then her sister arrived. That sister got some pretty terrible luck, and was born with a chronic, life-threatening condition. Their parents reacted like any parents would—they sprung into action and worked hard to keep their younger daughter alive. Who wouldn’t, right? But that daughter finally found a smidgen of the luck she’d missed out on early, and she hung in there. Eventually they got her stable, but it took over a decade.

And in that time, my friend? She was utterly sidelined. Her struggles at school, her loneliness? Yeah, her parents wanted to help her with them, but they only had so many hours in the day, and when they had to decide between the literal life-or-death struggle of their younger daughter or their older daughter’s English homework, the choice was pretty obvious.

None of that helps my friend, though.

The psychology of cPTSD

The basic premise of cPTSD is that the repeated denial of fundamental needs is an extended form of trauma just as severe as surviving something horrific—and when we’re talking about needs, Maslow’s hierarchy is just plain helpful.

It makes pretty obvious sense that if you grew up without enough food—a first-level need—that that’d probably give you a complicated and not-very-good relationship with food once there’s enough around, or that if you grew up in a war zone, that you wouldn’t feel properly safe, even once you’re out of it. In many ways, what cPTSD argues is that the same effect that you see from having these first-level needs going unmet is what you’d see from second- or third-level needs going unmet, just over a longer term.

That said, when you don’t get things like love, as opposed to not getting physical safety, the symptoms you see will be different. You won’t generally get violent outbursts, like you would if you were the kid growing up in a war zone, where those outbursts might save your life. That’s because these behaviors you pick up are something called adaptive behavior responses, which just means they’re behavior strategies you pick up because they’re advantageous at the time when you pick them up. Change the situation—remove the thing that’s actively traumatizing you—and those same adaptive behaviors become maladaptive, which just means that they get in the way of you adapting well.

So, in a nutshell: PTSD and cPTSD are what happens when our minds start doing things in an attempt to keep us safe, but either we escape the dangers or over-adapt and those coping strategies start hurting us.

Now, there’s a very specific set of cPTSD symptoms that I want you to consider. This isn’t a complete list, but it’s a little more than half of the list of all possible symptoms for cPTSD:

• Feeling detached from your emotions and your body, also known as dissociation.

• Feeling profound guilt or shame about who you are.

• Feeling like you can’t relate to, understand, or interact with other people as a whole human being.

• Dwelling heavily on the person or thing that causes you pain.

• Being preoccupied with the person or thing that’s causing you pain.

• Minimizing your needs and prioritizing the wants of others above them.

• Depersonalization and derealization.

Now, if you’re transgender, and if you’ve done any extended reading at all about gender dysphoria, that list probably sounds and feels a little spooky. After all, Zinnia Jones has written extensively about depersonalization and derealization, and that symptom list basically looks like a summary of the entirety of the Gender Dysphoria Bible. It probably feels pretty damn creepy, doesn't it?

Over the last few years, I’ve talked to a lot of trans people as they’ve figured out their gender, and even more trans people who are in transition. There’s glorious, kaleidoscopic variation in our experiences of gender and the way we see ourselves in relation to the world around us, but it is absolutely astounding to me how often that specific list of symptoms comes out from a stranger. I can’t say it’s universal—given how weird and messy people are, what is?—but it’s at least as common, in my experience, as gender getting sublimated into kink before we’re ready to transition.

So, why do so many trans people have a giant laundry list of cPTSD symptoms?

Which… yeah. That’s kind of my point.

Gender dysphoria as a form of cPTSD

Over the last few years, the consensus of psychological and medical research has congealed onto a few basic premises about being trans:

1. Living authentically, as your true gender, is a non-negotiable need, without which your overall psychological well-being suffers considerably.

2. Being transgender means that you have gender incongruence, which is simply a mismatch between your innate true gender and the gender you were assigned at birth.

3. Gender dysphoria, while very common among trans folks, is not universal among us, and is definitely not exclusive to trans people.

That being the case, we have a problem: we don’t really have an explanation for what gender dysphoria is anymore, or why it happens. Even the DSM-5TR struggles with this problem in its very definition of gender dysphoria:

Gender dysphoria: A concept designated in the DSM-5-TR as clinically significant distress or impairment related to gender incongruence, which may include desire to change primary and/or secondary sex characteristics. Not all transgender or gender diverse people experience gender dysphoria.

Like… we know it’s there. We can observe it. We know it’s related to gender incongruence. But we don’t have a very good understanding of why anymore. And we really don’t have an explanation for why it affects so many, but not all, of us.

In the face of this mystery, a number of trans activists, led by CJ Bellwether, have recently been making the argument that what gender dysphoria actually is is a specific, common expression of cPTSD, caused by being forced to grow up in a gender and body that aren’t your real gender.

"Gender Dysphoria" as the trans community uses the term as an active thing such as "I’m feeling gender dysphoric right now because someone just misgendered me", should be more commonly understood as complex PTSD.

All the responses that trans people feel are the same as someone who has just had their trauma triggered. Gender Dysphoria is just trauma from growing up in a gender incongruent body. It's not some magical new thing. Sex/gender is a deeply rooted unconsciously important thing to humans, and when we look at cis people who have issues regarding their sexual characteristics it is clearly a traumatic issue for them. Trans people just have to deal with that from birth, in small, ever increasing, ever present ways, and they have to hide it from everyone around them especially those who are their care givers / meant to be the people who love them for fear of being completely rejected - and so all love begins to get redirected to a survival performance of themselves. They build a shell of denial over their need and label it with bad things and oh look its C-PTSD.

I think she’s right. And the research is starting to catch up to us.

If we accept the first two premises I mentioned above—that living as your gender is a need, and that trans people experience gender incongruence from their innate gender mismatching their assigned gender—and apply our understanding of how complex trauma forms over time, the result becomes pretty obvious:

A person has a need to be seen, treated, and to live as a given gender, and that need goes almost entirely unmet over their early childhood development, when the meeting of those needs is most essential. That need is on the third tier of Maslow’s hierarchy, so they learn that their unmet need to live authentically, which is essential to love and belonging, means that they are unworthy of love and belonging, in the same way as they would learn that they are unworthy of love and belonging if they had a neglectful parent. Those emotions are painful, so they dissociate from them. They learn that this core aspect of who they are is undesirable, so they hide it, minimize it, and feel increasingly-intense shame over its very existence. After all, other people don’t have this part of themselves, and certainly don’t have to hide it. This child comes to believe it must mean that they’re inherently defective, bad, or wrong in some way.

As they enter puberty, their body develops permanent, physical indications of their unmet need which grow more pronounced by the month. They dwell on these physical indications of their gender incongruence as a symbol of their unmet need and unworthiness of love and belonging. Much later, they embrace their truth and begin to transition, driven by the pain of their traumas and, like any unmet need given a long enough time, needing to meet it at any cost.

So, we have adult trans people, in transition. They get misgendered, as happens to all people from time to time, because figuring out what gender an unknown person is is a messy and error-prone cognitive process. The trans person’s complex trauma is triggered, and they experience an emotional flashback, which overwhelms them.

No more black box, wondering “why do trans people feel gender dysphoria?” without any explanation beyond “because maybe there’s something different in their brains,” which had been the reigning theory until it was struck down a few years ago. Instead, if we accept that trans people are real, and that our feelings about our selves and our genders are real, it’s just a completely predictable trauma response.

I mentioned earlier that I have cPTSD. Well, one of the big reasons I didn’t realize I was trans until I was 35 was because, yes, I experience gender dysphoria, but I also have a history of profound abuse. I was never, even after coming out to myself, able to find a meaningful difference in the way that the emotional flashbacks I’d feel felt like when it was a dysphoria attack versus when I was experiencing an emotional flashback to my history of physical and emotional abuse. I could recognize the difference in what caused my flashback, but that pit of hopeless despair I’d end up in? It felt the same either way.

But what changed is that I worked in therapy on my complex trauma. A lot. And, because you can treat complex trauma, and resolve much of it, it got better. A lot better. In fact, after years of work, I basically don’t experience cPTSD attacks from my history of abuse anymore.

But the part that was connected to my gender didn’t get any better.

Not until I transitioned, and then did all my trauma work all over again.

Transphobes and the cPTSD discussion

It has to be mentioned here that there is a fair bit of bad-faith discussion in this area from far-right transphobes. The most notable of these is Genspect, a pseudoscientific anti-trans group funded by the Society for Evidence-Based Gender Medicine, and both have been trying to argue that being trans is nothing more than an expression of complex trauma, in an attempt to erase trans people entirely and strip us of our ability to access healthcare. In essence, it tries to reverse the cause and effect chain that I’ve described above. I won’t link their garbage here, because doing so helps them promote their hate.

Fundamentally, their argument rests on the idea that complex trauma can cause gender incongruence; in other words, that trauma can change a person’s gender or sexuality. That premise is the justification for conversion therapy: that if you abuse someone violently enough, you can change their sexuality or gender. In reality, conversion therapy is a pseudoscientific practice which is violent, ineffective, and harmful. In it, it demanded that queer patients search their history for some sort of traumatic event in their childhood that “caused them to be queer,” and repeatedly abused them mentally and physically in an attempt to somehow overwrite the prior “trauma.” The whole sorry mess is rather delightfully lampooned in the camp classic But I’m A Cheerleader, which I unconditionally recommend.

More than that though, what irritates me about transphobes’ argument here is that it’s scientifically illiterate, in that it shoehorns available evidence to a predetermined, pre-conceived conclusion, that it outright ignores a massive body of scholarly literature that’s inconvenient to its arguments without ever trying to refute them with data, and in that it reverses cause and effect. Conversion therapy was first developed over a hundred years ago, as a way to try to change gay peoples’ sexualities. CPTSD, meanwhile, has only even existed as a proposed diagnosis for about thirty years, and is still actively disputed as a unique diagnosis in some parts of the psychological community. The proposed link between gender dysphoria and cPTSD—whether we look at it from its advocacy by trans people or transphobes—is only a couple of years old.

Yet, somehow, according to these transphobes, this brand-new hypothesis perfectly and seamlessly fits, and somehow revives, a widely-discredited model of abuse that’s been discarded for decades.

Occam’s razor comes to mind. Is it more likely that mountains of research over the course of decades which has repeatedly and insistently demonstrated that every single foundational premise for their argument is wrong, or that a small group of mysteriously-well-funded people are knowingly lying for profit?

You judge.

Grinding glass to take the sharp edges off

Grinding Glass is a series I’ll be writing going forward that works from this basic premise: that growing up trans and closeted—whether that’s self-closeted or not—is a form of complex trauma, and that an important aspect of gender dysphoria, if not all of gender dysphoria, is the expression of that complex trauma. Authentic living is an absolute, non-negotiable psychological need, and being denied that is like growing up in a home where your parents neglected you. It hurts. It hurts deeply.

And it won’t stop hurting until we face those traumas and work to heal them.

There’s a saying in neurodivergent communities: society hasn’t yet produced an untraumatized neurodivergent person, because the way our society is built right now is inherently traumatizing to them. I’m not sure whether or not that’s also true of being trans, but looking around, at the way we’re treated and represented in our culture right now? I think it probably is.

But the thing about trauma is that you can heal from it.

One of the basic rules of trauma therapy is this: you can’t heal the trauma while it’s still occurring. People need to get out of the bad situations they’re in first. Only then can treatments like EMDR and CBT help patients start processing and healing their traumas.

If you’re reading this and you’re in transition? If you’re in the process of resolving the physical and social hurts your gender incongruence caused over the course of your life?

You should be able to start healing. Really healing.

That’s what Grinding Glass is going to try to do: help you start looking for where the hurts happened, so you can work to heal them.

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Other articles in the Grinding Glass series:

• Growing Up Broken, an examination of how trans trauma forms.

• Slivers, a discussion of how we reenact our trauma on ourselves.

• Complex Trauma Disorder? I hardly knew her!, which helps you walk through the process of accepting a complex trauma diagnosis.