High PTSD Rates in LGBTQ Community Demand A Better Approach

Trauma exposure remains insidiously pervasive throughout the world, with some estimates suggesting that more than 70 percent of the population has faced a potentially traumatic event at some point in their lives. But LGBTQ individuals endure inordinately higher rates of trauma, victimization, and minority stress.

The National Center for PTSD reports that “LGBTQ+ people are at higher risk of developing PTSD, with prevalence estimates of up to 48 percent of LGB individuals and 42 percent of transgender and gender diverse individuals meeting criteria for PTSD. These estimates are much higher than the general population prevalence of 4.7 percent.”

All of this can make posttraumatic stress disorder (PTSD) treatment for LGBTQ individuals even more challenging.

LQBTQ Community Faces Unique Challenges

In a recent review, a team of researchers sought to evaluate the efficacy of existing PTSD treatments, explore the limitations caregivers face, and offer some guidance for working with LGBTQ patients in the absence of any established guidelines for this demographic.

This research also highlighted the overlap between trauma, discrimination, microaggressions, and minority stress. All the participants of this review had experienced trauma that meets the criteria for PTSD. But many of them also described other non-qualifying events, such as the “trauma of the closet.” These experiences often included hypervigilance, paranoia, and increased mental health challenges, including drug use and sexual risk-taking.

Such findings underscore the importance of understanding these patients’ responses to trauma and the hostile environments they encounter.

Existing PTSD Treatments and Limits

Evidence-based PTSD treatments, such as trauma-focused cognitive-behavioral therapies, and pharmaceutical treatments, have performed well for most patients.

But the body of PTSD research has largely overlooked the singular stressors that LGBTQ individuals face. And that’s why traditional interventions might not be able to adequately address these stressors. Those can include systemic oppression, discrimination, and microaggressions, which constantly remind LGBTQ individuals of their minority status. Minority stress adds another layer of complexity, and a wide swath of caregivers don’t completely understand how these factors interact.

As a result, many of these patients expect rejection, feel shame, or conceal their identities to shield themselves. These behaviors can lead to – or exacerbate – physical and mental health problems and mirror PTSD symptoms.

For example, intrusions, such as intrusive thoughts and rumination, are everyday struggles for LGBTQ individuals experiencing minority stress. As a result, they turn to avoidance behaviors – such as concealing identity and withdrawing socially – while mood and cognitive disruptions overlap with symptoms of depression and anxiety.

Many LGBTQ individuals also have reported unpleasant experiences with healthcare workers, including incidents of discrimination and a lack of cultural sensitivity. These encounters can foster distrust in a healthcare system they already have reservations about.

Consequently, there’s a growing need for providers to develop cultural awareness and education specific to LGBTQ patients to offer more inclusive care.

Recommendations for More Inclusive Treatment

The authors stressed the importance of clear patient-provider communication as the foundation for effective care. For starters, that should include the draft of a comprehensive personal history that includes the impact of minority stress. Open discussions can improve emotional well-being and treatment outcomes.

Advocates also encourage caregivers to foster a more welcoming and inclusive environment, which starts with considerations such as inclusive advertising for services, signage that signals LGBTQ support, and paperwork that includes questions about sexual orientation and gender identity. This approach sets the stage for positive and collaborative patient-provider interactions.

The authors also pointed out that few clinicians receive training in the specific needs of LGBTQ patients. This lack of education hinders the ability to provide informed and effective care. Training healthcare professionals to ask relevant, respectful questions and to engage in shared decision-making with LGBTQ patients remains crucial for improving treatment outcomes.

This review also included practical proposals for adapting existing evidence-based PTSD interventions to meet the needs of LGBTQ patients. For example, caregivers could adjust trauma-focused therapies such as CPT and PE to address the intersection of trauma and minority stress, ensuring that the prescribed treatments account for both past traumatic events and ongoing stressors.

The researchers concluded by insisting that understanding the intersection of trauma and minority stress is essential for clinicians working with LGBTQ patients. A comprehensive, personalized approach to treatment – founded on cultural competence and patient-centered care – can help address the unique challenges faced by trauma-exposed LGBTQ individuals. While more research is needed, evidence suggests that fostering supportive clinical environments and considering the social context of LGBTQ patients’ experiences can improve treatment outcomes and aid in recovery.

Further Reading

Treatment of LGBTQ Patients Hardly a Point of Pride

Can Emotional Dysregulation Help Explain Adolescent PTSD?

Psychiatric Diagnoses Among Transgender and Gender Diverse Patients