Considerations and complexities of accurate PTSD assessment among transgender and gender diverse adults.
Considerations and complexities of accurate PTSD assessment among transgender and gender diverse adults.
复制标题
跨性别和性别多样化成年人准确评估 PTSD 的考虑因素和复杂性。
DOI：
10.1037/pas0001215
复制
发表时间：
2023
影响因子：
3.6
通讯作者：
Shipherd,JillianC
中科院分区：
文献类型：
--
作者：
Valentine,SarahE;Smith,AshM;Miller,Kristin;Hadden,Laura;Shipherd,JillianC
跨性别和性别多样性（TGD）成年人的创伤后应激障碍（PTSD）评估是复杂的，因为文献几乎没有提供关于准确捕捉创伤和歧视相关痛苦的肯定评估的指导。本研究的目的是描述在临床医生管理的PTSD量表精神疾病诊断和统计手册第五版（CAPS-5）中出现的精确PTSD评估的威胁。我们的样本（N= 44）包括跨性别女性（38%），跨性别男性（25%），非二元人群（23%）和其他TGD身份（14%）。参与者大多是白色（75%），非拉丁裔（82%），受过教育（91%至少有一些大学），平均年龄为37岁（SD= 15.5）。人口统计和CAPS-5评分数据，以及内容分析的音频记录的CAPS-5的采访报告。所有参与者都报告了创伤暴露，近一半符合PTSD诊断标准（49%）。人际攻击是一种常见的创伤类型，与创伤后症状有关（77%）; 41%是性攻击; 41%是基于歧视（例如，与性别认同有关）的身体或性攻击。定性研究结果表明，如何以及何时歧视相关的经验可能会威胁创伤后应激障碍评估的准确性，导致过度病理化或症状检测不足，例如，（a）最初选择一个非标准A歧视事件作为“最坏的事件"，（B）链接症状内化跨性别恐惧症（而不是创伤），（c）链接受害的性别认同/表达。当症状与基于歧视的创伤性事件联系在一起时，创伤后应激障碍评估的威胁更为常见，这表明了解指数事件的背景因素的重要性。我们提供了一个框架，了解独特的挑战，评估创伤后应激障碍TGD的人，并提供改进评估的建议。
Posttraumatic stress disorder (PTSD) assessment among transgender and gender diverse (TGD) adults is complex because the literature offers little guidance on affirming assessment that accurately captures both trauma-and discrimination-related distress. This study aimed to characterize threats to precise PTSD assessment that arose during the Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (CAPS-5). Our sample (N= 44) included trans women (38%), trans men (25%), nonbinary people (23%), and other TGD identities (14%). Participants were mostly White (75%), non-Latinx (82%), educated (91% at least some college), with a mean age of 37 years (SD= 15.5). Demographic and CAPS-5 scoring data as well as content analysis of audio-recorded CAPS-5 interviews are reported. All participants reported trauma exposure, and nearly half met PTSD diagnostic criteria (49%). Interpersonal assault was a common trauma type linked to posttraumatic symptoms (77%); 41% were sexual assaults; and 41% were discrimination-based (eg, linked to gender identity) physical or sexual assaults. Qualitative findings suggest how and when discrimination-related experiences may threaten PTSD assessment accuracy, leading to overpathologizing or underdetection of symptoms, for example,(a) initial selection of a noncriterion A discrimination event as “worst event,”(b) linking symptoms to internalized transphobia (rather than trauma), and (c) linking victimization to gender identity/expression. Threats to PTSD assessment were more common when symptoms were linked to discrimination-based traumatic events, suggesting the importance of understanding contextual factors of index events. We offer a framework for understanding unique challenges to the assessment of PTSD among TGD people and provide recommendations for improving assessment.