The LGBTQIA+ community experiences high levels of trauma, both acute and chronic.

The trauma can be from experiences of long term neglect such as what happened during the AIDS crisis, where the gay community was either demonized or ignored due to homophobia while a deadly virus ravaged their community as politicians and leaders did nothing about it for years. The trauma can be from sudden violence, assaults, or murder due to someone’s identity as a queer or transgender person. The trauma can be from being silenced, such as with “Don’t Ask Don’t Tell” in the military, where enlisted people were forced to not out themselves or engage in any non-straight cisgender activity. The trauma can be from being pushed out of spaces, such as being denied jobs and housing at a high rate due to discrimination, resulting in a high rate of homelessness. The trauma can be from long term exposure to harmful public policies and bills that oppress LGBTQIA+ people due to who they love or what their gender identity and/or expression is. The trauma can be from years of trying to fit into the doctrine of a specific religion that makes LGBTQIA+ people live in fear of being less than or “bad”. The trauma can be from transgender people feeling trapped in a body that they don’t align or connect with and that causes chronic distress. There are endless ways trauma shows up in the LGBTQIA+ community outside of the main trauma of going against what a large portion of society deems acceptable.

Trauma that isn’t processed out of oneself will store itself in the body. This shows up as a variety of ailments within the body of someone who has experienced acute (PTSD) or prolonged trauma (cPTSD). This is referred to as somatic, or bodily, issues. There are currently some therapy modalities that address this, such as somatic experiencing and EMDR. These modalities require a higher skill level and are often seen in practices with sliding scales that no do accept private insurance or Medicaid due to complications and unfair compensation practices within systems of insurance. This causes these much needed and specialized therapies to be inaccessible to many people within the LGBTQIA+ community.

Signs of untreated trauma include the following: addictive behaviors and usage problems, dissociation, inability to tolerate intense feelings, avoiding conflict, feeling broken or “bad”, flashbacks or nightmares, depression, anxiety, intrusive thoughts, hypervigilance or feeling numb, eating disorders, suicidal thoughts or ideations, chronic bodily issues, memory problems, trouble concentrating, guilt or self-blame, trouble with relationships, difficultly maintaining employment, etc. Now imagine trying to be your true self while living with untreated trauma. It is either extremely drainage and debilitating, causing someone to barely function, or it ultimately results in taking someone out completely due to inaccessible life-saving support.

Many recovery pathways focus solely on the issue or drugs and/or alcohol and its effects on the mind and body. Although progress is being made towards a greater understanding and availability of the variety of pathways towards recovery, there is still much work to be done to make all pathways accessible and workable. These pathways must include mental health support, programming, and therapy in order to treat both the addiction and any underlying mental health concerns cohesively. Addiction and mental health is a vicious cycle that requires a lot of help to overcome. We have seen cases of addiction where the individual desperately wants to recover but has immense mental health challenges and not nearly enough support to overcome them. The result - we end up attending funerals wondering what more could be done to help people break this vicious cycle. The drug or alcohol usage is but the symptom of a much greater issue. For the LGBTQIA+ community, that greater issue is most often untreated or inconsistently treated mental health concerns.

This is called co-occurrence, when someone has both mental health issues and a substance use problem. Those with co-occurring disorders tend to need longer periods of treatment and extra support in order to remain stabilized. They are much more likely to experience relapses, social struggles, hospitalizations, serious medical problems, family issues, homelessness, sexual or physical victimization, financial insecurity, and incarceration.

Commonly seen co-occurring mental health concerns include depression, anxiety, dissociative disorders, bipolar disorders, schizophrenia, and personality disorders. Co-occurrence can also happen when someone is neurodivergent, such as is seen with people who experience ADHD, Tourette’s, PTSD or CPTSD, and Autism. Co-occurrence often happens because people who experience either mental health concerns or neurodivergence often use substances or alcohol to self-medicate or self-regulate. They might also be prescribed a variety of medications that become addictive over time and ultimately cause the person to become dysregulated. Dysregulation almost always leads back to problematic usage behaviors.

The prevalence of these co-occurring disorders strongly affects one’s “window of Tolerance”. The window of tolerance is one’s optimal emotion “zone” where they can better function, grow, and stay regulated. Mental health concerns or neurodivergence can easily push someone outside of this “window” and cause dysregulation. Dysregulation then kicks in one’s survival responses such as aggression, extreme avoidance, or becoming paralyzed by fear. When someone is constantly being flung outside of their window of tolerance, such survival responses can result in a variety of behavioral issues and/or relapse. Attempts to self-regulate by self-medicating with substances then begins to reoccur, thus the cycle continues.

Treating co-occurrence requires what is called integrated treatment, where both the substance usage and mental health concerns are treated at the same time. The ways that they overlap is addressed when different professionals communicate and work together towards a cohesive treatment plan. The Dandelion Hive works to identify gaps within the treatment of co-occurring disorders by helping educate professionals on how co-occurrence shows up in the LGBTQIA+ community and what type of specialized interventions are needed.

Many transgender people experience an additional mental health concern in the form of gender dysphoria. Gender dysphoria itself is not a mental health disorder, but rather a mismatched sense of one’s “being” in relation to their body and emotions that lead to dysregulation within the body. This dysregulation can cause mental health issues to arise. It is important to be clear that simply not aligning with the sex one was assigned at birth is not a mental health disorder. It does, however, most often require interventions to help the individual achieve a sense of safety and regulation within their own body.

When someone experiences high or chronic levels of trauma or mental health challenges, they might also experience chronic ideations as a way to mentally and emotionally deal with the prolonged stress. The LGBTQIA+ population has higher levels of ideations than most populations. Having persistent ideations makes daily functioning more different. It can cause feelings of helplessness or hopelessness, making recovery from mental health concerns and/or substances seem nearly unachievable. Some people do live with intrusive lifetime chronic ideations and some people can work past them with proper care and support. Seeking such care and support and finding it to be inaccessible is a major cause of furthering these suicidal ideations. A caterpillar cannot evolve into a butterfly without the support of its cocoon. Transgender people cannot become healthy, happy, and whole without access to the support that they need.

Transgender people experience a very high rate of cPTSD and PTSD specifically due to violence against the trans community such as assault, murder, neglect, hateful policies and bills, social discrimination, housing and employment discrimination, family ostracization, and religious trauma. Some of these are acute or sudden traumas and some are long term chronic traumas that persist. They all occur due to someone’s identity as a trans person and cause exhaustion and dysregulation and can exacerbate mental health concerns.

We work to continue to identify trans specific trauma and mental health needs in both mental health and recovery spaces. We work to educate people around these needs and to challenge the professional community to build equitable systems of care that address the sheer amount of trauma that the transgender community experiences.