Treating Trauma in the LGBTQIA+ Community
When somebody has repeated exposure to traumatic events and experiences, they may develop complex trauma.
The National Child Traumatic Stress Network describes complex trauma as exposure to multiple traumatic events, as well as the “wide-ranging, long-term effects” of this exposure. It’s different from post-traumatic stress disorder (PTSD), in that PTSD is caused by one single traumatic event. You may hear complex trauma be described as complex post-traumatic stress disorder, or C-PTSD.
Complex trauma is one of the LGBTQIA+ community’s biggest challenges – it affects LGBTQIA+ people at a higher rate than the population as a whole, for reasons including discrimination, bullying, abuse, and isolation.
However, there are ways to help and support LGBTQIA+ people who are dealing with complex trauma. Here, we’ll explore why LGBTQIA+ people are more likely to be affected by complex trauma, how it affects them, and what we can do.
If you are seeking support for issues with coming out, relationships, bullying, self-harm, and more, contact the LGBT National Hotline at 1-888-843-4564 for one-to-one peer support.
For more mental health resources, see our National Helpline Database.
Understanding complex trauma
Complex trauma often forms through exposure to incidents or experiences from which someone feels as though they can’t escape.
Children are more likely to develop complex trauma than adults, though complex trauma can develop at any age. LGBTQIA+ people may develop complex trauma through oppression, discrimination, and bullying. Meanwhile, neglect in childhood, as well as physical, emotional, and sexual abuse, can all contribute to the development of complex trauma.
According to Emily Haas, M.D., director of the Triumph Program at Silver Hill Hospital, violent assault is four times more likely to be a cause of trauma in LGBTQIA+ individuals, with sexual assault, rape, and child sexual abuse all more common causes of trauma, including PTSD, in LGBTQIA+ people.
And, she says that over 40% of LGBTQIA+ people meet the criteria for a diagnosis of PTSD at any point.
But there are other stressors, too, which may not be so overtly traumatic but can stack up cumulatively – closer meeting the definition of complex trauma. “When you think about PTSD, initially, someone has to have a major trauma to meet the criteria,” explains Haas.
“But oftentimes in this community, it’s actually a series of smaller stressors as well that amount to be a larger trauma, and so it’s something that actually gets missed more often than because they may not have had, like a single car accident trauma sort of thing, but they have a series of chronic traumas over time that you have to ask about, and that can actually meet the threshold of criteria for PTSD.”
It’s important to consider other causes of complex trauma, that may intersect with the complex trauma LGBTQIA+ individuals are more likely to experience. For example, an LGBTQIA+ person of color may develop complex trauma from racism as well as homophobia or transphobia, and the idea that being cisgender and heterosexual is ‘normal’ or ‘correct’.
This is a form of cultural violence – but anti-LGBTQIA+ cultural violence is almost unique in that it often comes from places like the family. And, LGBTQIA+ people who experience rejection from their family are more likely to be at higher risk of homelessness, self-harm, suicide, and various mental health conditions.
Likewise, an LGBTQIA+ person may also develop complex trauma from living in poverty – LGBTQIA+ people disproportionately live in poverty – from violence, war, or terrorism, or from having a family member who struggles with mental health or substance use disorder.
Prevalence of complex trauma in the LGBTQIA+ community
While anyone can develop complex trauma, it’s more prevalent in LGBTQIA+ individuals. Research from 2017 suggests that around 3% of people have complex trauma, while it’s thought that LGBTQIA+ young people are disproportionately exposed to adverse childhood experiences (ACEs) and potentially traumatic events (PTEs) when compared to non-LGBTQIA+ young people. And, there’s a correlation between these events and an increased risk of both mental and physical health difficulties.
People in the LGBTQIA+ community may be at higher risk of experiencing things that can cause complex trauma to develop. This can range from microaggressions to bullying and discrimination to abuse, intimate partner violence, and homophobia, biphobia, and transphobia.
Per The GLSEN National School Climate Survey, over half (59.5%) of LGBTQ+ students felt unsafe at school due to their sexual orientation, and almost half (44.6%) due to their gender expression. Meanwhile, 62.2% of LGBTQ+ students experienced discriminatory policies at school, while a huge 98.5% reported hearing homophobic and transphobic comments from teachers and fellow students, with 91.8% of students feeling distressed as a result.
And, on a larger scale, the enaction of anti-LGBTQIA+ legislation can be a contributing factor. Take the anti-LGBTQIA+ laws dictating what can be taught as part of the curriculum,
According to the CPTSD Foundation, 48% of gay and bisexual people and 42% of transgender and non-binary people have complex trauma. Meanwhile, Haas says that over 50% of the patients in her residential trauma, complex trauma, and dissociative disorder program are in the LGBTQ+ community.
Impact of complex trauma on LGBTQIA+ individuals
“When you think about trauma in other communities or other minority groups, for example, sometimes those individuals might be experiencing discrimination and hate crimes and things of that nature and assault by the community or in various element aspects of their life, but when they go home, they may often have the support of their community,” explains Haas.
In contrast, LGBTQIA+ people might not always have that support at home, and may even experience the same sort of traumas at home, too, from their family. Many LGBTQIA+ people are used to simply not having any support, and never being heard. As Haas puts it, “When I think about treatment, the first thing is, what was home life actually like? Was there ever a moment of peace and respite, or was it kind of always hate and terror all the time? It may actually be very different than their peers.”
The effects of trauma on LGBTQIA+ people can be similar to the effects of trauma on their cisgender and heterosexual counterparts. However, after a traumatic event, LGBTQIA+ people are more likely to progress to developing PTSD simply because they’re less likely to have the support of their family, or a community. So, LGBTQIA+ people can often feel isolated and lonely after experiencing trauma.
Of course, many LGBTQIA+ people find community online, and this can be helpful. However, it’s important to have support in your immediate surroundings, too, particularly when you’re going through or have been through trauma.
If you have complex trauma, you may find it hard to feel connected to other people. You may find keeping friends and romantic partners difficult, and you may also struggle to control your emotions. Feelings of worthlessness, shame, and guilt can also be common in people with complex trauma.
Trauma-informed care for the LGBTQIA+ community
Getting help for complex trauma isn’t always easy for people in the LGBTQIA+ community. Treatment can be expensive, meaning that some people are priced out – and those who can afford it may still find that the financial burden causes more stress and anxiety. It’s important to remember, too, that when LGBTQIA+ young people do reach out, they’re met with higher rates of stigma and discrimination – and this can add to their stress, and further alienate them.
According to Keith Menhinick, Ph.D., visiting assistant professor of Spiritual Care and Pastoral Theology at Emory University, “A general rule of trauma-informed care, especially when working with LGBTQ+ people, is to treat everyone as if they have a history of trauma. However, we should be careful not to ask about someone’s trauma too quickly.”
He recommends asking people about their strengths, gifts, and wisdom to help build their trust, and asking questions like “Who or what is helping you the most right now?”
“Establishing environments of safety is always the top priority,” says Menhinick. “In our work with others, especially those who have experienced trauma, we must move at the speed of trust. Building trust takes time and a commitment to keep showing up. A common maxim in trauma studies is the slower you go, the faster you get there.”
This is something echoed by Haas, who explains that, when treating trauma in LGBTQ+ patients, safety comes first, and she aims to make the space and her approach non-judgment-focused. “That’s not just judgment from staff or peers, but also internal judgment and internal shame and the negative narrative people can have in our their mind – when we treat ourselves in that way, we are actually re-traumatizing ourselves, and we can’t heal from that, right?” she says.
She explains that the LGBTQ+ people she works with will look at how their identity changes, how their identity affects trauma, trauma symptoms, and what affects their likelihood of developing trauma. “We have groups specifically for the LGBTQ+ community in the program to give them a safe space to talk about some of the things that are interwoven with their traumatic experiences but may not apply to the whole group,” she continues.
Something Menhinick adds is that it’s important to remember that behavioral issues are often efforts to help someone cope with unresolved trauma. “Rather than punishing “bad” behavior, we can get curious about a person’s history and their current strategies and practices for coping with stress,” he says.
Healing and recovery for LGBTQIA+ individuals with complex trauma
There are many things that LGBTQIA+ people with complex trauma can try to help with healing and recovery, too.
Among the treatments available for LGBTQIA+ people with complex trauma include psychotherapy, cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), exposure therapy, and eye movement desensitization and reprocessing (EMDR).
Often, the same treatments used to help manage PTSD can be useful, but people with complex trauma can sometimes need more intensive treatment over a longer period of time. It can also be helpful to get support with other conditions you may have, like anxiety, depression, or dissociation.
Self-care can also be really beneficial when dealing with complex trauma. It helps to have friends and loved ones to speak to, while on your own you could try meditation or journaling. Consistency and sticking to a routine can help, too. This might involve going to bed and waking up at the same times each day, keeping track of your daily chores, or making sure you exercise, enjoying a nutritious diet with plenty of water, and staying on top of personal hygiene.
Advocacy and support for the LGBTQIA+ community
For LGBTQIA+ people affected by complex trauma, groups and organizations providing safe spaces and advocacy for them are invaluable.
The CPTSD Foundation works with survivors of trauma worldwide and offers a lot of resources to support people with complex trauma. Meanwhile, Out of the Storm offers a free and anonymous service to adults living with the symptoms of complex trauma.
Beauty After Bruises helps people who experienced trauma as children, while for teens and young adults, The Trevor Project’s TrevorSpace is an online community and source of support.
Keep in mind.
Living with complex trauma can be tough, but there are resources out there that can help. You could speak to a loved one or your physician, or take a look at the resources above. If you aren’t living with complex trauma yourself, but would like to better support a friend or loved one, the resources above may still be useful – and you can help in the meantime simply by listening and letting them know you’re there.