Va dsm 5 criteria for ptsd
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LGBTQ+ people report a range of sometimes overlapping experiences that are associated with a client's experience of PTSD symptoms (11). Recovery From Discrimination-Based Stress and Trauma Can Be Interrelated Some LGBTQ+ individuals may also anticipate or fear rejection from others, leading to difficulties navigating interpersonal relationships and interactions. One's own agreement with negative societal attitudes toward LGBTQ+ people, known as internalized stigma (also internalized homophobia or transphobia), may heighten the distress experienced by an LGBTQ+ person. Uncertainty about when to conceal identity (for personal safety) can lead to attentional drain and further distress. Some consider this to be an important option that offers protection yet concealment often comes at a considerable psychological and interpersonal cost (10). Proximal/Internal Experiences: The ability for some individuals to conceal their identity distinguishes LGBTQ+ people from other minoritized groups. Given this, it is not surprising that 15% to 33% of LGBTQ+ people report mistreatment in health care (7-9). As such, gender affirming care is contingent upon DSM-5 gender dysphoria diagnosis even in cases where a person's experience does not meet diagnostic levels. Additionally, mental health providers have been positioned as gatekeepers of life-saving gender affirming medical and surgical care for transgender and gender diverse people. The history of mental health care is especially problematic, given the inclusion of aspects of sexual identity and orientation in psychiatric diagnoses (e.g., "high risk homosexual behavior" in the ICD10 homosexuality as psychiatric diagnosis until 1973). For transgender and gender diverse people, relevant policies have changed over time, with bans on military service being predominant. Only since 2011 have lesbian, gay and bisexual individuals been allowed to serve openly in the military. For example, LGBTQ+ people can currently be evicted, denied housing, or denied entry to businesses in over twenty states. Furthermore, LGBTQ+ people face structural discrimination at local, state and federal levels (e.g., laws and policies that offer less protection to LGBTQ+ people) and across institutions such as education, employment, religion, housing and health care. Minority stressors include external or distal experiences, such as discrimination and violent victimization, as well as internal or proximal experiences such as internalized stigma (shame), expectations or fears of rejection, and identity concealment (5,6).ĭistal/External Experiences: Nearly half (48%) of transgender people report interpersonal discrimination, such as being verbally harassed or physically assaulted due to their identity in the past year (7). LGBTQ+ people also experience various socially-produced stressors due to their identities-these are often referred to in the research as minority stressors. These estimates are much higher than the general population prevalence (4.7% 4).
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As a result, LGBTQ+ people are at higher risk of developing PTSD, with prevalence estimates of up to 48% of LGB individuals and 42% of transgender and gender diverse individuals meeting criteria for PTSD (3). In fact, LGBTQ+ individuals are nearly 4 times more likely to experience violent assault (rape or sexual assault, robbery, and aggravated or simple assault) than their cisgender (i.e., person whose gender identity is the same as their sex as assigned at birth), heterosexual counterparts (2). Lesbian, gay and bisexual identities have been associated with higher victimization across the lifespan compared to those with a heterosexual identity, including experiences of child abuse and sexual and physical assault (1). LGBTQ+ People Experience a Range of Stressors Assault This article focuses on describing the unique experiences of LGBTQ+ people who have experienced trauma, discrimination and PTSD. The "+" indicates any other minoritized identities such as intersex, asexual, pansexual or nonbinary. The LGBTQ+ acronym represents individuals who identify as lesbian, gay, bisexual, transgender or queer. The Department of Veterans Affairs (VA) uses LGBTQ+ to refer to people with diverse gender and sexual identities. Trauma, Discrimination and PTSD Among LGBTQ+ People
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