Science Fact or Science Fiction: Is Gender Nonconformity a Mental Disorder?

Trans is an umbrella term that refers to a diverse group of people whose gender identity or expression differs from prevailing societal expectations.1 Being trans, also known as gender nonconformity, is often mischaracterized as a mental disorder. Trans people have been found to experience higher rates of depression, anxiety disorders and suicidality than non-trans people, but is this because of their gender identity alone? What do we really know about the mental health of trans people?

Confusing Difference with Disease

Until recently, we’ve known very little about the relationship between gender nonconformity and mental health. Conflicting media reports, outdated studies, and changing terminology within the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) have made it challenging to separate science fact from science fiction. The inclusion of Gender Identity Disorder as a diagnostic category in previous versions of the DSM has resulted in many trans people being characterized as "mentally ill" on the basis of their gender identity alone. In other words, being trans has been labelled as a mental disorder, which has in turn pathologized gender nonconformity. While the pathologizing of gender non conformity has always been contested by trans communities and advocates, we now have ground breaking research that is advancing our understanding of the mental health of trans people and demonstrating that difference is, in fact, not disease. Difference, however, can make trans people vulnerable to forms of social exclusion that compromise their health in substantial ways.

The Evidence

New studies by the Trans PULSE project are showing that the higher rates of depression and suicidality experienced by trans people are actually due to experiences of transphobia and discrimination.1234 Transphobia has been defined as "an irrational fear of, aversion to, or discrimination against people whose gendered identities, appearances, or behaviours deviate from societal norms".5 The Trans PULSE project is a CIHR-funded initiative that surveyed 433 trans people aged 16 and older in the province of Ontario. The study found that 98% of respondents had experienced at least one instance of transphobia, and 96% had heard that trans people are not normal.6 Twenty percent of respondents had been the victim of a transphobic physical or sexual assault, and an additional 34% experienced harassment or verbal threats.4 The study confirms a correlation between experiences of transphobia and increased risk of depression and suicidality.

Participants reported a high prevalence rate of depression: 66.4% of female-to-male Ontarians and 61.2% of male-to-female Ontarians reported symptoms consistent with depression.23 Among trans Ontarians, about three-quarters had seriously considered suicide: 50%, for reasons related to their experience as a trans person, and an additional 27% for reasons they felt were unrelated to being trans.7

Transphobia is harmful to the physical and mental health of trans people. Transphobia presents barriers to stable income, housing and access to health care and social services.1 Social and identity supports are crucial for improving mental health outcomes for trans people.2348 For trans youth, for example, having strong parental support is associated with a 93% reduction in reported suicide attempts.9


Gender nonconformity, or being trans, is not a mental disorder. New evidence demonstrates that the increased risk of depression and suicidality among trans people is associated with experiences of transphobia and discrimination. The implementation of anti-transphobia initiatives that address the impacts of transphobia is key to protecting the mental health of trans people.

About the Trans PULSE Project

The Trans PULSE project is a community-based mixed-methods research project that investigates the impact of social exclusion and discrimination on the health of trans people in Ontario. Trans PULSE aims to provide the information necessary to change policies and practices to improve the health of trans communities.



Footnote 1

Bauer, Greta R., Hammond, Rebecca, Travers, Robb, Kaay, Matthias, Hohenadel, Karin M. and Boyce, Michelle. ""I Don’t Think This Is Theoretical; This is Our Lives": How Erasure Impacts Health Care for Transgender People." Journal of the Association of Nurses in AIDS Care 20, no. 5 (2009): 348-361.


Footnote 2

Rotondi, Nooshin K., Bauer, Greta R., Travers, Robb, Travers, Anna, Scanlon, Kyle and Kaay, Matthias. "Depression in Male-to-Female Transgender Ontarians: Results from the Trans PULSE Project," Canadian Journal of Community Mental Health 30, no.2 (2011): 113-133.


Footnote 3

Rotondi, Nooshin K., Bauer, Greta R., Scanlon, Kyle, Kaay, Matthias, Travers, Robb and Travers, Anna. "Prevalence of and Risk and Protective Factors for Depression in Female-to-Male Transgender Ontarians: Trans PULSE Project," Canadian Journal of Community Mental Health 30, no.2 (2011): 135-155.


Footnote 4

Bauer, Greta R., Pyne, Jake, Francino MC, Hammond R. "Suicidality among trans people in Ontario: Implications for social work and social justice / La suicidabilité parmi les personnes trans en Ontario: Implications en travail social et en justice sociale." Revue Service social, 59, no.1 (2013): 35-62.


Footnote 5

Serano, Julia. Whipping girl: A transsexual woman on sexism and the scapegoating of femininity. Emeryville: Seal Press, 2007: p.12.


Footnote 6

Marcellin, Roxanne L., Scheim, Ayden, Bauer, Greta and Redman, Nik, "Experiences of Transphobia among Trans Ontarians," Trans PULSE E-Bulletin 3, no.2 (2013, March 7).


Footnote 7

Scanlon, Kyle, Travers, Robb, Coleman, Todd, Bauer, Greta and Boyce, Michelle. "Ontario’s Trans Communities and Suicide: Transphobia is Bad for Our Health," Trans PULSE E-Bulletin 1, no.2 (2010).


Footnote 8

Moody, Chérie and Smith, Nathan Grant. "Suicide Protective Factors Among Trans Adult," Archives of Sexual Behaviour 42 (2013): 739-752., Rotondi, Noushin K. "Depression in Trans People: A review of the Risk Factors," International Journal of Transgenderism 13, no.3 (2012): 104-116.


Footnote 9

Travers, Robb, Bauer, Greta, Pyne, Jake, Bradley, Kaitlin, Gale, Lorraine and Papadimitriou, Maria. "Impacts of Strong Parental Support for Trans Youth", Trans PULSE (2012, October 2).


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