Table 3.

Proportion of CAPS-5 Assessments with Validity and Context Codes for TGD Persons, and PTSD Criterion Where Considerations Presented (N=44)

	n	%	PTSD Criterion
			A	B	C	D	E
Validity Codes
Initially names a non-criterion A discrimination event as index trauma (“worst event”)	26	57	x
Describes the presence of symptom, but did not link to index trauma (scored as “0-absent”)	16	35			x	x	x
Links gender expression to violence risk (feminine expression or ‘not passing’ increases risk)	11	24	x	x	x	x	x
Unable to disentangle discrimination- v. trauma-related symptom expression, even after probing	10	22	x	x	x	x	x
Social or occupational impairment is higher than expected based on PTSD symptom severity	9	20				x
Describes how they were targeted because of their gender identity or expression (self-blame)	8	17	x			x
Reports the presence of negative internalized beliefs about self (gender-related)	8	17	x			x
Observation that ongoing minority and general stressors impair participant’s ability to link symptoms to discrete traumatic event	6	13	x	x	x	x	x
Describes symptom onset as predating traumatic event, in relation to discrimination	5	11				x	x
Comments that chronic/pervasive discrimination is more impactful than a discrete traumatic event	5	11	x
Describes inappropriate guilt related to “burden” of their gender identity on their social supports	5	11	x			x
Links media portrayal of discriminatory policies (e.g., military ban, bathroom bill) to symptoms	5	11		x		x
Links media portrayal of violence against trans women to symptoms	4	9	x			x	x
Describes gender dysphoria “body detachment” when asked about traumatic dissociation	4	9
Links global fears (not based on personal history) about transphobic violence to symptoms	3	7				x	x
Describes verbal assaults (e.g., slurs) as trauma reminders	3	7		x	x
Context Codes
Features of the trauma
Traumatic event was a discrimination-based event based on gender identity or expressiona	18	41	x
Perpetrator of traumatic event was family member (family of origin)a	13	28	x			x
Perpetrator of traumatic event was peer or romantic partner	12	26	x
TGD community was the context for interpersonal violence (TGD-identified peer or partner)	6	13		x		x
Structural discrimination and social determinants
Describes difficulties with employment	22	48	x	x		x	x
Describes difficulties with housing loss, homelessness, and household conflict	14	30	x	x		x	x
Ongoing crises impair ability to report on trauma-related distress (hierarchy of needs)	6	13	x		x	x
Exclusion and rejection
Describes experiences of familial rejection as ‘traumatic’ or linked to symptomsb	16	35	x		x	x
Describes experiences of peer rejection as ‘traumatic’ or linked to symptoms	9	20	x	x		x
Describes experiences of transphobia within one’s racial/ethnic group or religious community	7	15	x		x	x
Describes isolation, exclusion, or avoidance of TGD community post-trauma (when this was context for violence)	3	7	x		x
Describes complicated bereavement when loss of someone who was not gender affirming	2	4	x
Decision to disclose trauma to social supports was based on how affirming these supports were of gender identity	2	4		x	x
Gender dysphoria and gender affirming services
References gender affirming talk therapy when discussing symptoms	6	13			x	x	x
References gender affirming surgical care when discussing symptomsb	5	11	x			x	x
References gender affirming medical care (e.g., hormone therapy) when discussing symptomsb	3	7		x			x
Describes distress associated with reminders that body does not match gender identitya	3	7	x	x		x	x

Note. CAPS-5, Clinician Administered PTSD Scale for the DSM-5; PTSD, posttraumatic stress disorder; TGD, transgender and gender diverse.

^aLinkage to discrimination event was determined by additional probing questions; standard assessment of criterion A on the CAPS-5 only revealed discrimination for 8 (17.8%) of participants.

^bLinked to dissociation sub-type items.