A Bottom-Up Approach to Developing a Unified Trauma-Minority Stress Model for Transgender and Gender Diverse People.

Clinical Impact Statement This study uses perspectives of transgender and gender diverse people and their providers to visualize relationships between Criterion A traumas, minority stress experiences, and the resulting psychiatric symptoms. We find that minority stress experiences are typically perceived as more directly related to symptoms than Criterion A traumas by both groups, which highlights the importance for practitioners and researchers to consider minority stress as beyond what is traditionally defined by Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) as "traumatic." Objective: Transgender and gender diverse (TGD) people are at heightened risk of both Criterion A trauma exposure and other bias-related minority stressors (e.g., discrimination, rejection). In the absence of a unified trauma-minority stress theory, it remains unclear how to best conceptualize psychopathology for people who experience both trauma and minority stress. Method: Using a participant-driven q-sort methodology and network analytic approach, we analyzed card sort data from 18 TGD people and 16 providers with expertise in TGD care to derive thematic networks of trauma and minority stress experiences, as they connected to transdiagnostic symptoms (e.g., hyperarousal, avoidance). Results: The TGD participants' resulting network illustrates conceptualizations of identity- and nonidentity-based Criterion A traumas as similar and only related to psychiatric symptoms via the shared connection through other minority stressors. The provider network was more granular, although the general pattern was consistent with TGD participants, demonstrating similar perceptions of how these experiences are associated. Conclusions: Evidence of inextricable links between trauma and psychiatric symptoms through the conduit of minority stressors lays the groundwork for novel, integrated models of trauma, minority stress, and their transdiagnostic symptom sequelae.