Study Under Fire for Harmful Language Targeting Transgender and Non-Binary Individuals

Activists and researchers urge the adoption of alternative frameworks to better understand and support transgender experiences.

A recent meta-analysis published in the Journal of Family Medicine and Primary Care revealed that individuals diagnosed with Gender Identity Disorder frequently received concurrent diagnoses of personality disorders, with Borderline Personality Disorder being the most common. Activists criticized the stigmatizing, pathologizing, and dehumanizing language used by the authors, as it can negatively impact the lives of transgender and non-binary individuals.

In a response to the meta-analysis, Hattie Porter, Jay Watts, and Jee Smith stated:

“The paper lacks reflection on the criticisms which delegitimize the personality disorder construct and the implications these discussions have for transgender people. In addition, the authors use medicalized, biased, and microaggressive language, for example, referring to ‘normal’ as opposed to transgender individuals and describing transgender identities as ‘disease.’ Pathologizing transgender identities indicates a viewpoint that this is not a natural and beautiful experience but a condition which could – and perhaps should – be cured.”

Transgender individuals and those with other marginalized gender expressions and identities often face a lack of gender-affirming health services, which creates barriers to healthcare. Such non-affirmative practices not only hinder access to treatment but also harm their mental health.

While some residency programs have started training psychiatrists on LGBTQ cultural competence and sensitivity, a significant gap in training remains. Over the past decade, the mental health field has taken numerous steps to better serve transgender, non-binary, and gender non-conforming individuals, such as no longer considering transgender experiences as mental disorders.

However, psychiatrists who still rely on the biomedical model for understanding psychological distress and suffering often perpetuate pathologizing discourses and harmful practices. This includes the overdiagnosis of borderline personality disorder (BPD), with some studies suggesting rates of 80% or higher among transgender individuals. Prior research has also found that transgender women are more likely to be diagnosed with psychosis, post-traumatic stress disorder (PTSD), substance use disorder, generalized anxiety disorder, and major depressive disorder compared to their cisgender counterparts.

Alternative frameworks to the psychiatric biomedical model of mental disorders have been developed to depathologize the suffering experienced by transgender and non-binary individuals. For instance, the Power Threat Meaning Framework and the Biosocial Model both recognize that chronic interpersonal and societal invalidation, along with other forms of traumatic experiences like anti-trans laws and policies, contribute to minority stress and the development of symptoms associated with BPD or other psychiatric disorders.

These models emphasize how discrimination and oppression impact the psychological distress experienced by this population. Research has shown that improved social and interpersonal conditions, such as using a person’s chosen name and pronouns, legal protections, and pro-LGBTQ policies, can reduce distress and suicidality. Additionally, gender-affirming treatment significantly enhances psychological well-being.

Porter and colleagues identified several issues with the language used in the meta-analysis:

  • They challenged the assertion that transgender individuals are more likely to suffer from personality disorders, arguing they are simply more likely to be diagnosed with one.
  • They pointed out the use of medicalized, biased, and microaggressive language, such as referring to “normal” instead of transgender individuals and describing transgender identities as “diseases.”
  • They questioned the validity and reliability of personality disorder diagnoses, which often rely on psychiatric consensus rather than empirical data.
  • They argued that psychiatric disorder consensus often depends on identifying deviations from societal and cultural norms rather than actual diseases.
  • They noted that diagnoses undermine the role of oppression and discrimination in developing suicidality and other distressing experiences categorized as symptoms.
  • They asserted that the high prevalence of personality disorder diagnoses could be attributed to “clinician bias, prejudice, and misdiagnosis,” which are experienced as a “character assassination” and can deprive people of the needed help.
  • Lastly, they urged the authors to consider the implications of recommending routine assessments of personality disorders for transgender patients, as it may lead to denial of access to gender-affirming care and worsen treatment-seeking behaviors.

The language and discourses employed in psychiatric research and practice continue to stigmatize, pathologize, and dehumanize transgender individuals and decontextualize their suffering. Future research should adopt frameworks recognizing and celebrating transgender experiences while contextualizing their struggles. Doing so can humanize these individuals and more accurately address the root causes of their distress.



Porter, H., Watts, J., & Smith, J. (2023, April 14). My personality is not disordered, and neither is my gender. Response to: Evaluation of personality disorders in patients with Gender   Identity Disorder (GID).

Meybodi, A. M. & Jolfaei, A. G. (2023). Evaluation of personality disorders in patients with   Gender Identity Disorder (GID): An update. Journal of Family Medicine and Primary Care, 11(6),3196-3202 (Link)


  1. “The language and discourses employed in psychiatric research and practice continue to stigmatize, pathologize, and dehumanize [all they meet, including] transgender individuals and decontextualize their suffering.”

    How much longer must our society be subjected to the fraud of the scientifically debunked psychiatric and psychological DSM “bible” believing systems? It’s been ten plus years, since their debunked DSM “bible” was confessed to as fraud.

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  2. How can language harm?

    I am asking this philosophical question out of curiosity. Language does not have a body. A body can inflict harm. Language is made of words which are either read or sung or said. If read then words are made of ink and need to be seen and given any number of choices of meaning by the mind. How can ink alone harm? If sung or said then words are made of vibrations of air fluttering at the ear drum and remain meaningless until given any number of choices of meanings by the mind. How can words that are flutters of air harm?
    No human should feel obliged to love or feel forced to love. No human should be obliged to think or speak lovingly. If they do not speak lovingly then they should not be chastened for freely choosing to not feel or think lovingly. To impose an order that says a human “has to” feel and think lovingly or utter loving words in language is a loveless encroachment on a human’s freedom to feel and think and speak as they wish to.
    If a human is free to love then they must also be free to curtail love or love a bit less or love a bit more or love tomorrow maybe but not love today or perhaps never love again if this is how they feel. A person’s freedom to feel should be respected. Respect does not mean “having to understand” that person and their feelings. You can respect and tolerate someone whom you think is inaccurate or drunk or crazy and whom you do not understand. A person with feelings, and thoughts and language does not “have to” make themselves logically comprehensible or believeable just to earn a bit of respect and tolerance. A person who wants to act eccentrically by wearing a hat made of cheese does not “have to” explain “why” they made a “different choice” just to get respect and tolerance. Likewise a person who wishes to be feeling grumpy and loveless and think loveless thoughts and utter loveless words does not “have to” change that into loving feelings and loving thoughts and loving words just to be “respected” and “tolerated” as a human being. Animals use no words. Animals do not burden themselves with “having to” sound loving towards other animals. Animals do not roar nicely. Yet we do not destroy all the roaring not nice animals. Roaring is not harmful since roaring does not have a body. For an animal to actually harm requires them also deliberately using the kinetic force of their badly behaving body. If terse feelings or thoughts or language is not followed up with bodily bad behaviour then there is no harm. Live and let live.
    The reason we have arrived at monitoring each others feelings and thoughts and language is because these seem to be where we may unearth instances of the freedom to feel or think or use words that are “loveless”. But to “force love” destroys the authentic spontaneous nature of love. A lack of love is a lack of a demonstrated or expressed “feeling”.
    What Grand Old Psychoanalysis has brought about is the idea that a “lack of love” in infancy is damaging psychologically. Taken to extreems this looks like unless we all show love 24/7 then we are outwardly damaging other people. This instruction, to be perpetually loving 24/7 is NOT NATURAL. And because it is not natural it causes unhinging imblances within to even try to be that loving. Such imbalances then destroy whatever flourishing tendrils of love there ever were. Until the whole globe, ordered to be feeling and thinking lovingly at all times becomes full of despising and resentment and division. So such love-monitoring via control over what words are going on in peoples brains has the very opposite effect of the harmonious live and let live one intended.

    Lovelessness is not pleasant but for the most part in adult life it is endurable. A person only needs to walk away from the loveless, not order them to brim with sentiment at them.

    What cannot EVER be endured is bullying. Bullying may have elements of loveless feeling and thinking within it but merely feeling loveless or having loveless thoughts or even using loveless language is not actual physical outward acts of bullying. There is a subtle difference.

    Nothing is cut and dried of course and so there is an overlap in the Venn diagram where lovelessness can seem menacing and intimidating and the loveless can group together to plot acts of outward bullying via using the seductive allure of inspiring words. This is where bullying can “hide” in lovelessness, but lovelessness on its own is NOT responsible for harming so much as a fluttering breeze. More needs added to a feeling of lovelessness for it to be part of bad outward antipathy.

    Children are different. Children need to thrive in loving homes. Adults obviously fare better in loving homes also. A loving just world is one to aspire towards co creating. But to force love ruins any hope of love. It is like imposing a forced marraige. Love is worth nothing if it is not heartfelt true love.

    It is good to go after bullying. It is wrong to go after billions of people for their myriad passing harmless “different choices” of feelings, thoughts or language.

    Between the freedom to feel or think or use any words or language you like, there is a line in the sand, where if outward behaviour becomes involved it moves over that line and becomes actual bullying. But the cause of bullying behaviour is usually from NOT being allowed to freely feel or freely think or make millions of harmless choices for yourself. This NOT being allowed to feel or think has a deleterious effect on wellness and such UNwellness brings about the numbness and glacial disregard behind most cases of outwardly lashing out.

    But heh what do I know eh? I am a schizophrenic mad woman who has just had a visit from a psychiatric nurse. Do not listen to my mad notions.

    By the way The Hoover Dam is going to be exploded by terrorists. And later a huge global epic flood is coming. The last thing humans will be thinking about when that day dawns is language. Instead they will all wish they had LEARNED HOW TO SWIM!!!!

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    • That was great! How did we get to this place where words are violence or microaggressions?
      No, I won’t be forced to feel something to soothe someone’s ego.
      When one feels they have been unfairly attacked, criticised or defamed, stand up for yourself and your right to your feelings, choices, etc. When some assaults you, there’s laws. Call the cops.

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      • I really appreciate this…what you are saying Nancy.
        We are entering a precarious future where totalitarianism from “all sides”, and their heavy handed over reactions to perceived threats, will ensure an increse in bickering and this will cause a crack down on speech.
        I watched a video on George Orwell last night. He was against totalitarianism. But I see the flourishing of totalitarianism as not just springing out of nowhere, rather it “grows” like a branch from an earlier branch of different totalitarianism. The new branch grows via the rippling out of tree rings that hold accusations of earlier society being totalitarian. On and on shoot the branches of the latest totalitarianism, growing leftward, then growing rightward, or growing fundamentalist religion totalitarianism and then growing secular or atheist totalitarianism, on and on and on, and upon each branch are hung a million innocents, lynched by ideological puppets on strings who accuse such innocents of being puppets on strings.
        Totalitarianism is often stopped in its tank tracks by guess what…new totalitarianism. Violence is often stopped by yet more bloodshed. And so violence continues to rule the world.
        “There is real victimhood, then there is fabricated victimhood.” Ayaan Hirsi Ali.
        We must be free to explore our stray thinking. In times of bickering extreem rationalism “logic” tilts into paranoia. This is due to the way “logic” asks endless questions. As soon as it finds a comforting answer “logic” is running off again with deep suspiscion and “doubt”. Doubt is not comfortable to the extreemly analytical brain. And this doubting that brings more fear and unease starts to “other”. In rank paranoia the extreemly rational questioners of everything and everyone cannot relax about simply “not knowing”.
        But to “not know” who your neigbhour is may be a gift, since the reduction in paranoid assumptions opens up the possibility of only using “curiosity” in approaching the neighbour, or unhoused person, or the eccentrically dressed person, or LGBTQ+ person, or the religious person, or the scientific person, or the atheist person, or the voice hearing person.
        To crackdown on speech curtails people’s innocuous “curiosity” and “wonder” about the mysterious “other”.
        Extreem rationalism (and I am only talking of exteemism here, I am quite fond of being rational at times) is an extreem that is perfectionist about “thinking”. It wants your “thinking” to be analytically perfect. The trouble with this is that we are mammals.We are messily “emotional” most of the time. Our hesitant “thinking” is under pressure in these hyper rational totalitarian times to produce “flawless factual argumentation”. Our thoughts are stockpiled like ammo to shoot down anyone with a wayward clumsy opinion. It is a basic human right that each individual should be entitled to hold their own opinion. An opinion is not dangerous in an outwardly bruising behaviourally bullying way. Any more than a five year old child airing an opinion is dangerous. There is a difference between a child feeling loveless and hissing out opinions and actual, direct kinetic bullying. Not everyone in life is going to adore us. That is part of life. (Of course there are caveats to this where it comes to campaigns in a school play yard where a gang of opinionators are miserably intimidating one child).
        On balance though a few decades ago it was understood that “a thought” aired by an adult could “change” by mid-afternoon. And remorse or apology would follow. A “thought” could venture out into the world quite harmlessly and be chased later by the “thought blurting” person’s own “emotional conscience”. It was as if there was freedom to experiment with trying on different choices of thought to see which thought felt like the best representative of the individuals holistic whole psyche. Retracting thoughts was easily done. Like apologetically later tweezering out a splinter or thorn of a thought from a friend’s tender mood. No police would show up at the door. And because we are entering an era of “thought policing” from “all sides”, because “all sides” are now extreemly rational and tilting into paranoia about neighbours through discomfort about “doubt”, discomfort due to escalating fear churned up by ever-questioning “what if” thinking, that comes from extreem rationalism, we are being told that our “thinking” is so dangerous to the world that we ourselves are. This makes us all have to only express “perfect” thoughts. Only “thoughts” that “know it all” and are fact checked and flawless can be aired. Clumsy messy sloppy thinking is damning. But what these imposed restrictions by any totalitarianism mindset then cause is an impulse “to be a damner of other people’s sloppy thinking”. So that it then becomes a fighting exteem rationalism by using extreem rationalism, until “all sides” begin to bully anyone who says a remark off the cuff, or a casual comment in the online Colloseum.
        The uptight use of argy bargy “logic” to battle against the uptight use of argy bargy “logic” looks like it is the road to peace.

        Truly it is the road to apocalype.

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  3. Humour goes out the window when totalitarianism comes to town. Healthy use of “logic” and “reason” can become extreem rationalism devoid of the flexibility of heart. Extreem rationalism becomes a tilting over into imbalance until it becomes the irrationslism of paranoia. It becomes a paranoia that uses the mirroring security found in wearing academia not for the abundant joy of accumulating shiny new knowledge but rather worn as if donning a suit of protective armour.
    The problem with logic is its increments are like bricks, one brick of a fact is put there, someone puts another brick of a fact next to it, a new person adds their brick and so on, as if “getting somewhere” but soon the whole globe is so covered in the bricks of “logic” that the last triumphant brick on that sphere locks into place beside the first analytical brick, right back where “logic” started. It is this propensity of “logic” on its own to “add a bit” and “add another bit” and “add one more retort” that stops “logic” from relaxing into other forms of knowing, or making intuitive leaps, or having soulful understandings.

    “There are more ways of knowing that through words, listen”…said the mystic poet Rumi.

    Another thing “logic” sets up is the allure of oppositionally countering “logic” by using yet more “logic”. Banal humour does not quite succeed with “logic”. Common sense does not succeed with “logic” since it has vague or “common” emotion fed “sensory sense” in it.
    There is no humour in totalitarian times, on “all sides”. A mushroom cloud does not have a lot of laughs in it. But there can be a warped sense of humour as through imbalance ordinary humour moves from liberated joyful decadence to debauchery to downright depravity. The depraved cruel humour of the fascist boot kicking the old man into a mass grave. Really such despotic humour is not humour in any balanced sense of the word but is more akin to an explosive release of pent up tension from being so exteemly rational as to brick together a nerve gas shower room. Maniacal laughter comes from deep distess at feeling nothing about flinging a baby from a tank.

    You may think that decadance leads to depravity. In fact decadance prevents depravity. Decadance is the relaxing of the hyper fussy critical rational mind by instead going with the inexplicable flow of feelings. I am wearing a feather boa because it feels good. No “logical explaination” is required for merely “feeling”. A feather boa feeling harms nobody. A feeling is an interior affair. Abuse and bullying and cruelty are outward bodily forcings and these DO harm people. By bullying I do not mean being a grump. Decadance meets the needs of feelings and this in turn leads to calm and wellbeing. Which makes a person far less likely to want to be abusive or bullying or cruel. And so this is how decadance, by allowing people just enough flexible acceptance of their feelings, arrives at the sort of calm and wellness that stops the imbalanced tilt into depravity. To be depraved you have to be completely divorced from feeling. In particular a feeling of caring for the wellbeing of others.
    But what is arising in this era is both a positive acceptance of decadance but also a rise in callous depravity masquerading as decadance. Illness often masquerades as health and sets up a sales stall on in a bookshop. Berlin on the night before the war thought it had all the rational answers. Rationalism enticed decadance away from caring and gave “logical” reasons why unleashing depravity was even more liberating.

    Decadance is not into child sex abuse. Decadance is not into setting an agenda on others. Decadance is not into harm. Decadance is not into imposing or being provocative for the sheer hell of upsetting others. Decadance is not into bullying others to change from their choice to be as healthily logical or rational or religious or puritan as they want to be. Decadance is respectful of “differences” because decadance causes appropriate healthy caring. Decadance respects the boundaries of other people who choose not to be decadant. There is a kind of decadance going on in piety when piety is from “a feeling”, so just because a person is in a rather uptight religion does not mean they are imbalanced and need rescuing by a bunch of hippies.
    People do their own rescuing for the most part. In their own chosen way.

    Because decadance has been enticed by extreem numb rationalism tilting into irrational paranoia and rigid fear that seeks an outlet in acts of depravity, much blame, coming from “rational leaders” is beginning to be laid at the feet of the harmlessly decadant for supposely “ruining order in the world”.
    To some onlookers the “rational leaders” have a fair point. Decadance seems to have gone into excess. But actually it is not decadance at all that is pushing that excess, but rationalist depravity hiding within the temples of the decadant who are forcing agendas. The rationalist depraved lurk within the communities of the harmlessly hippies AND the rationalist depraved lurk within the communities of the harmlessly traditionalist.
    And this is why the decadant feeling hippies call the traditionslists depraved monsters AND this is why the decadant feeling pious call the hippies depraved monsters. Both are wrong yet both have a point, their are some monsters in both camps. Stirring and stirring by using the chilling utensil of extreem rationalist academia.

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    I saw this video today. It is quite well made I thought.

    Being a prophet, as well as a mad schizophrenic, I feel that in the future a huge REGIME is coming that will be totalitarian. A Hitler type of figure will steer that regime into place. I do not mean that he will be a doppelganger of Hilter, he will not believe things Hitler believed, but he will behave like that historical figure. In this video there is the idea that fascism can only come about via a hyped up sense of national bonding. I would say that because of the internet and air travel people can be in other countries with comparitive ease. This means that a new sense of “the world” has become like the properties of one nation. Utopian ideas now get swept up into an idea of owning “the world” and therefore having a right to organize it. And the collective fervour of being born in “the world” and therefore the fervour to “unite” and be honour bound to sublimate individual freedom, strikes me as not far distant from the fervour of old style nationalism. Blood and soil can be swapped in ambience to mean the way we are of shared blood by being born in “the world” and the soil can be the globe’s soil.

    Someone did a comment under the video that is a quote by Nietzche. Its says…

    “In individuals insanity is rare, but in groups, parties, nations, and epochs, it is the rule”.

    Language is vocalizations that come out of the babbling of infants but it soon gets governed by “consensus opinion” or “groups”. The control over your language is an attempt to steer your thinking. As if language and thinking are harmful.

    Jesus oddly enough did not come to “change” the order of “the world”. As a travelling lone babbler of parables few could understand he was here to be love. He did not set out to engineer a colossal institutional Church. He had friends who were called disciples but these were “individual” friends. Jesus came not to radically overhaul the taverns and street worker houses nor the laws of the day. He may not have liked “the world” as it was, but he did not “impose” how “the world” should be. Choice matters. Humans need the choice to learn from their own mistakes, or a God is living their life for them, like invasion of the body snatchers. What happened long after Jesus was crucified was the vast machine of the Institutional Church took it upon itself to be rather totalitarian in telling people how to “think” and “speak” in order the “save the world” from sin. Policing the language and uniquely “different” thinking of individuals in order to “save the nation” or “save the world” creates eight billion “puppets on strings” who will obediently massacre their neighbours in order to “save the world”.
    Jesus knew not to try to change “the world” but just to be “love” to “individuals” encountered along his journey. I say “just” be “love” but such “radical acceptance” found in “love” is really not easy. It is easier to go to war. Acceptance means accepting that some “individuals” may not hold your views. Acceptance means accepting their “freedom of choice” to be “different”, in their thinking and feelings and beliefs.
    What cannot be “loved” or “accepted” is someone’s free choice to wreak havoc on the choices of others. A regime is coming that will wreak havoc on everyone’s freedom to think and feel and speak for themselves. Totalitarianism comes about in counterpoint reaction to previous totalitarianism. This is because it is easy to point an accusatorial finger at “controllers” of freedom of choice but then make an attempt to superimpose “control” over those “controllers” that can also become just as totalitarian down the line. A regime usually dies by its own poison. “Control” seldom stacks up to “utopia”.

    This morning I checked out the Mad Slam poetry video on MIA. I am very impressed by the poetry on it. But I was a little puzzled by the talk of “trigger warnings”. Some listeners were invited to mute the poem if it perturbed them. We do not want a poem to trigger upset. I am not sure how I feel about this caution over the harmless phenomon of language. A poem that does not “move” or “perturb” or “disturb” or “trigger” does not seem like “a poem”. In any country poets noise up and tell it like they “feel” it is, as “individuals” with “individual thoughts and feelings”. A crackdown by a regime imprisons all the poets first and foremost because a regime imagines that poetry does “move” the masses, challenging a regime’s attempt to move the masses by dogmatic persuasion, usually extreem rationalist persuasion. In short, poetry, the freedom of “individuals” to use words from their own vocabulary and their own unique experiences is a freedom too far for any regime’s collective mindset. And so muffling harmless poetry by saying some words are dangerous is like saying freedom of choice is dangerous.

    But I do believe in being “baby caring”. That is I do believe in being attentive and tender towards the inner child in all of us. I think there is a growing understanding of emotionality and how we should be more caring towards others. So alerting others that might not a movie picture because it contains distressing scenes is part of being a “baby caring” society. But then what can occur is a regime insists that “individuals” stop thinking or feeling or speaking in particular ways that upset the regime “as if” the regime IS now “the baby”. As if a gigantic global bully who insists on obedience in how to “save the nation” or “save the world” is crying like an overgrown baby any time someone writes a little private poem about how their own “inner child” authentically feels.

    A monster or abuser or a regime dictator will often behave to their victim like they need protection from the victims very freedom to think or feel or believe or choose as they feel moved to.

    So on the one hand their is a spirit of the impulse to be healingly caring in giving trigger warnings to the delicate but on the other hand it can become a pandering to the listener and not celebrating the “individual poet’s” need to be who they are.

    As a regime germinates in a society there is accompanying awareness of times turning more rule ridden and less “baby caring”. In response to this comes amorphous bewildered outrage at anyone who seems not to be “baby caring”. As if the paucity of “baby caring” is somehow emanating from cruel “individuals” whose freedom must be curtailed, rather than the cruelty coming from the escalation of cold rational collective consensus regime rules.

    To write a little poem is the ultimate in freedom of choice. A poem where you can use any words you like. Just like a child does when that child writes a poem.

    Jesus loved talking in poems. Look what they did to that free chooser.

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