When we talk about attachment wounds in therapy, most people think of early childhood dynamics, moments when caregivers couldn’t show up consistently, or times when love felt conditional. But for many queer and trans people, Attachment-Focused EMDR healing addresses challenges magnified by something larger than family: society itself.

Gender nonbinary people—who often call themselves enby—do not identify with the male-female gender binary. There are a wide range of gender expressions and identities under the enby umbrella, including agender, gender outlaw, genderqueer, and genderfluid. Gender nonbinary people are not a monolith. Some see gender as a problematic concept to be rejected and fought. Others do not object to gender yet feel they personally do not fit into a specific gender identity. Many enbies identify as trans.

Trans people often report a feeling of gender dysphoria. This is stress, anxiety, and frustration associated with being labeled as a gender with which one does not identify. For example, a trans boy whose parents force him to wear dresses may feel intense gender dysphoria that affects his self-esteem and mental health. Gender dysphoria is highly prevalent among people who are not allowed to express their gender identity.

A person does not have to identify with either the male or female gender to experience dysphoria. Enbies can feel dysphoria, too.

What Gender Dysphoria Looks Like in Nonbinary People

Some of the DSM-5’s diagnostic criteria for gender dysphoria are inclusive of enbies. Common symptoms include:

• Inconsistencies between one’s lived gender identity and assigned gender identity
• Wanting to be treated as a member of a different or alternative gender
• Dislike of or frustration with gender signifiers

However, the DSM-5 also focuses heavily on gender dysphoria as the desire to be the “opposite” gender. Because gender nonbinary people do not wish to be the “opposite” gender, they may not feel included in traditional diagnostic criteria.

Gender dysphoria in nonbinary people may manifest in slightly different ways, including:

• A shifting attitude toward gender signifiers. For example, a person might dislike their breasts one day but feel fine with them on another day.
• Feeling troubled by some gender signifiers but not others. For instance, a person might want to be rid of their chest hair but like their penis.
• Feeling pressured to defend their gender identity. Some enbies report being told that they are adopting a trend, not expressing their identity and lived experience.
• Facing pressure to conform to multiple gender roles. Some enbies present in androgynous ways or embrace signifiers of two or more gender identities. They may face pressure to conform to conflicting gender identities.

Gender Dysphoria in Nonbinary Youth

Binary trans people—those who identify as male or female—and enbies generally report developing gender dysphoria around the same time. For most people dysphoria sets in around puberty, getting progressively more intense as puberty changes the body.

John Sovec, LMFT, a California therapist who works with LGBT clients, says, “Gender dysphoria is often discussed in the treatment of adult nonbinary clients, but it is important to also note its influence on the development of nonbinary adolescents. When you reflect on the pressures to fit in that already exist in a teen’s world, imagine the distress and anxiety that can manifest when gender dysphoria is present.

Adolescents are already experiencing the myriad changes that are occurring during the onset of puberty, and these changes in the body can magnify the feelings of dysphoria. “Adolescents are already experiencing the myriad changes that are occurring during the onset of puberty, and these changes in the body can magnify the feelings of dysphoria. What was once a generalized feeling of being uncomfortable with their physical sex and/or gender role can be heightened with the onset of puberty and manifest in feelings of depression, anxiety, shame, and self-hatred.

“It is important to assist adolescents in establishing their identity by actively exploring identity-related choices and encouraging identity development in their affirmed identity in a safe and supportive environment.”

Research suggests enbies face significant difficulty accessing gender-affirming health care. This may be because traditional notions of gender dysphoria take the gender binary for granted. A 2018 study of more than 800 trans youth found that just 13% of nonbinary youth sought hormone therapy, compared to 52% of binary trans youth. They were also more likely report encountering barriers to accessing hormone therapy.

The study also found that older enbies (aged 19-25) were significantly more likely than older binary youth to avoid necessary health care. However, younger enbies and binary trans people (aged 14-18) saw no differences in foregoing primary health care. Cultural shifts in attitudes regarding gender may play a role in this. As awareness of enbies increases, so too may the willingness of younger enbies to identify as nonbinary and demand gender-affirming health care.

When Nonbinary People Seek Treatment for Gender Dysphoria

Gender nonbinary people are sometimes reluctant to seek health care for gender dysphoria, as well as for unrelated issues. This may be because doctors commonly believe inaccurate stereotypes about enbies or are unaware of their existence.

A 2017 study of enbies seeking health care found that they often feel misunderstood, stigmatized, disrespected, or pigeonholed into the incorrect gender. Even when enbies seek care at gender-affirming clinics, they may encounter clinicians who are accustomed to relying on a strict gender binary. According to the study, nonbinary people may feel pressure to conform to the gender binary in health care settings.

In some cases, a health care provider may trigger feelings of dysphoria. For example, a doctor might call a chest binder a bra. This can deter enbies from seeking appropriate medical care and make it more difficult to access hormonal therapies and other treatments for dysphoria.

Research consistently shows significant health care disparities between trans and cis individuals. There may be similar disparities between binary and nonbinary trans people. This could affect access to all forms of health care, including potentially life-saving treatments that are unrelated to gender.

How Therapy Can Help Nonbinary People with Gender Dysphoria

The right therapist can provide a supportive, affirming environment for enbies with gender dysphoria. In therapy, a nonbinary person can discuss their feelings about gender in general, as well as their own gender identity. Therapy that supports these feelings instead of stigmatizing them can be a powerful antidote to the pressure many nonbinary people face to conform to a gender binary.

A therapist may also:

• Support a nonbinary person in accessing dysphoria treatment options, finding a supportive health care provider, and choosing the treatment most consistent with their identity.
• Help a nonbinary person discuss their identity with friends or family. Not all nonbinary people present as obviously nonbinary. They may need help coming out, discussing their identity, and educating loved ones about what it means to be nonbinary.
• Discuss issues such as self-esteem, body image, depression, and anxiety.
• Help a nonbinary person understand that being nonbinary is not a mental health condition or a personal failing.

In therapy, a nonbinary person can better understand their own identity, become a stronger advocate for their needs, and tackle internalized dysphoria and transphobia.

References:

1. Clark, B. A., Veale, J. F., Townsend, M., Frohard-Dourlent, H., & Saewyc, E. (2018). Non-binary youth: Access to gender-affirming primary health care. International Journal of Transgenderism, 19(2), 158-169. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1394954
2. LGBTQ 101: terminology and tips. (n.d.) Retrieved from https://www.kenyon.edu/about-kenyon/diversity-at-kenyon/lgbtq-plus/terminology
3. Lykens, J. E., Leblanc, A. J., & Bockting, W. O. (2018). Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT Health, 5(3), 191-196. Retrieved from https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6016091&blobtype=pdf
4. Mamone, T. (2017, October 19). Yes, non-binary people experience gender dysphoria. Retrieved from https://theestablishment.co/yes-non-binary-people-experience-gender-dysphoria-c056eb3df3c9
5. Providing affirmative care for patients with non-binary gender identities. (n.d.). Retrieved from https://www.lgbthealtheducation.org/publication/providing-affirmative-care-patients-non-binary-gender-identities

Many people see sexuality as key to their identity. But sexuality can change over time. These changes often cause shifts in identity, experiences, and relationships.

Sexuality: A Continuum of Experiences

Most people use sexuality to refer to the gender(s) to which they are attracted. However, sexuality means different things to different people. Not everyone experiences sexual feelings. Others have sexual feelings only in certain contexts. Someone who is asexual may have no sexual feelings. Meanwhile, someone who is demisexual may only have sexual feelings in a committed relationship. Even within these identities, there are numerous variations.

Sexuality can change over time. Some of the many reasons a person’s identity might change include:

• Feeling less encumbered by social norms. Some people grow up in repressive families or feel stuck in marriages they did not want or no longer want. When they no longer have these restrictions, they may explore their sexuality. This can cause an identity shift.
• Attraction to a new person. Some people connect strongly with a specific identity. They may then become attracted to a new person who calls that identity into question.
• Political or ideological shifts. Some people change their sexuality for political reasons. Lesbian separatism is the refusal to participate in heterosexual relationships. Some women choose lesbian separatism due to firmly held feminist beliefs.

Understanding Sexual Fluidity

Sexual fluidity is the ability of sexual feelings to change over time. Some people embrace this notion. They may be more open to changes in their sexuality. Others are surprised to experience a shift in sexual feelings.  [fat_widget_right]

Sexologists are people who study human sexuality. They have attempted to understand and quantify human sexuality using scales. For example, the Kinsey Scale ranges from 0-6. It includes identities ranging from exclusively heterosexual to exclusively homosexual. Most people fall somewhere between the two extremes. This is one way to explain sexual fluidity. If most people are not entirely homosexual or heterosexual, then the right experiences or setting may cause a person’s orientation to change.

Other scales that measure sexuality include:

• The Klein Grid. This scale looks at a person’s past, present, and ideal experiences. It includes measures of romantic, sexual, and social attractions. The Klein Grid also makes room for personal sexual identity.
• The Multidimensional Scale of Sexuality. This measure breaks sexuality into nine categories. It was developed primarily as a criticism of other tools that don’t distinguish sexual identity from behavior or treat sexual orientation as something that remains consistent across a person’s lifetime.

Researchers have developed dozens of other scales. Many of these are slight variations on the Kinsey Scale.

Are Sexuality and Gender the Same? The Link Between Sexuality and Gender

Sexuality and gender are distinct. A person’s sexuality includes a wide range of factors, including the gender to which they are attracted. Gender refers to gender identity. Most people are male or female, while others may have a different gender identity or be nonbinary. Some believe that the concept of gender is harmful or problematic.

Gender and sexual identities can change with time, but a change in one does not necessitate a change in the other. When a person’s gender identity changes, they may remain attracted to the same gender(s) of people. For example, a trans woman who once identified as heterosexual may identify as a lesbian following her transition.

The notion that sexuality can change has long been used to oppress sexual minorities. Conversion therapy uses physical and emotional abuse to urge non-heterosexual people to become heterosexual. It hinges on the idea that it’s possible to force someone to change their sexuality.

How Sexuality Affects Identity

Most people see sexuality as a fundamental part of their identity. Relationships often depend on sexual identity. It is common for people to participate in sexuality-based subcultures. For instance, a heterosexual couple may have primarily heterosexual friends.

When sexuality changes or when someone questions their sexuality, their identity may also shift. Sexuality changes may spur fears of rejection. For example, a lesbian who begins to be attracted to men may worry her friends will judge her.

People with non-normative sexual identities—including lesbian, gay, bisexual, queer, pansexual, and asexual identities—can be especially anxious about shifts in their sexuality. The notion that sexuality can change has long been used to oppress sexual minorities. Conversion therapy uses physical and emotional abuse to urge non-heterosexual people to become heterosexual. It hinges on the idea that it’s possible to force someone to change their sexuality.

The Difference Between Change Over Time and Forced Change

Forced change is categorically different from natural shifts in sexuality. People change many preferences or interests over a lifetime. These include changes that are key to their identity. Careers, hobbies, romantic partners, and political ideals figure prominently in identity. And while they often change with new experiences, they are unlikely to change under duress.

Sexuality is similar, though one’s sexual orientation is never a matter of preference. People cannot change who they love or are attracted to. While those feelings may shift with time, attempting to force change for political or religious reasons is unlikely to work. It can also cause lasting harm. Most medical and psychological organizations oppose conversion therapy as a form of psychological abuse. Several states have banned the practice.

When Sexual Practices and Identity Differ

People align with specific sexual orientations for many reasons. Sometimes a person’s sexual practices are not included in their sexual identity. Someone might identify as heterosexual but occasionally have sex with people of the same gender. Many factors, including stigma, may contribute to this behavior.

The philosopher and social theorist Michel Foucault famously argued that sexual identity is a social and historical construct, not an unchangeable identity. He saw sexual identity as linked to power structures and historical shifts. Foucault disputed the idea that sexual orientation is a fundamental part of one’s essence. With this understanding of sexuality, shifts in identity may be inevitable. They may be no different than changes in taste or fashion.

No matter how someone views their sexual identity or how that identity changes over time, sexuality can prompt important questions about relationships, politics, religion, and more. A therapist can help untangle these issues in a respectful and nonjudgmental setting.

References:

1. Berkey, B. R., Perelman-Hall, T., & Kurdek, L. A. (1990). The multidimensional scale of sexuality. Journal of Homosexuality,19(4), 67-88. doi: 10.1300/j082v19n04_05
2. Overview of sexual orientations. (n.d.). Retrieved from http://www.soc.ucsb.edu/sexinfo/article/overview-sexual-orientations
3. Sexual fluidity. (n.d.). Retrieved from https://vaden.stanford.edu/health-resources/lgbtqia-health/sexual-fluidity
4. The emergence of sexuality: Foucault, sexual identities, and the modern self. (n.d.). Retrieved from http://www.thinkolio.org/olios/emergence-sexuality-foucault-sexual-identities-and-modern-self
5. The Klein Sexual Orientation Grid. (n.d.). Retrieved from http://www.americaninstituteofbisexuality.org/thekleingrid