Citation: Feil, K.; Riedl, D.; Böttcher, B.; Fuchs, M.; Kapelari, K.; Gräßer, S.; Toth, B.; Lampe, A. Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study. J. Clin. Med. 2023, 12, 4501. https://doi.org/10.3390/jcm12134501 Academic Editors: Angel L. Montejo and Elena Tomba Received: 22 May 2023 Revised: 22 June 2023 Accepted: 3 July 2023 Published: 5 July 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Journal of Clinical Medicine Article Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study Katharina Feil 1 , David Riedl 2,3, * , Bettina Böttcher 1, * , Martin Fuchs 4 , Klaus Kapelari 5 , Sofie Gräßer 2 , Bettina Toth 1 and Astrid Lampe 3,6 1 Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; bettina.toth@i-med.ac.at (B.T.) 2 University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria; sofie.graesser@gmx.net 3 Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria; astrid.lampe@rehabilitation.lbg.ac.at 4 Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, 6020 Innsbruck, Austria; martin.fuchs@tirol-kliniken.at 5 Department of Pediatrics I, Medical University of Innsbruck, 6020 Innsbruck, Austria; klaus.kapelari@tirol-kliniken.at 6 VAMED Rehabilitation Center, 6780 Schruns, Austria * Correspondence: david.riedl@rehabilitation.lbg.ac.at (D.R.); bettina.boettcher@i-med.ac.at (B.B.); Tel.: +43-1-3615220 (D.R.); +43-512-504-23267 (B.B.) Abstract: Adverse childhood experiences (ACE) have been shown to have a tremendous nega- tive impact on health outcomes later in life. This study presents data on the prevalence of ACEs, psychological distress, and trauma-related symptoms in transgender and gender-diverse (TGD) people compared to cisgender people. TGD adults (n = 35) and a matched sample of nonpsychiatric hospital patients (n = 35) were surveyed between September 2018 and March 2019. Participants completed the Maltreatment and Abuse Chronology of Exposure Scale to assess ACEs, as well as the Brief Symptom Inventory and the Essener Trauma Inventory to assess psychological distress and trauma-related symptoms. TGD patients reported a higher number of ACEs than cisgender patients (0.7 vs. 2.4; p < 0.001; d = 0.94). A total of 28.6% of TGD vs. 5.7% cisgender patients reported four or more ACEs (p < 0.001). The most common forms of ACEs were parental abuse (54.3%) and peer abuse (54.3%). No significantly increased prevalence of sexual abuse was found (p > 0.05). TGD patients also reported a higher prevalence of depression (48.4% vs. 5.7%, p < 0.001), posttraumatic stress disorder symptoms (59.4% vs. 13.8%, p < 0.001), and anxiety (58.1% vs. 28.6%, p = 0.016). Health care providers should be aware of and assess ACEs, especially in vulnerable groups such as TGD people, and create a safe place through open-minded, affirming care. Keywords: transgender; adverse childhood experience; mental health; trauma; abuse 1. Introduction The terms “transgender” and gender incongruence describe the discrepancy between the assigned and the experienced gender. If the discrepancy leads to distress, this is referred to as gender dysphoria. In The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) by the American Psychiatric Association, gender dysphoria is defined as clinically relevant distress caused by the discrepancy between the assigned gender and experienced gender [1]. The spectrum of gender is diverse: both a clearly female or male gender identity, in the sense of a binary gender system, as well as a nonbinary gender identity can be sought. Often, but not always, medical treatment options such as gender-affirming hormone therapy (GAHT) or surgical intervention are desired. J. Clin. Med. 2023, 12, 4501. https://doi.org/10.3390/jcm12134501 https://www.mdpi.com/journal/jcm