The Silent Conflict Between Layers of Identity
A person’s identity is far more than the label assigned at birth. It is a complex interplay of biological, psychological, and social dimensions. For many transgender individuals, this unity is often fragmented.
Identity unfolds across three dimensions: assigned identity (the label given at birth), inner gender identity, and social or visible identity. When these layers fall out of sync, the result is not merely external conflict but a deep psychological tension resonating through body, self, and society.
Modern psychology now recognises identity as a fluid process rather than a fixed state. This understanding is vital to appreciating the inner and outer conflicts experienced by trans individuals. After all, identity is not only about who we are but also about who we are allowed to be.
1. Living Across Three Dimensions: Between Visibility and Validation
The experience of being trans is shaped by the interaction—and often misalignment—of three identity dimensions:
-
Assigned identity: the gender designated at birth, based on biological sex;
-
Inner identity: the authentic sense of self and one’s true gender;
-
Social identity: how one’s identity is recognised, named, and affirmed by others.
When these three dimensions fail to align, the individual may feel as though they are constantly “switching roles.” In daily life, this dissonance manifests as fear of expression, anxiety about rejection, or the wish to remain unseen.
Trans people frequently find themselves caught between the right to self-expression and the need for social acceptance—a tension known in the literature as gender incongruence.
The 2019 revision of the ICD-11 reclassified this phenomenon from a mental disorder to a sexual health condition—a landmark move aimed at reducing stigma and affirming identity diversity.
2. Minority Stress and Psychological Impact: The Invisible Weight
One of the most significant factors affecting the mental health of trans individuals is minority stress.
The Gender Minority Stress Model (Hendricks & Testa, 2012) conceptualises this within two main categories:
-
Distal stressors: external forms of discrimination, violence, and social exclusion;
-
Proximal stressors: internalised transphobia, anxiety about rejection, concealment, and hypervigilance.
Together, these layers form a chronic emotional burden.
Research shows that depression, anxiety, trauma symptoms, and low self-worth among trans individuals are closely tied to these stress processes (Tordoff et al., 2022; Chen et al., 2023).
In Türkiye, similar findings emerge: restricted access to healthcare, social prejudice, and bureaucratic uncertainty in gender-affirming procedures contribute to emotional exhaustion and diminished well-being.
For some, life becomes an ongoing effort to “prove” one’s own identity to the world.
3. The Role of Therapy: Seeing All Three Selves
For therapists, a crucial question arises in this work:
“Which identity dimension is my client speaking from right now?”
At times, a client may discuss their inner identity while still using the language of their assigned one.
That is why affirmative therapy is not merely a clinical orientation but an ethical stance, a commitment to:
-
Accept the client’s gender identity without conditions;
-
Honour their right to define their own experience;
-
Support their journey toward identity integration and authenticity.
In many cases, the therapy room becomes the first safe space where a trans person feels truly seen.
Even subtle shifts in language and tone can create profound psychological effects. Research suggests that gender-affirming therapy activates neural pathways linked to trust and belonging, a biological reflection of psychological safety.
4. Toward Identity Integration: Healing the Divide
The goal in working with trans clients is not to “change” identity but to cultivate identity integration, bringing the assigned, inner, and social selves into harmony.
-
Assigned identity connects to the societal and administrative framework of recognition.
-
Inner identity represents the acceptance of one’s true self.
-
Social identity concerns visibility, affirmation, and representation.
Bridging these dimensions allows individuals to regain coherence and self-agency.
For instance, following a name or gender marker change, therapy can help clients emotionally integrate this new stage of life—transforming administrative validation into psychological belonging.
For clinicians, the task is to walk alongside the client with sensitivity, non-judgment, and empowerment—creating a therapeutic environment that honours complexity rather than conformity.
Conclusion: Giving Voice to All Layers of the Self
The trans experience is not a disorder but a multilayered expression of being. As the gap between assigned, inner, and social identities widens, so does the emotional cost.
Yet with affirming support, therapeutic care, and broader social understanding, these voices can once again find harmony.
Psychological healing does not come from changing who we are, but from embracing every layer of our being—recognising, accepting, and expressing the self in full.
For clinicians, this is not only a matter of competence, but an act of respect for human dignity itself.