Thematic Analysis Themes and Subthemes.

People who identify as both transgender and plural (more than one person sharing a body), including those with a diagnosis of Dissociative Identity Disorder, make decisions related to gender identity and presentation, and may engage with healthcare providers to receive gender affirming care. Internal decision-making by people experiencing plurality has not been studied extensively. Furthermore, the existing literature on plural decision-making does not address the intersection of transgender identity and the associated choices to be made about external gender expression or shared body modifications. Using a community-based participatory research design and a non-pathologizing lens, the research team interviewed 15 transgender and plural participants. Through thematic analysis, three themes were developed, describing the context of conflict, collective decision-making processes, and solutions that promoted harmony within plural systems. Plural participants were able to effectively navigate decision-making regarding harmful societal narratives about transgender identity, external gender presentation, and receiving gender-affirming medical care. Recommendations from the data serve to assist clinicians in understanding and supporting affirming, autonomous and informed decision-making by trans and plural clients.

同时认同为跨性别（transgender）与多元人格（即共享同一躯体的多个人格群体）的人群，包括确诊解离性身份障碍（Dissociative Identity Disorder）的个体，会做出与性别认同、性别呈现相关的决策，并可能接洽医疗服务提供者以获取性别肯定照护（gender affirming care）。目前针对多元人格群体的内部决策机制的研究尚未得到充分开展。此外，现有关于多元人格决策机制的研究文献，并未涉及跨性别认同与外部性别表达、共享躯体改造相关决策之间的交叉关联。本研究团队采用社区参与式研究设计（community-based participatory research design）与非病理化研究视角，访谈了15名跨性别多元人格参与者。通过主题分析（thematic analysis），研究团队提炼出三大主题，分别为冲突情境、集体决策流程，以及促进多元人格系统内部和谐的解决方案。参与研究的多元人格参与者能够妥善应对围绕跨性别认同、外部性别呈现以及获取性别肯定医疗服务的有害社会叙事相关的决策议题。本研究所得出的建议，旨在帮助临床工作者理解并支持跨性别多元人格服务对象开展符合其身份认同、自主且知情的决策。