Summary

Researchers at a gender clinic in Bari, Italy, checked 118 adults with gender dysphoria for dissociation, which means feeling cut off from your body, yourself or your surroundings. They used a clinical interview and a questionnaire, then checked again after hormone treatment and, for some, surgery. About 3 in 10 met criteria for a dissociative disorder. These patients more often had a history of depression, suicide attempts and childhood trauma. Dissociation was lower after treatment. The authors suggest that some of this "dissociation" may really be part of distress about one's body, and that standard tests struggle to tell the two apart. The high rates point to complex needs when people are first assessed. But the improvement comes from one clinic, with no comparison group and short follow-up, so it cannot show that treatment caused it.

Key findings

• 118 voksne med kønsdysfori (82 født som mænd, 36 født som kvinder), der gik på en kønsklinik i Bari, Italien, blev vurderet.
• 29,6 % (omkring 3 ud af 10) opfyldte kriterierne for en eller anden form for dissociativ lidelse i et klinisk interview; kun én patient (0,8 %) opfyldte kriterierne for multipel personlighedsforstyrrelse.
• 45,8 % havde på et tidspunkt haft svær depression, 21,2 % havde forsøgt selvmord, og 45,8 % rapporterede traumer i barndommen.
• Depression, selvmordsforsøg og traumer i barndommen var alle mere almindelige hos patienter med en dissociativ lidelse.
• Patienterne rapporterede mindre dissociation ved opfølgningen efter krydskønshormoner og for nogles vedkommende kirurgi.
• Forfatterne argumenterer for, at lidelse over ens krop overlapper med dissociation, så nuværende test har svært ved at skelne dem.
• Patienterne var en del af det samme forskningsprogram i Bari, som frembragte forfatternes artikler fra 2013 og 2014 om hormonbehandling.

Abstract

This study evaluated dissociative symptomatology, childhood trauma and body uneasiness in 118 individuals with gender dysphoria, also evaluating dissociative symptoms in follow-up assessments after sex reassignment procedures were performed. We used both clinical interviews (Dissociative Disorders Interview Schedule) and self-reported scales (Dissociative Experiences Scale). A dissociative disorder of any kind seemed to be greatly prevalent (29.6%). Moreover, individuals with gender dysphoria had a high prevalence of lifetime major depressive episode (45.8%), suicide attempts (21.2%) and childhood trauma (45.8%), and all these conditions were more frequent in patients who fulfilled diagnostic criteria for any kind of dissociative disorder. Finally, when treated, patients reported lower dissociative symptoms. Results confirmed previous research about distress in gender dysphoria and improved mental health due to sex reassignment procedures. However, it resulted to be difficult to ascertain dissociation in the context of gender dysphoria, because of the similarities between the two conditions and the possible limited application of clinical instruments which do not provide an adequate differential diagnosis. Therefore, because the body uneasiness is common to dissociative experiences and gender dysphoria, the question is whether dissociation is to be seen not as an expression of pathological dissociative experiences but as a genuine feature of gender dysphoria.

Conclusion

Results confirmed previous research about distress in gender dysphoria and improved mental health due to sex reassignment procedures. However, it resulted to be difficult to ascertain dissociation in the context of gender dysphoria, because of the similarities between the two conditions and the possible limited application of clinical instruments which do not provide an adequate differential diagnosis. Therefore, because the body uneasiness is common to dissociative experiences and gender dysphoria, the question is whether dissociation is to be seen not as an expression of pathological dissociative experiences but as a genuine feature of gender dysphoria.