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Kinder mit Geschlechtsdysphorie zeigten meist eine Hochrisiko-Bindung – wie Kinder mit anderen psychiatrischen Störungen

Bindungsmuster bei Kindern und Jugendlichen mit Geschlechtsdysphorie

Kohorten- & RegisterstudienAutismus, Trauma & Begleiterkrankungen
Authors
Kasia Kozlowska, Catherine Chudleigh, Georgia McClure, Ann M. Maguire, Geoffrey R. Ambler
Journal
Frontiers in Psychology
Year
2021
Source
https://doi.org/10.3389/fpsyg.2020.582688

Summary

Clinicians at the Children's Hospital at Westmead in Sydney interviewed 57 children and teens referred for gender distress. The interviews measured attachment, meaning how a child bonds with and relies on carers, and were scored by coders who did not know which group the child was in. Compared with matched children from the community, the gender-referred children were far more likely to show 'at-risk' attachment and unresolved loss or trauma. They had more hard childhood experiences such as abuse or family breakdown (5.5 vs 1.7 on average), and only 35% lived with both birth parents. Their attachment patterns looked the same as those of children referred for other mental health problems. The authors call for assessment of the whole child and family. The study cannot show that attachment problems cause gender distress, and it comes from one clinic using a specialised scoring system.

Key findings

  • 57 von 70 Kindern, die zwischen Dezember 2013 und Juni 2017 an das Gender-Angebot in Westmead überwiesen wurden, nahmen an strukturierten Interviews zur Bindung teil, mit Fassungen für Schulkinder und ältere Jugendliche.
  • Kinder mit Geschlechtsleidensdruck wurden überwiegend als Hochrisiko-Bindung eingestuft, anders als 57 Kinder aus der Allgemeinbevölkerung gleichen Alters und Geschlechts. Nur 8 (14 %) zeigten typische, gesunde Muster. Der Unterschied war viel zu groß für Zufall.
  • Sie hatten auch viel mehr ungelösten Verlust oder Trauma als die Kinder aus der Allgemeinbevölkerung.
  • Ihre Bindungsmuster und die Raten ungelösten Verlusts oder Traumas unterschieden sich nicht von denen von 51 Kindern mit verschiedenen psychischen Problemen.
  • 50 von 57 (88 %) hatten andere psychische Diagnosen, und ihre Alltagsfunktion war beeinträchtigt, mit durchschnittlich etwa 55 von 100 Punkten.
  • Wegen Geschlechtsfragen überwiesene Kinder hatten durchschnittlich 5,5 belastende Kindheitserfahrungen wie Missbrauch, Vernachlässigung oder Zerbrechen der Familie, gegenüber 1,7 bei Kindern aus der Allgemeinbevölkerung. Nur 35 % lebten mit beiden leiblichen Eltern, verglichen mit 75 %.
  • Niedrigeres Familieneinkommen und niedrigerer Status, eine nicht traditionelle Familienkonstellation und belastende Erfahrungen einschließlich Missbrauch oder Vernachlässigung hingen mit Hochrisiko-Bindung zusammen.

Abstract

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42-15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25-95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs-including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)-increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.

Conclusion

Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs. The authors conclude that gender dysphoria in children arises in association with developmental pathways shaped by disruptions to family stability, adverse experiences and socioeconomic status, and that treatment requires a comprehensive biopsychosocial assessment of the child and family, followed by interventions addressing the breadth of interconnected factors.