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

• इटली के बारी में एक जेंडर क्लिनिक में आने वाले लिंग डिस्फोरिया वाले 118 वयस्कों (82 पुरुष जन्मे, 36 महिला जन्मे) का आकलन किया गया।
• नैदानिक साक्षात्कार में 29.6% (लगभग 10 में से 3) किसी प्रकार के विघटनकारी विकार के मानदंडों पर खरे उतरे; केवल एक मरीज़ (0.8%) बहु-व्यक्तित्व विकार के मानदंडों पर खरा उतरा।
• 45.8% को किसी समय गंभीर अवसाद रहा था, 21.2% ने आत्महत्या का प्रयास किया था, और 45.8% ने बचपन का आघात बताया।
• अवसाद, आत्महत्या के प्रयास और बचपन का आघात, सभी विघटनकारी विकार वाले मरीज़ों में अधिक आम थे।
• क्रॉस-सेक्स हार्मोन और, कुछ के लिए, सर्जरी के बाद अनुवर्ती पर मरीज़ों ने कम विघटन बताया।
• लेखक तर्क देते हैं कि अपने शरीर के बारे में परेशानी विघटन से मेल खाती है, इसलिए मौजूदा परीक्षणों के लिए दोनों को अलग करना कठिन है।
• मरीज़ उसी बारी शोध कार्यक्रम का हिस्सा थे जिसने हार्मोन उपचार पर लेखकों के 2013 और 2014 के शोधपत्र बनाए।

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.