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

• Sono stati valutati 118 adulti con disforia di genere (82 nati maschi, 36 nate femmine) che frequentavano una clinica per il genere a Bari, in Italia.
• Il 29,6% (circa 3 su 10) soddisfaceva in un'intervista clinica i criteri di una qualche forma di disturbo dissociativo; un solo paziente (0,8%) soddisfaceva i criteri del disturbo da personalità multipla.
• Il 45,8% aveva avuto in qualche momento una depressione maggiore, il 21,2% aveva tentato il suicidio e il 45,8% riferiva traumi infantili.
• Depressione, tentativi di suicidio e traumi infantili erano tutti più comuni nei pazienti con un disturbo dissociativo.
• I pazienti hanno riferito meno dissociazione al follow-up dopo gli ormoni cross-sex e, per alcuni, la chirurgia.
• Gli autori sostengono che il disagio per il proprio corpo si sovrapponga alla dissociazione, quindi i test attuali faticano a distinguerli.
• I pazienti facevano parte dello stesso programma di ricerca di Bari che ha prodotto gli articoli degli autori del 2013 e del 2014 sul trattamento ormonale.

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.