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

• イタリアのバーリのジェンダークリニックに通う、性別違和のある成人118人（男性として生まれた82人、女性として生まれた36人）が評価されました。
• 臨床面接で、29.6%（約10人に3人）が何らかの解離性障害の基準を満たしました。多重人格障害の基準を満たしたのは1人（0.8%）だけでした。
• 45.8%にこれまでに大うつ病があり、21.2%が自殺を図ったことがあり、45.8%が子ども時代のトラウマを報告しました。
• うつ病、自殺未遂、子ども時代のトラウマは、いずれも解離性障害のある患者でより多く見られました。
• 患者は、異性ホルモンの後、一部では手術の後の追跡時に、解離が減ったと報告しました。
• 著者らは、自分の体についての苦痛は解離と重なっているため、現在の検査ではそれらを区別するのが難しいと主張しています。
• 患者は、著者らのホルモン治療に関する2013年と2014年の論文を生んだものと同じバーリの研究プログラムの一部でした。

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.