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

• 이탈리아 바리의 성별 클리닉에 다니는 성별 불쾌감이 있는 성인 118명(출생 시 남성 82명, 여성 36명)이 평가를 받았습니다.
• 29.6%(약 10명 중 3명)가 임상 인터뷰에서 어떤 종류의 해리성 장애 기준을 충족했고, 다중 인격 장애 기준을 충족한 환자는 한 명(0.8%)뿐이었습니다.
• 45.8%는 어느 시점에 주요 우울을 겪었고, 21.2%는 자살을 시도했으며, 45.8%는 어린 시절 트라우마를 보고했습니다.
• 우울, 자살 시도, 어린 시절 트라우마는 모두 해리성 장애가 있는 환자에서 더 흔했습니다.
• 환자들은 반대 성 호르몬과 일부는 수술을 받은 뒤 추적 시점에 해리가 줄었다고 보고했습니다.
• 저자들은 자신의 몸에 대한 고통이 해리와 겹치므로 현재의 검사로는 둘을 구별하기 어렵다고 주장합니다.
• 환자들은 호르몬 치료에 대한 저자들의 2013년과 2014년 논문을 낳은 같은 바리 연구 프로그램의 일부였습니다.

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.