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

• 118 volwassenen met genderdysforie (82 als man geboren, 36 als vrouw) die een genderkliniek in Bari, Italië bezochten, werden beoordeeld.
• 29,6% (ongeveer 3 op de 10) voldeed in een klinisch interview aan de criteria voor een soort dissociatieve stoornis; slechts één patiënt (0,8%) voldeed aan de criteria voor een meervoudige persoonlijkheidsstoornis.
• 45,8% had ooit een depressie gehad, 21,2% had een suïcidepoging gedaan, en 45,8% meldde trauma in de kindertijd.
• Depressie, suïcidepogingen en trauma in de kindertijd kwamen allemaal vaker voor bij patiënten met een dissociatieve stoornis.
• Patiënten meldden bij de follow-up minder dissociatie na cross-sex hormonen en, voor sommigen, operaties.
• De auteurs betogen dat nood over het eigen lichaam overlapt met dissociatie, waardoor huidige tests moeilijk onderscheid kunnen maken.
• De patiënten maakten deel uit van hetzelfde onderzoeksprogramma in Bari dat de artikelen van de auteurs uit 2013 en 2014 over hormoonbehandeling opleverde.

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.