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

• Ocenjenih je bilo 118 odraslih s spolnim nelagodjem (82 rojenih kot moški, 36 kot ženske), ki so obiskovali kliniko za spol v Bariju v Italiji.
• 29,6 % (približno 3 od 10) jih je pri kliničnem intervjuju izpolnjevalo merila za neko vrsto disociativne motnje; le en bolnik (0,8 %) je izpolnjeval merila za motnjo večkratne osebnosti.
• 45,8 % jih je kdaj imelo veliko depresijo, 21,2 % je poskusilo samomor in 45,8 % je poročalo o otroški travmi.
• Depresija, poskusi samomora in otroška travma so bili vsi pogostejši pri bolnikih z disociativno motnjo.
• Bolniki so ob nadaljnjem spremljanju po hormonih nasprotnega spola in pri nekaterih operaciji poročali o manj disociacije.
• Avtorji trdijo, da se stiska zaradi lastnega telesa prekriva z disociacijo, zato trenutni testi težko razločijo med njima.
• Bolniki so bili del istega raziskovalnega programa v Bariju, ki je pripravil članke avtorjev iz let 2013 in 2014 o zdravljenju s hormoni.

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.