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 vuxna med könsdysfori (82 födda som män, 36 födda som kvinnor) som gick på en könsklinik i Bari, Italien, bedömdes.
• 29,6 % (cirka 3 av 10) uppfyllde kriterierna för någon sorts dissociativ störning i en klinisk intervju. Bara en patient (0,8 %) uppfyllde kriterierna för multipel personlighetsstörning.
• 45,8 % hade haft egentlig depression någon gång, 21,2 % hade försökt ta sitt liv och 45,8 % rapporterade trauma i barndomen.
• Depression, självmordsförsök och trauma i barndomen var alla vanligare hos patienter med en dissociativ störning.
• Patienterna rapporterade mindre dissociation vid uppföljning efter korskönshormoner och, för vissa, kirurgi.
• Författarna hävdar att lidande över den egna kroppen överlappar med dissociation, så att nuvarande tester har svårt att skilja dem åt.
• Patienterna var en del av samma forskningsprogram i Bari som gav upphov till författarnas artiklar från 2013 och 2014 om hormonbehandling.

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.