Childhood abuse, depressive vulnerability and gender dysphoria: Part 2

Background The recent reclassification of gender identity disorder as gender dysphoria (GD) in DSM-5 identifies those seeking to pursue gender transition via specialist services as necessarily ‘distressed’ and therefore mentally disordered. Distress in gender variant clients may arise from a variety of stressors, external and intra-psychic, many of which may have their roots in childhood experience [E. Bandini et al. (2011)]. Aims (1) to review current thinking on gender variance and recognition and classification of GD (2) to detail the contribution of childhood adversity to distress in gender variant clients from an audit of 50 such clients (33 assigned/natal males and 17 assigned/natal females) of a mainstream NHS psychosexual service. Methods Current issues in classification and diagnosis of GD, and debate on the aetiology of gender variance, are reviewed briefly. Audit findings on health, treatment issues and support, and thematic analysis of childhood experiences, provide the basis for a case example of a post-transition client experiencing some common difficulties associated with GD and childhood adversity. Conclusions Pragmatism of diagnosis and treatment of GD contrasts with the variety of theories of causation of gender variance itself. ‘Distress’ as a precondition of treatment may reflect childhood experience as much as GD-specific symptoms, and may contribute more to persistent psychological vulnerability. While educational programmes in schools and a better knowledge base in counselling and related training curricula are indicated, gender dysphoric clients, pre- and post-transition, experience common life problems for which generic forms of counselling and therapy are appropriate.