Separation anxiety among birth-assigned male children in a specialty gender identity service

Abstract

Previous research suggested that separation anxiety disorder (SAD) is overrepresented among birth-assigned male children clinic-referred for gender dysphoria (GD). The present study examined maternally reported separation anxiety of birth-assigned male children assessed in a specialty gender identity service (N = 360). SAD was determined in relation to DSM-III and DSM-IV criteria, respectively. A dimensional metric of separation anxiety was examined in relation to several additional factors: age, ethnicity, parental marital status and social class, IQ, gender nonconformity, behavioral and emotional problems, and poor peer relations. When defined in a liberal fashion, 55.8% were classified as having SAD. When using a more conservative criterion, 5.3% were classified as having SAD, which was significantly greater than the estimated general population prevalence for boys, but not for girls. Dimensionally, separation anxiety was associated with having parents who were not married or cohabitating as well as with elevations in gender nonconformity; however, the association with gender nonconformity was no longer significant when statistically controlling for internalizing problems. Thus, SAD appears to be common among birth-assigned males clinic-referred for GD when defined in a liberal fashion, and more common than in boys, but not girls, from the general population even when more stringent criteria were applied. Also, the degree of separation anxiety appears to be linked to generic risk factors (i.e., parental marital status, internalizing problems). As such, although separation anxiety is common among birth-assigned male children clinic-referred for GD, it seems unlikely to hold unique significance for this population based on the current data.

The association of attachment, mentalization and reflective functioning with mental health in gender diverse children and adolescents: A systematic review

“…Three cross-sectional studies and one retrospective explicitly addressed the issue of SA: we have already cited the work from Santarossa et al (2019). VanderLaan et al (2018) in a clinical sample of birth-assigned boys found SA significantly more prevalent in the gender-referred group, compared to the estimated US population prevalence; however, when testing the predictive role gender nonconformity along with of socio-demographic characteristics, CBCL Internalizing, Externalizing and poor peer relations scores, gender nonconformity did not significantly predict SA; only CBCL internalizing score, age and parental marital status significantly predicted SA. Thus, the authors concluded that SA could be understood as a problem within the spectrum of internalizing problems for which male children clinic-referred for GD show elevation.…”