Autism and transgender identity: Implications for depression and anxiety

Murphy, Jennifer; Prentice, Freya; Walsh, Reubs J.; Catmur, Caroline; Bird, Geoffrey

doi:10.1016/j.rasd.2019.101466

Cited by 45 publications

(21 citation statements)

References 41 publications

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“…The symptoms of the presented case supported the findings of the studies reporting a higher risk of depression, anxiety, suicidal thoughts, attempts, and self-injury in GD adolescents compared to their non-transgender peers (18). The symptoms are reported to be highest in the individuals with both conditions (GD and ASD) (19). Social isolation is additionally increased among those with comorbid GD and ASD (20) as was seen in the presented patient as well.…”

Section: Discussionsupporting

confidence: 87%

Case Report: Adolescent With Autism and Gender Dysphoria

et al. 2021

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There is increasing clinical evidence of an association between gender variability, gender dysphoria (GD), and autism spectrum disorder (ASD). This seems to be a two-way relationship, a person with GD is more likely to be diagnosed with ASD and vice versa. In youth, it is important to distinguish whether the presented symptoms are a manifestation of ASD focus on special interests or symptoms of co-occurring GD. This distinction is crucial in the process of planning reversible and especially irreversible medical procedures in the context of treatment. We present the case of a birth-assigned female adolescent with GD, who enrolled in our clinic at the age of 16.5 years with “being transgender” as her main complaint accompanied by a wish for surgical breast removal. His (as the patient prefers to use male pronouns) medical and developmental history involved obesity, hyperlipidemia, delays in social and language development and specific interests and rituals. He presented with half a year of untreated depression, suicidal thoughts and non-suicidal self-injuring, social phobia and relative social isolation. Comprehensive clinical assessments revealed a female karyotype (46, XX), normal female genitalia and unremarkable hormonal status. Clinical psychological assessments reported GD, ASD with average intellectual abilities and co-occurring symptoms of depression and anxiety. Other disorders, such as psychosis, personality disorder and dysmorphophobia, were excluded during longer-term diagnostic and psychotherapeutic processes. Our first aim was to build a good therapeutic alliance with the patient and treat depression and suicidality. He refused to take sertraline, but took a St. John's Wort over-the-counter peroral preparation in the form of infusions. His mood improved, he was no longer suicidal and started social transitioning, yet he remained socially phobic. At the time of writing, he is 20 years old, waiting for bilateral mastectomy and receiving regular triptorelin depot and testosterone depot intramuscular injections. Even though the diagnostic procedures and transition process in autistic gender diverse adolescents may take longer than in non-autistic individuals, ASD is not a contraindication to the gender transition process. We present a well-documented case of a slow social and medical transition resulting in gradual improvement of co-occurring symptoms of GD.

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Section: Discussionsupporting

confidence: 87%

Case Report: Adolescent With Autism and Gender Dysphoria

et al. 2021

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“…Autistic adults generally report higher levels of transgender, non-binary, and gender-fluid identities than the general population [56,61]. It is important to explore the impact of camouflaging on mental health in this group, who are already at a greater risk of mental health problems compared to cisgender individuals [62,63]. Additionally, our sample did not include individuals who are representative of the entire autistic population; only those who were able to complete online surveys in English were able to take part.…”

Section: Limitationsmentioning

confidence: 99%

Is social camouflaging associated with anxiety and depression in autistic adults?

et al. 2021

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Background There is inconsistent evidence for a clear pattern of association between ‘camouflaging’ (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. Methods This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. Results Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. Limitations These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. Conclusions The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.

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“…Mental health problems are more common in autistic people ( Lai et al., 2019 ) and in transgender individuals ( Dhejne et al, 2016 ). There is emerging evidence that being both transgender and autistic is associated with yet higher rates of mental health problems ( George & Stokes, 2018 ; Murphy et al, 2020 ; Strang et al, 2021 ; Strauss et al, 2021 ). While there have been numerous studies investigating the increased prevalence of transgender identities in autistic people ( Glidden et al, 2016 ), there have been fewer attempts to understand the inner experiences of this group.…”

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confidence: 99%

The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis

Cooper

Mandy

Butler

et al. 2021

Autism

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Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about this incongruence or gender dysphoria. Few studies have aimed to understand the inner experiences of this group. In this study, we used Interpretive Phenomenological Analysis to understand the lived experience of gender dysphoria. Twenty-one autistic adults were interviewed about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. The interviews were transcribed and analysed using Interpretive Phenomenological Analysis. Participants described significant distress because their bodies did not match their gender identities, their need to understand their identities more broadly and to manage complex intersecting needs. Participants experienced distress due to living in a world which is not always accepting of gender- and neuro-diversity. Participants described barriers in accessing healthcare for their gender needs. Some participants felt being autistic had facilitated their understanding of their gender identity. Other participants described challenges such as a tension between their need to undergo a physical gender transition versus a need for sameness and routine. In conclusion, there can be both positive experiences and additional challenges for autistic transgender people. Lay Abstract Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about their gender and sex assigned at birth not matching which is called gender dysphoria. Research has focused on finding out why autistic people are more likely to have gender dysphoria, and less on what the experience of gender dysphoria is like for autistic people. We interviewed 21 autistic adults about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. We carefully read the transcripts of the interviews, focusing on how participants understood their experiences. We found a range of themes from the interviews. Participants were distressed because their bodies did not match their gender identities. Participants told us they had to work hard to understand themselves and who they were, and to manage having multiple different needs such as mental health needs. It was upsetting for participants to experience discrimination because of being autistic and/or transgender. Some participants said it was more difficult to get transgender healthcare as an autistic person. Some participants thought being autistic had helped them understand their gender identity more than non-autistic people. Other participants found it was challenging to be both autistic and transgender. For example, most participants wanted to change their bodies to match their gender identity, but some participants were nervous about making changes to themselves and their routine due to being autistic. We conclude that autism can in some ways be helpful and other ways contribute to challenges for transgender autistic people.

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Autism and transgender identity: Implications for depression and anxiety

Cited by 45 publications

References 41 publications

Case Report: Adolescent With Autism and Gender Dysphoria

Case Report: Adolescent With Autism and Gender Dysphoria

Is social camouflaging associated with anxiety and depression in autistic adults?

The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis

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