Gender dysphoria and attention problems: possible clue for biological underpinnings

Abstract

OBJECTIVES: Development of gender identity is a complicated process. Several biological, familial, environmental, and cognitive factors thought to play role during this process. When a person has a persistent discomfort with his/her assigned gender and exhibits crossgender identification, gender dysphoria is to be considered. In this study, we aimed to determine the rates of psychiatric diagnoses in youth presenting with gender dysphoria and compare them with a control group in terms of family functioning, emotional, and behavioural problems. METHODS: The study sample consisted of 20 cases with gender dysphoria and 40 controls (5-17 years of age). The instruments included were Sociodemographic Form, Family Assessment Device (FAD), Child Behavior Checklist, and Schedule for Affective Disorders and Schizophrenia for School Aged Children Present-Lifetime Version. RESULTS: Ninety per cent of the cases with gender dysphoria had at least one psychiatric diagnosis. Attention-deficit/hyperactivity disorder (ADHD) (75%) was the leading comorbidity, followed by major depressive disorder (25%). Gender dysphoria group had significantly higher scores in communication, roles, affective involvement, and general family functioning subscales of FAD and in all Child Behavior Checklist subscales. High Child Behavior Checklist attention subscale score was significantly associated with the diagnosis of gender dysphoria in binary logistic regression analysis (odds ratio: 0.82; p < .001). CONCLUSIONS: Our results pointed out a possible biological background for gender dysphoria, along with psychosocial/psychodynamic explanations. The individuals with gender dysphoria will benefit from an integrative approach where all possible contributing factors are considered. Therefore, in addition to psychosocial and psychodynamic evaluation, assessment and interventions regarding ADHD will help to improve well-being and quality of life of these individuals.

Cinsiyet Hoşnutsuzluğu Belirtileri Gösteren Çocuklarda Demografik ve Klinik Özellikler: Bir Türkiye Örneklemi

“…Psychiatric problems such as anxiety, depression, suicidal behaviors, self-harm, eating disorders, ASD, and disruptive disorders are more prevalent in children and adolescents with GD. Literature suggests that in youth experiencing GD, internalizing problems (such as depression, social withdrawal, and anxiety) are more frequent than externalizing problems (such as aggression) (10,13,26,30,36,37). Along with similar lines, 55% of our study sample exceeded the clinical threshold for internalizing problems and 40% exceeded the clinical threshold for externalizing problems in CBCL ratings.…”

“…Since there is no control group in the study, we cannot compare the rates of pre-peri and postnatal factors between children admitted with problems with regard to their gender identity and children with other psychiatric problems or healthy counterparts. On the other hand, recent research suggests that neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are common in children and adolescents with GD (13,(29)(30)(31). Maternal prenatal stress, maternal pre and postnatal depression, risk of miscarriage, and prematurity are risk factors associated with ASD and/or ADHD (32)(33)(34)(35).…”

“…There is scarce evidence on clinical and demographic characteristics of gender nonconforming prepubertal children, yet the majority of the existing research is conducted in western countries (9,10). In Turkey, there is few research on GD in children and adolescents; of those only two have study samples that include prepubertal children; however, the mean age of the participants in these studies is considerably higher (11)(12)(13). Therefore, in this study, we aim to describe the demographic and clinical characteristics and psychological functioning of Turkish children aged between 3-12 years presenting with GD symptoms.…”

Is being gender nonconforming distressing? It depends where you live: gender equality across 15 nations predicts how much gender nonconformity is related to self-esteem

“…Conversely, if self-esteem turns out to be equally related to gender conformity across societies, regardless of the societies' prevailing gender role norms, this would pose a challenge for social role explanations of the psychological implications of gender non-conformity, warranting a search for alternative etiologies, such as the possibility of a common neurogenetic disposition underlying both gender nonconformity and psychiatric disorders (e.g. Shumer, Roberts, Reisner, Lyall, & Austin, 2015; Yildirim, Perdahli Fis, Yazkan Akgul, & Ayaz, 2017). Because the DSM-5 defines mental disorders as dysfunctions in the individual and does not regard conflicts between the individual and society as mental disorders (American Psychiatric Association, 2013, p. 20), evaluating evidence related to these alternative positions is not only of scientific interest, but may also have a bearing on clinical considerations and practices.…”