Gender Identity Disorder and Attachment Theory: The Influence of the Patient's Internal Working Models on Psychotherapeutic Engagement and Objective. A Study Undertaken Using the Adult Attachment Interview

Abstract

Until now, studies related to gender identity disorder (GID) in adult patients carried out within the framework of attachment theory have been scarce. The current research project aimed to explore the theme related to the specific nature of the current states of mind with respect to attachment in adult male patients suffering from GID, and to evaluate simultaneously the level of psychopathology associated with conditions of GID. The first 18 patients suffering from GID, who came to the Functional Area of Psychology of the Clinical Department of Neuroscience and Behaviour of the "Federico II" University Hospital between 2005 and 2007 to psychological assistance for problems connected to gender dysphoria, were registered in sequential order. The following tests were administered to all patients: (a) investigation of case histories and motivation, (b) Minnesota Multiphasic Personality Inventory (MMPI-2), and (c) Adult Attachment Interview. The results show an increase, among people with GID, of insecure conditions of the mind and of unresolved/disorganized conditions of the mind with respect to traumas or losses. Results obtained by MMPI-2 confirm the absence of other psychopathological conditions previously reported in the scientific literature. Based on the results of our exploratory research, we discuss how psychological intervention could have a dual objective of improving the possibility of access to a fuller and more satisfying emotional-relational life and of allowing an adequate working-through of complex traumatic events, which appear to affect the life experiences of individuals with GID and, often, seem not to have been adequately worked through.

Adult Attachment and Transgender Identity in the Italian Context: Clinical Implications and Suggestions for Further Research

“…Contrary to authors’ expectations and to the results previously obtained by one of the authors through the Adult Attachment Interview (Vitelli & Riccardi, 2010), the current study has revealed a higher prevalence of secure attachment styles among Italian transgender individuals. Therefore, to some extent, the current findings seem to be in line with those which emerged from a previous study on another Italian sample, where different evaluation measures were used (Conte et al, 2008).…”

“…Therefore, to some extent, the current findings seem to be in line with those which emerged from a previous study on another Italian sample, where different evaluation measures were used (Conte et al, 2008). The authors of the present study believe that their findings differ from those obtained by Vitelli & Riccardi (2010) mainly because in the latter study participants were a clinical sample, differently from the current research. In addition, the two samples were recruited with different modalities, namely face-to-face versus online, respectively.…”

“…Birkenfeld-Adams (1998) reported a high prevalence of ambivalent attachment styles among gender nonconforming children. Similarly, in adulthood, although some studies have stated that insecure styles are not prevalent (Conte, Prunas, & Hartmann, 2008), research findings by Vitelli and Riccardi (2010) did indicate a higher prevalence of Insecure States of Mind with Reference to Attachment (Dismissing, Entangled and Unresolved/Disorganized) than the averages commonly found in non-clinical samples.…”

“…So far, these dimensions have been scarcely explored within the Italian context, with the exception of the works by Gerini et al (2008), who confirm the presence of an high prevalence of enacted stigma, and Prunas et al (2014), who focus on the defensive mechanisms profile of male-to-female (MtF and female-to-male (FtM) transsexual people seeking Gender Affirmation Surgery (GAS). On the contrary, two interesting Italian studies (Conte, Prunas, & Hartmann, 2008; Vitelli & Riccardi, 2010) have been previously addressed to explore adult attachment dimensions of transgender people. Nevertheless, considering the more general scientific literature, little research has been carried out on the affective relational area.…”

“…In particular, the rationale of exploring the prevalence of attachment styles was due to the contradiction between the findings obtained in the only two Italian studies on attachment styles in transgender people (Conte, Prunas, & Hartmann, 2008; Vitelli & Riccardi, 2010). Furthermore, because secure attachment is a protective factor (e.g., Prior & Glaser, 2006; Schore, 2001; Sroufe 2005), it was hypothesized that those who present this kind of attachment report also higher scores of positive transgender identity, whereas those who present insecure attachment styles are higher in internalized transphobia.…”