No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Prevalence of Childhood Trauma in a Clinical Population of Transsexual People
Abstract
Few studies have focused on the prevalence and extent of childhood trauma in the transsexual population. In our study of 42 transsexual people (34 = natal males, 8 = natal females), 55% (n = 23) reported experiencing an unwanted sexual event before the age of 18, with the average age of initial sexual contact being 13. This sexual event differs from other clinical populations in that the unwanted sexual experiences in this sample were the consequence of adolescents satisfying their curiosity about the gender of the transsexual rather than for their own sexual gratification. Consequently, the sequalae of the unwanted sexual touches in our sample did not lead to sexualised behaviours described in the sexual abuse literature of clinical samples. Our sample also reported being: verbally abused (77%), insulted (81%), embarrassed in front of others (55%), made to feel guilty by their parents (58%) before their fifteenth birthday.
... Other research has reported higher rates of contact sexual violence in childhood, with 55% of transgender and gender nonconforming respondents endorsing a history of sexual abuse (Gehring & Knudson, 2005). The average age of first sexual victimization was thirteen. ...
... Additionally, over half of this sample endorsed experiences of childhood psychological abuse, with 55% endorsing being made to feel embarrassed by a parent or caregiver in front of other people. Fifty-eight percent of respondents endorsed being made to feel guilty by a parent or caregiver (Gehring & Knudson, 2005). ...
Adverse Childhood Experiences and Intimate Partner Violence in Gender Minority Populations - Claire Mason McCown, M.P.S.
Childhood adversity has been linked to numerous health and mental health concerns in adulthood (Felitti et al., 1998). Among the many outcomes associated with adverse childhood experiences (ACEs), victimization and perpetration of intimate partner violence (IPV) remains a public health crisis. Research has found that those identifying as gender minority individuals are disproportionately impacted by IPV (Messinger, 2017; Peitzmeier et al., 2020). Further, gender minority individuals experience equivalent, if not higher, rates of ACEs when compared to their cisgender counterparts (Baams, 2018; Juárez-Chávez et al., 2018; Schnarrs et al., 2019; Tobin & Delaney, 2019). While many factors contribute to the pathway from ACEs to IPV, the role of internalized transphobia (IT) in this relation is poorly understood. However, previous research has underscored the role of internalized shame in relation to both ACEs and IPV (Rood et al., 2017; Thaggard & Montayre, 2019; Thomson & Jaque, 2018b). Internalized transphobia may therefore serve as a mediator in the relationship between adverse childhood experiences and intimate partner violence. Using a cross-sectional quantitative single administration survey design, this research aimed to better understand the relation between ACEs, IT, and IPV in adults identifying as gender minorities. This study used a mediated regression model to discern if internalized transphobia mediated the relationship between childhood adversity and intimate partner violence. Findings from this research indicated that while internalized transphobia did not mediate the relationship between ACEs and IPV, IT was still predictive of IPV. Endorsement of ACEs also predicted endorsement of IPV.
Keywords: Gender Minority, Adverse Childhood Experiences, Intimate Partner Violence
... This is roughly comparable with data from Shipherd et al., who found 14-27% of trans participants endorsing sexual assault as a child (Shipherd et al., 2011). Meanwhile, a small study with 42 participants (Gehring & Knudson, 2005) found hints that unwanted sexual contact before the age of 18 could be associated with "adolescents satisfying their curiosity about the gender of the transsexual rather than for their own sexual gratification" (Gehring & Knudson, 2005). ...
... This is roughly comparable with data from Shipherd et al., who found 14-27% of trans participants endorsing sexual assault as a child (Shipherd et al., 2011). Meanwhile, a small study with 42 participants (Gehring & Knudson, 2005) found hints that unwanted sexual contact before the age of 18 could be associated with "adolescents satisfying their curiosity about the gender of the transsexual rather than for their own sexual gratification" (Gehring & Knudson, 2005). ...
Trans people suffer from increased rates of depression and suicidality even after gender-affirming medical interventions. The present study aims to examine the prevalence of childhood adversities in patients with gender dysphoria and to analyze its impact on adult depression and suicidality.
Participants meeting diagnostic criteria of Gender Dysphoria were recruited in a cross-sectional multicenter study at four German health-care centers. Childhood adversities were assessed with the childhood trauma questionnaire (CTQ) and additional single items for other childhood adversities. Associations between childhood adversities and adult depression and suicidality were calculated using regression analyses.
A large majority of participants reported childhood adversities, and only 7% endorsed no adversities in the CTQ. Over 30% reported severe to extreme childhood adversities. One-fourth reported parents exhibiting violent behavior while bullying by peers was experienced by 70%. These adversities were associated with an increased risk for adult depression and suicidality. Time since beginning of hormonal therapy did not show a significant influence neither on depression nor on suicidality.
Childhood adversities are common and associated with adult depression and suicidality in trans people. Adequately addressing these childhood adversities and providing trauma-informed mental health care might ameliorate the mental health burden in trans people.
... In manchen Fällen liegen der Ablehnung des eigenen Geschlechts und einem sozialen, ggf. auch juristischen und medizinischen Transitionswunsch reale körperliche Gewalt-und insbesondere die traumatische Erfahrung eines erlittenen sexuellen Übergriffs zugrunde (Gehring & Knudson, 2005;Becerra-Culqui et al., 2018), wobei es sich nicht notwendigerweise um Handon-Delikte gehandelt haben muss. Auch in der Genese von Essstörungen können Missbrauchserfahrungen eine Rolle spielen. ...
... However, no study demonstrates a high rate of regret among those who exhibit these traits nor offers insight into how to distinguish the subset who would experience regret from within these groups. While some studies suggest a high prevalence of some of these traits among people who regret transitioning (Littman, 2021;Vandenbussche, 2022), they are also common among those who do not express regret (Gehring & Knudson, 2005;Hanna et al., 2019). Anecdotal reports of correlation may merely reflect the high prevalence of sexual trauma, internalized homophobia and/or misogyny, mental illness, and neurodiversity in trans communities. ...
Gender assessments are traditionally required before accessing gender-affirming interventions such as hormone therapy and transition-related surgeries. Gender assessments are presented as a way of preventing regret experienced by some people who reidentify with the gender they were assigned at birth after medically transitioning. This article reviews the theoretical and empirical foundations of commonly used methods and predictors for assessing trans patients’ gender identity and/or dysphoria as a condition of eligibility for gender-affirming interventions. We find that the DSM-5 diagnosis, taking gender history, standardized questionnaires, and regret correlates rely on stereotyping, arbitrary, and unproven considerations and, as a result, do not offer reliable ways of predicting future regret over-and-above self-reported gender identity and embodiment goals. This finding is corroborated by empirical data suggesting that individuals who circumvent gender assessments or pursue care under an informed consent model do not present heightened rates of regret. The article concludes that there is no evidence that gender assessments can reliably predict or prevent regret better than self-reported gender identity and embodiment goals. This conclusion provides additional support for informed consent models of care, which deemphasize gender assessments in favor of supporting patient decision making.
... A systematic review showed that sexual minority populations are at a higher risk of childhood maltreatment, which is linked to psychiatric symptoms and substance abuse in adulthood. 80 Studies have reported increased rates of sexual abuse (> 50%) in individuals with GD. 81,82 Additionally, a recent metanalysis revealed that physical and sexual abuse is linked with increased risk for depression and anxiety in adulthood. 83 In this regard, our group has found that a quarter of individuals with GD experienced some degree of childhood maltreatment, 61 and it was associated with psychiatric disorder, suicide GD, as already demonstrated. ...
Introduction:
Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5).
Methods:
Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay.
Results:
Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine.
Conclusions:
These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
... The overall pervasiveness of discrimination and its tolls on transgender populations is well established Grant et al., 2011;James et al., 2016). Transgender people face higher rates of childhood trauma, PSTD, and other mental health issues than the general population, seemingly due to living in a transphobic world (Gehring & Knudson, 2005;Reisner et al., 2016). Interpersonal and family rejection is also high in this population and associated with negative health outcomes (Klein & Golub, 2016). ...
Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns.
Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S.
Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes.
Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which “intersect like a star.” Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping.
Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.
... GD children and adolescents have been found to have a high risk of experiencing adversity and psychological vulnerability [14][15][16][17], with these risks increasing as they approach puberty [18,19]. Trans-children's families and peer relations are generally poorer than non-referred children [14,20,21], and they are at a high risk of abuse and maltreatment [22] by parents and caregivers too [23]. This risk is particularly evident in Italy, the country of the current study, where gender non-conforming people still suffer several forms of discriminations in families and peer and social groups, and they are often object of medical stigma too [24][25][26][27]. ...
Purpose
In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments.
Methods
Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. Results: the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality.
Conclusions
The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.
... are twice as likely to report childhood sexual abuse and neglect than heterosexual men (Hughes et al., 2010). Another study noted that 55.0% of transgender males and females report exposure to unwanted sexual contact (Gehring & Knudson, 2005). LGBTQ individuals may be particularly vulnerable to victimization due to stigma attached to their LGBTQ identity (Hughes et al., 2010;Meyer, 2003;Woulfe & Goodman, 2018). ...
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face heightened risk of potentially traumatic events (PTEs) exposure, including hate crimes and childhood abuse. Past research demonstrates associations between PTEs exposure and sexual risk behavior; however, examining the indirect effect of PTEs on sexual risk behavior remains understudied among LGBTQ individuals. This study tested a path analysis model to inform interventions targeted to reduce sexual risk behavior, as conceptualized by condomless sex with casual partners without knowing the person’s HIV or sexually transmitted infection (STI) status, among LGBTQ individuals with PTEs exposure. Participants completed an online one-time survey and included 207 LGBTQ adults who experienced at least one PTE during the past year. Indirect effect results indicated that PTEs exposure was related to sexual risk behavior through serial associations between shame, loneliness, and substance use. Direct effect estimates indicated that greater PTEs exposure was associated with greater shame, loneliness, substance use, and sexual risk behavior. Greater shame was associated with greater loneliness, which was associated with greater substance use. Also, greater substance use was associated with greater sexual risk behavior. This study adds to the burgeoning body of literature on the relationship between PTEs exposure and sexual risk behavior among LGBTQ individuals. Clinical and counseling interventions for LGBTQ individuals with PTEs exposure should work to address modifiable psychosocial risk factors associated with sexual risk behavior.
... Most studies involving transsexual people have samples composed predominantly of transsexual women, making it difficult to apply the results exclusively to transsexual men. In some articles, however, separate analyses were performed for transsexual men, which confirmed: lower quality of life, particularly mental health (Newfield, Hart, Dibble, & Kohler, 2006); high exposure to sexual abuse during childhood (Gehring & Knudson, 2005); greater drug use (Scheim, Bauer, & Shokoohi 2017) and heavy episodic drinking (Scheim, Bauer, & Shokoohi 2016). Half of them lived in poverty, and one quarter met criteria for depression. ...
The present study assessed the prevalence of sexually transmitted infections (STIs) in 90 transsexual men (female-to-male transsexual persons) from southern Brazil. A retrospective review of the medical records of all transsexual men who visited an outpatient clinic in Rio Grande do Sul from 1998 to 2017 was performed. Although the sample had a high prevalence of risk factors for contracting STIs, such as drug use, one-third of the participants had never been tested for STIs and, when screened, it was mostly for HIV, but not for syphilis or other STIs. Based only on laboratory-tested transsexual men, the prevalence of syphilis and hepatitis C was 3.4% and 1.6%, respectively, which is higher than the general population. It is clear that health professionals need to broaden their understanding of transsexual men, acknowledging STIs as a possible diagnosis.
... Furthermore, in one study, 40% of transgender individuals with unmet gender-affirming health needs reported sexual dissatisfaction, even though sexuality was reported as important by 47% of the transgender women and 57% of the transgender men 40 . Previous traumatic sexual experiences with partners, friends, or unknown persons in childhood or adulthood are more prevalent in transgender persons than in the cisgender population 44,[105][106][107] . Historically, some studies have suggested that childhood sexual abuse experience might be implicated in the aetiology of gender incongruence 108,109 , whereas more recent papers have argued that minority groups are more vulnerable to sexual abuse [110][111][112] . ...
Sexuality is important for most cisgender as well as transgender persons and is an essential aspect of quality of life. For both the patient and their clinicians, managing gender dysphoria includes establishing a comfortable relationship with sexual health issues, which can evolve throughout the course of gender-affirming treatment. Gender-affirming endocrine treatment of transgender men and women has considerable effects on sex drive and sexual function. Gender-affirming surgery (GAS) can improve body satisfaction and ease gender dysphoria, but surgery itself can be associated with sexual sequelae associated with physical constraints of the new genitals or postsurgical pain, psychological difficulties with accepting the new body, or social aspects of having changed gender. In general, a positive body image is associated with better sexual function and satisfaction, but satisfaction with sexual function after GAS can be present despite dissatisfaction with the surgery and vice versa. Factors involved in the integrated experience of gender-affirming treatment and the way in which sexuality is perceived are complex, and supporting sexuality and improving sexual function in transgender patients is, correspondingly, multifaceted. As the transgender patient moves through their life before, during, and after gender-affirming treatment, sexuality and sexual function should be considered and maximized at all stages in order to improve quality of life.
... Assigned males at birth were also more exposed to disengaged mothers and more emotional neglect or criticism from their fathers (Simon et al., 2011). Finally, in a sample of transgender women and transgender men seeking evaluation prior to gender-affirming treatment, 77% reported being verbally abused, 58% were made to feel guilty by their parents, and 55% reported to be victims of childhood sexual abuse (Gehring & Knudson, 2005). ...
... In comparison to the general population, individuals with GD have been shown to be more subject to devaluation, oppression and discrimination (e.g., Lombardi et al., 2002;Melendez and Pinto, 2007;Bockting et al., 2013). Some (mostly descriptive) studies have reported a high frequency in transsexual individuals of childhood sexual and physical abuse perpetrated by parents and caregivers (Pauly, 1974;Lothstein, 1983;Devor, 1994;Gehring and Knudson, 2005;Wilchins, 2006;Wharton, 2007;Veale et al., 2008;Cussino et al., 2017;Lingiardi et al., 2017). Moreover, one study showed that patients in gender clinics were more likely than psychiatric patients to report parental death during adolescence and early adulthood (Bernstein et al., 1981). ...
The current study investigated attachment representations and complex trauma in a sample of gender dysphoric adults. Although it has been proven that the psychological wellbeing of gender diverse persons is largely mediated by family acceptance and support, research on their relationships with parental figures is scarce. A total of 95 adults took part in the study. The attachment distribution was as follows: 27% secure, 27% insecure and 46% disorganized. Regarding early traumas, 56% experienced four or more traumatic forms. Further, gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimisation, relative to controls. Comparisons of subgroups, defined by natal gender, showed that trans women, compared to control males, had more involving and physically and psychologically abusive fathers, and were more often separated from their mothers; trans men, relative to female controls, had more involving mothers and were more frequently separated from and neglected by their fathers. The research has several implications for treatment, clinical health psychology, family support and education.
... 17,18 Moreover, some studies have reported a high frequency in trans persons of childhood sexual and physical abuse, perpetrated by parents and caregivers (e.g. [19][20][21] ). Finally, research has shown that trans youth are at higher risk of self-harm, suicidal ideation and suicidal attempts (e.g. ...
In recent years, the use of gonadotropin-releasing hormone (GnRH) analogues in adolescents with gender dysphoria (GD) to suppress puberty has been adopted by an increasing number of gender clinics, generating controversial debate. This short essay provides an overview of the difficulties associated with this heterogeneous group of adolescents and discusses arguments for and against the suspension of puberty. Further, it reviews the main follow-up studies conducted in some of the world's largest clinical centres for gender-variant children and adolescents.
... Trans individuals were also found to receive, or perceived themselves to receive, less social support from their family and friends than non-trans siblings and matched general population (Davey et al., 2014;Factor & Rothblum, 2007;Gooren et al., 2015;Kim et al., 2006;Simon et al., 2011). Social and parental support, completed medical transition, and disclosure of transgender identity were all protective factors (Bandini et al., 2011;Bauer et al., 2015;Bazargan & Galvan, 2012;Bockting et al., 2013;Clements-Nolle et al., 2006;Davey et al., 2015;Gehring & Knudson, 2005;Gooren et al., 2015;Lombardi et al., 2001;Nuttbrock et al., 2011Nuttbrock et al., , 2014Rotondi, 2011). ...
Studies investigating the prevalence of psychiatric disorders among trans individuals have identified elevated rates of psychopathology. Research has also provided conflicting psychiatric outcomes following gender-confirming medical interventions. This review identifies 38 cross-sectional and longitudinal studies describing prevalence rates of psychiatric disorders and psychiatric outcomes, pre- and post-gender-confirming medical interventions, for people with gender dysphoria. It indicates that, although the levels of psychopathology and psychiatric disorders in trans people attending services at the time of assessment are higher than in the cis population, they do improve following gender-confirming medical intervention, in many cases reaching normative values. The main Axis I psychiatric disorders were found to be depression and anxiety disorder. Other major psychiatric disorders, such as schizophrenia and bipolar disorder, were rare and were no more prevalent than in the general population. There was conflicting evidence regarding gender differences: some studies found higher psychopathology in trans women, while others found no differences between gender groups. Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population.
... Trans individuals were also found to receive, or perceived themselves to receive, less social support from their family and friends than non-trans siblings and matched general population Factor & Rothblum, 2007;Kim et al., 2006;. Social and parental support, completed medical transition, and disclosure of transgender identity were all protective factors (Bandini et al., 2011;Bauer et al., 2015;Bazargan & Galvan, 2012;Bockting et al., 2013;Gehring & Knudson, 2005;Lombardi et al., 2001;Nuttbrock et al., 2011Nuttbrock et al., , 2014Rotondi, 2011). ...
The current literature shows growing evidence of a link between gender dysphoria (GD) and autism spectrum disorder (ASD). This study reviews the available clinical and empirical data. A systematic search of the literature was conducted using the following databases: PubMed, Web of Science, PsycINFO and Scopus; utilizing different combinations of the following search terms: autism, autism spectrum disorder (ASD), Asperger's disorder (AD), co-morbidity, gender dysphoria (GD), gender identity disorder (GID), transgenderism and transsexualism. In total, 25 articles and reports were selected and discussed. Information was grouped by found co-occurrence rates, underlying hypotheses and implications for diagnosis and treatment. GD and ASD were found to co-occur frequently - sometimes characterized by atypical presentation of GD, which makes a correct diagnosis and determination of treatment options for GD difficult. Despite these challenges there are several case reports describing gender affirming treatment of co-occurring GD in adolescents and adults with ASD. Various underlying hypotheses for the link between GD and ASD were suggested, but almost all of them lack evidence.
... Although important differences characterize participants within the clinical/at-risk sample, we decided to combine those groups due to their history of trauma exposure as suggested by literature. Indeed, several studies highlighted early trauma in dissociative patients (Dutra et al., 2009;Schmahl et al., 2010), parents of maltreated children (Dixon et al., 2005a(Dixon et al., ,b, 2009, participants with gender identity disorder (Kersting et al., 2003;Gehring and Knudson, 2005;Veale et al., 2010), and those with personality disorders (Afifi et al., 2011). The combined clinical/at-risk sample (N = 150) was composed of 37 men, 72 women, 27 male-to-female and 15 female-to-male transsexuals, ranging from 16 to 62 years of age (M = 30.44; ...
Research on the etiology of adult psychopathology and its relationship with childhood trauma has focused primarily on specific forms of maltreatment. This study developed an instrument for the assessment of childhood and adolescence trauma that would aid in identifying the role of co-occurring childhood stressors and chronic adverse conditions. The Complex Trauma Questionnaire (ComplexTQ), in both clinician and self-report versions, is a measure for the assessment of multi-type maltreatment: physical, psychological, and sexual abuse; physical and emotional neglect as well as other traumatic experiences, such rejection, role reversal, witnessing domestic violence, separations, and losses. The four-point Likert scale allows to specifically indicate with which caregiver the traumatic experience has occurred. A total of 229 participants, a sample of 79 nonclinical and that of 150 high-risk and clinical participants, were assessed with the ComplexTQ clinician version applied to Adult Attachment Interview (AAI) transcripts. Initial analyses indicate acceptable inter-rater reliability. A good fit to a 6-factor model regarding the experience with the mother and to a 5-factor model with the experience with the father was obtained; the internal consistency of factors derived was good. Convergent validity was provided with the AAI scales. ComplexTQ factors discriminated normative from high-risk and clinical samples. The findings suggest a promising, reliable, and valid measurement of early relational trauma that is reported; furthermore, it is easy to complete and is useful for both research and clinical practice.
... These findings suggest that abuse and neglect during childhood could have a role in dissociative disorders as well as in the development of gender identity. Consistently, previous studies have shown high rates of childhood sexual, emotional, and physical abuse among transsexuals (Pauly, 1974;Lothstein, 1983;Devor, 1994;Kersting et al., 2003;Gehring and Knudson, 2005), although these studies did not use control groups. Only two controlled studies have indicated an association between a less warm, more emotionally distant, controlling or rejecting parent and gender-variant outcomes (Parker and Barr, 1982;Cohen-Kettenis and Arrindell, 1990). ...
... Psychosocial factors hypothesised to influence the development of this psychopathology include parental factors such as an emotionally distant father (Cohen-Kettenis 1990), parents with an unfulfilled desire for a child of the opposite sex (Buhrich 1978) and parental encouragement of the child participating in the opposite gender role (Schott 1995). Childhood abuse has also been implicated in the development of gender variant behaviour (Gehring 2005). ...
The role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this ar ticle considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.
... As noted by Veale et al. (2010) one must be cautious in assuming causality here, as it is not clear whether those who are gender-variant are more susceptible to abuse or whether sexual abuse is itself a risk factor in gender variance (cf. also Gehring & Knudson, 2005). ...
We explored the personal history of men who voluntarily seek genital ablation for reasons other than male-to-female transitioning. We focused on three groups: (a) men who have had voluntary genital ablation; (b) men who desire genital ablation and fantasize about it (self-described “wannabes”); and (c) those who claim to be merely interested in the subject of castration. An online survey was posted at eunuch.org that asked about religiosity, childhood abuse, sexual orientation, parental threats of castration, and whether the respondents had witnessed animal castrations in their youth. Data were collected on 301 men who had obtained genital ablations (mean age 45.4 years old), 1,385 wannabes (44.3 years old), and 1,242 individuals who were reportedly “just interested” in castration (41.8 years old). We have confirmed that: (a) having witnessed animal castrations during childhood, (b) having been threatened with castration as a child for behaviours deemed inappropriate by a parent figure, and (c) being homosexual or bisexual, are all common among individuals with extreme castration ideations. In addition, the prevalence of childhood sexual abuse among men who had genital ablations and wannabes was 1.4 times greater than among “just interested” individuals. For men who had obtained genital ablations, “very devout” parental religiosity was 1.8 times more common than it was for wannabes and 1.3 times more common than it was for “just interested” individuals. Individuals who were raised by “very devout” parents and who were also sexually abused had significantly greater odds and likelihood of reporting being voluntarily castrated and/or penectomized than respondents without those risk factors. Our study may aid clinicians in identifying and distinguishing individuals who are at risk of genital ablation through self-surgery or by nonprofessionals. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
... However, the life-long perspective of the victimization of transgender individuals is lacking from the psychiatric account that focuses on childhood and frames CSA as causing "gender identity disorder." Gehring and Knudson (2005) found that 55% of their sample had experienced sexual assault prior to their eighteenth birthday. They also identified a specific form of sexual assault not applicable to other groups, the sexual assault of transgender persons due to a curiosity about that person's gender or genitalia. ...
Psychiatric diagnoses related to transgenderism span a wide range of terms, theories, and treatments. Similarly, intersexuality is coming increasingly under the psychiatric gaze, being incorporated into the “gender dysphoria” criteria as with or without a “disorder of sex development” (APA, 2013). Despite the diagnostic link between these two groups, histories of childhood sexual abuse within psychiatric theorizing are particularly visible within “gender dysphoria,” but markedly invisible within medical discourse on “disorders of sex development.” While sexual abuse has been problematically argued by psychiatry to play a role in the development of gender dysphoria, the potentially abusive touching of intersex children’s bodies in distressing or painful ways is legitimized and standardized. Thus pathological accounts of transgenderism and intersexuality are given prominence, whereas non-consensual touching is marginalized. The focus in both accounts is the pathologized body, rather than the normalization of sexualized violence or the experience of such touching as non-consensual and abusive. Ultimately, such discourses function to detract attention from the sexualized violence experienced by those who do not fit into the societally imposed gender binary and continue psychiatry’s framing of gender nonconformity, rather than sexual violence, as pathological.
... Compared to a group of psychiatric inpatients, transgender clients reported a higher prevalence of emotional maltreatment in childhood, which, in adulthood, was associated with higher levels of dissociative systems (Kersting et al., 2003). In addition, more than half of transgender adults reported an unwanted sexual event before the age of 18, which Gehring and Knudson (2005) attributed to peers' curiosity about the sex of the transgender person. In this sample, transgender participants also reported experiencing verbal abuse (77%), social embarrassment (55%), and guilt from parents (58%) before their 15th birthday. ...
Transgender clients frequently experience multiple types of violence (Mizock & Lewis, 2008), including interpersonal (violence that occurs between, at least, two people), self-directed (violence that is self-inflicted), and collective (violence that is inflicted by larger groups of people/institutions; Krug et al., 2002). Transgender clients who experience any of these types of violence are at a higher risk for developing psychiatric symptoms that may require the attention of a mental health care provider (Mizock & Lewis, 2008). Thus, it is crucial that clinicians understand how transgender clients respond to such violence and how these reactions relate to the clinical needs of transgender clients (Lev, 2004). In this article, we will summarize and cluster the types of violence that have been documented in the transgender literature. We will then highlight PTSD and complex PTSD as conceptual frameworks for working with transgender clients. Furthermore, we will examine how the binary notion of gender ignores ways in which race, class, and other identities interact with gender and make recommendations for how clinicians can affirm multiple identities as a way to minimize psychological distress following a traumatic event (Roen, 2006). We will also highlight clinical guidelines and provide feminist and multicultural recommendations for working with transgender clients.
... Agencies advocating for transgender rights report high rates of discrimination, violence, and bias-related events (Kosciw & Cullen, 2001;Xavier, 2000). For example, a recent report noted that 55% of transgender individuals experienced unwanted sexual contact before the age of 18 (Gehring & Knudson, 2005). Another study that interviewed transgender individuals revealed that 54% experienced sexual assault, 56% endorsed violence in the home, and 51% had experienced physical abuse (Kenagy, 2005). ...
The frequency of potentially traumatic events (PTEs) and associated symptoms were examined in a cross-sectional study of 97 transgender participants who had been classified as male at birth. A total of 98% reported at least one PTE and 91% endorsed multiple events. Of those with PTE exposures, 42% reported that at least one event was transgender bias-related. Among those with PTEs, 17.8% endorsed clinically significant symptoms of PTSD and 64% reported clinically significant depressive symptoms. The percentage of transgender individuals in this sample reporting clinically significant symptoms was higher than in trauma-exposed samples of men in the general population, but roughly similar to rates of female trauma survivors. Amount of time spent dressed consistent with gender identity was associated with increased risk for PTE exposure and was positively associated with mental health symptoms. No differences in symptoms were observed when comparing those with and without transgender bias-related PTEs. Overall, transgender individuals endorsed high prevalence of PTE exposure along with elevated PTSD and depressive symptoms, when compared to other traumatized populations.
... However, the life-long perspective of the victimization of transgender individuals is lacking from the psychiatric account that focuses on childhood and frames CSA as causing "gender identity disorder." Gehring and Knudson (2005) found that 55% of their sample had experienced sexual assault prior to their eighteenth birthday. They also identified a specific form of sexual assault not applicable to other groups, the sexual assault of transgender persons due to a curiosity about that person's gender or genitalia. ...
Full paper available at:
http://journals.library.mun.ca/ojs/index.php/IJ/article/view/739
Psychiatric diagnoses related to transgenderism span a wide range of terms, theories, and treatments. Similarly, intersexuality is coming increasingly under the psychiatric gaze, being incorporated into the “gender dysphoria” criteria as with or without a “disorder of sex development” (APA, 2013). Despite the diagnostic link between these two groups, histories of childhood sexual abuse within psychiatric theorizing are particularly visible within “gender dysphoria,” but markedly invisible within medical discourse on “disorders of sex development.” While sexual abuse has been problematically argued by psychiatry to play a role in the development of gender dysphoria, the potentially abusive touching of intersex children’s bodies in distressing or painful ways is legitimized and standardized. Thus pathological accounts of transgenderism and intersexuality are given prominence, whereas non-consensual touching is marginalized. The focus in both accounts is the pathologized body, rather than the normalization of sexualized violence or the experience of such touching as non-consensual and abusive. Ultimately, such discourses function to detract attention from the sexualized violence experienced by those who do not fit into the societally imposed gender binary and continue psychiatry’s framing of gender nonconformity, rather than sexual violence, as pathological.
... In addition, highly stressful factors or traumas were found in the primary attachment figures' history operating just before or during early childhood of transsexual patients [40]. Moreover, transsexual children have shown, on average, more behavior and emotional problems than their siblings and controls [41]; they have also shown a high rate of traumatic experiences that may relate to specific transgenerational dynamics [42,43]. ...
IntroductionGender identity disorder may be a stressful situation. Hormonal treatment seemed to improve the general health as it reduces psychological and social distress. The attachment style seemed to regulate distress in insecure individuals as they are more exposed to hypothalamic-pituitary-adrenal system dysregulation and subjective stress. AimThe objectives of the study were to evaluate the presence of psychobiological distress and insecure attachment in transsexuals and to study their stress levels with reference to the hormonal treatment and the attachment pattern. Methods
We investigated 70 transsexual patients. We measured the cortisol levels and the perceived stress before starting the hormonal therapy and after about 12 months. We studied the representation of attachment in transsexuals by a backward investigation in the relations between them and their caregivers. Main Outcome MeasuresWe used blood samples for assessing cortisol awakening response (CAR); we used the Perceived Stress Scale for evaluating self-reported perceived stress and the Adult Attachment Interview to determine attachment styles. ResultsAt enrollment, transsexuals reported elevated CAR; their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy, transsexuals reported significantly lower CAR (P<0.001), falling within the normal range for cortisol levels. Treated transsexuals showed also lower perceived stress (P<0.001), with levels similar to normative samples. The insecure attachment styles were associated with higher CAR and perceived stress in untreated transsexuals (P<0.01). Treated transsexuals did not expressed significant differences in CAR and perceived stress by attachment. Conclusion
Our results suggested that untreated patients suffer from a higher degree of stress and that attachment insecurity negatively impacts the stress management. Initiating the hormonal treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be. Colizzi M, Costa R, Pace V, and Todarello O. Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. J Sex Med 2013;10:3049-3058.
... A less warm, more emotionally distant, controlling or rejecting father has been associated with gender-variant outcomes in two controlled studies (Cohen-Kettenis & Arrindell, 1990; Parker & Barr, 1982). Studies have also shown high rates of childhood sexual, emotional, and physical abuse among transsexuals (Devor, 1994; Gehring & Knudson, 2005; Kersting et al., 2003; Lothstein, 1983; Pauly, 1974; Veale, Clarke, & Lomax, 2008a), although these studies did not use control groups. ...
This article presents a comprehensive model to explain the development of the various manifestations of gender variance amongst birth-assigned males and females. As background, two previous theories of gender-variance development proposed by Richard Docter and Ray Blanchard are introduced. The model presented in this article is called the identity-defense model of gender-variance development because it has two parts. Firstly, biological factors and early childhood influences determine whether and to what degree a gender-variant identity develops. Secondly, personality and environment factors determine whether defense mechanisms are used to repress the gender variance. If defense mechanisms are used, then the resultant outcome is either a nonclassical transsexual or cross-dresser, depending on the degree of gender variance. If defense mechanisms are not used, then classical transsexuals or drag artists are the likely outcomes, again depending on the level of the gender variance. Sexual orientation and cross-gender eroticism are strongly correlated with the gender-variant outcomes in the model, and this is explained in the model using Bem's (1996)4.
Bem , D. J. 1996. Exotic becomes erotic: A developmental theory of sexual orientation. Psychological Review., 103: 320–335. [CrossRef], [Web of Science ®]View all references exotic becomes erotic developmental theory of sexual orientation.
... Although gender problems have not been found in parents of individuals with GID, (Zucker & Bradley, 1995;Zucket et al., 1997, cited in Dettore & Ristori, 2005, highly stressful factors or traumas (loss of important family members, abortions, illness of parents or conflicts between them) were found in the primary attachment figures' history operating just before or during early childhood of patients with GID (Coates & Moore, 1998;Zucker & Bradley, 1995). At the same time, several recent studies have also shown a high rate of traumatic experiences (Di Ceglie, 2000;Gehring & Knudson, 2005;Herek, Gillis, & Cogan, 1999;Kersting Roberto Vitelli and Elisabetta Riccardi 243 et al., 2003;Kuehnle & Sullivan, 2001) in the autobiographical narratives of individuals with GID, which may relate to specific, though as yet unknown, transgenerational dynamics. ...
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.
... .that, in some cases, transsexualism may be an adaptive extreme dissociative survival response to severe child abuse " (1994, p. 49). On the other hand Gehring and Knudson (2005) believed that children with gender-variance are more of a target to abusers. They stated that their findings ''do not support any notion that childhood trauma is associated with . . . the formation of transsexualism . . . ...
This article reviews research on biological and psychosocial factors relevant to the etiology of gender-variant identities. There is evidence for a genetic component of gender-variant identities through studies of twins and other within-family concordance and through studies of specific genes. Evidence that prenatal androgens play a role comes from studies that have examined finger length ratios (2D:4D), prevalence of polycystic ovary syndrome among female-to-male transsexuals, and individuals with intersex and related conditions who are more likely to have reassigned genders. There is also evidence that transsexuals have parts of their brain structure that is typical of the opposite birth-assigned gender. A greater likelihood of non-right-handedness suggests developmental instability may also contribute as a biological factor. There is a greater tendency for persons with gender-variant identities to report childhood abuse and a poor or absent relationship with parents. It is unclear if this is a cause or effect of a gender-variant identity. Parental encouragement of gender-variance is more common among individuals who later develop a gender-variant identity. We conclude that biological factors, especially prenatal androgen levels, play a role in the development of a gender-variant identity and it is likely that psychosocial variables play a role in interaction with these factors.
... However, the life-long perspective of the victimization of transgender individuals is lacking from the psychiatric account that focuses on childhood and frames CSA as causing "gender identity disorder." Gehring and Knudson (2005) found that 55% of their sample had experienced sexual assault prior to their eighteenth birthday. They also identified a specific form of sexual assault not applicable to other groups, the sexual assault of transgender persons due to a curiosity about that person's gender or genitalia. ...
The American Psychiatric Association (APA) labels gender nonconformity in childhood as Childhood Gender Identity Disorder (GID) (DSM-IV-TR, 2000) or Gender Dysphoria (GD) (APA, 2011). This approach is challenged by those who advocate for gender to be viewed as a diverse spectrum of possibilities rather than a rigid binary, although the diagnoses are often required to access medical support (Lev, 2005; GID Reform Advocates, n.d). However, despite Childhood GID being featured in the DSM for over 40 years, there is a lack of consensus on the etiology of the diagnosis, which has resulted in an accumulation of theories and correlational studies that assume causation. One such theory purports that childhood GID is reactive; a defense mechanism in response to childhood sexual abuse (CSA) (e.g. Beitchman et al. 1991; Zucker & Bradley, 1995; Zucker & Kuksis, 1990; Zucker, 2006; 2008). This perspective neglects the documented victimization and sexual coercion experienced by transgender youth in response to gender nonconformity (Wyss, 2004) and individualizes and pathologizes such persons rather than address this form of ‘corrective’ rape (Di Silvio, 2011). It also further legitimizes therapeutic intervention by constructing GID as symptomatic of childhood trauma that has altered their ‘natural’ trajectory of ‘normal’ gender expression. This paper will critically interrogate psychiatric constructions of gender nonconformity as a reaction to sexual abuse and highlight the importance of including transgender experience into feminist theories of sexual coercion.
... A fter decades of research, the etiology of gender identity disorder (GID) remains largely unknown. Developmental psychological models have identified temperamental vulnerabilities of the GID child, particular patterns of parent-child interaction, family dynamics, and traumatic events as possible risk factors [1][2][3], although, in one recent study, there was a failure to identify parental problems [4]. ...
The etiology of gender identity disorder (GID) remains largely unknown. In recent literature, increased attention has been attributed to possible biological factors in addition to psychological variables.
To review the current literature on case studies of twins concordant or discordant for GID.
A systematic, comprehensive literature review.
Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same-sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P=0.005). Of the seven opposite-sex twins, all were discordant for GID.
These findings suggest a role for genetic factors in the development of GID.
The Self-determination Law passed by the German Bundestag on April 12 2024 has the intention that in the future every person over 14 years old, whose subjective feeling of identification deviates from their objectively given biological gender, can once per year explain to the registry office that the information should be altered or deleted, without presuppositions, as long as there is consent by their legal representative. An assessment or medical certification is no longer necessary and a mandatory expert counselling is also not required for minors. Exactly this part of the draft of the law is the subject of criticism. For some it goes too far and for others not far enough: a topic that misleads to polemics, but which in view of the exponentially increased number of young girls with gender-related identity conflicts deserves to be differentially considered and to be illuminated from different perspectives in the best interests of the child.
Purpose
Conduct a systematic review of abuse of transgender and gender nonconforming (TGNC) people in childhood.
Design and Methods
Scopus, PubMed, PsychInfo databases were searched. Articles included in final analysis were those with respondents who reported childhood abuse and were either transgender adults or described gender nonconforming traits in childhood. Of 186 articles originally identified, 14 are included in the final review.
Findings
Research on TGNC individuals and child abuse varied in how populations were identified and methodology used. Those who are transgender and those who display gender nonconforming traits in childhood are at risk for child abuse and sequelae.
Conclusion
Research should use the two‐step methodology of identifying transgender people. Recalled Childhood Gender Identity Scale should be used. Providers should screen for child abuse.
Introduction
According to the DSM-5 (APA, 2013), gender dysphoria is a form of incongruence between the subjective experience of belonging to a specific gender and the gender one has been assigned at birth.
Objective
The purpose of this paper is to explore attachment state of mind in a transsexual adult population in order to identify the most appropriate ways and forms of interventions, since improving attachment state of mind might boost the subject's quality of life.
Method
The sample consisted of 52 transsexual patients, of whom 51.9% were biologically male (MtF; n = 27) and 48.1% female (FtM; n = 25).
Results
The data obtained through the Adult Attachment Interview (AAI, George et al., 1985) show that the majority of the participants (92.3%) were found to have an insecure attachment state of mind. When classifying participants with GD on the basis of one of three attachment state of mind, 71.2% (n = 37) of the sample showed a dismissing state of mind with respect to attachment and 21.2% (n = 11) an entangled state of mind. The data obtained through the AAI also show that almost half of the sample reported one or more traumatic life events, with no differences found between the MtF and FtM groups. Using the Unresolved/disorganized (U/d) condition to classify the AAI data, we found frequent signs of unresolved experiences of trauma among those with an insecure attachment state of mind. No traumatic experiences with respect to attachment were reported by participants who were classified as secure.
Conclusion
Our findings suggest that interventions with transgender patients should impact on their current state of mind relating to attachment and traumatic experiences by promoting a secure state of mind with respect to attachment.
Objectives:
To identify patterns of childhood adversity in a sample of adolescents and assess disparities in these experiences for lesbian, gay, bisexual, transgender, and questioning adolescents and by level of gender nonconformity.
Method:
By using the cross-sectional, statewide, anonymous 2016 Minnesota Student Survey, 81 885 students were included in the current study (50.59% male; mean age = 15.51). Participants were enrolled in grades 9 and 11 in a total of 348 schools.
Results:
Four patterns of childhood adversity were identified with sex-stratified latent class analyses (entropy = 0.833 males; 0.833 females), ranging from relatively low levels of abuse (85.3% males; 80.1% females) to polyvictimization (0.84% males; 1.98% females). A regression analysis showed that compared with heterosexual adolescents, gay, lesbian, bisexual, and questioning adolescents were more likely to be classified into profiles characterized by polyvictimization (odds ratio [OR] 1.81-7.53) and psychological and/or physical abuse (OR 1.29-3.12), than no or low adversity. Similarly, compared with nontransgender adolescents, transgender adolescents were more likely to be classified into profiles characterized by patterns of polyvictimization (OR 1.49-2.91) and psychological and/or physical abuse (OR 1.23-1.96). A higher level of gender nonconformity predicted a higher likelihood of being classified into each adversity profile compared with the no or low adversity profile (OR 1.14-1.45).
Conclusions:
Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians.
Theories regarding gender violence have moved beyond a simple dichotomy, where women are positioned as victims and men are perpetrators. This complexity is through a nuanced analysis of privilege, power, and oppression, drawing on intersectionality theory, as well as problematizing the gender binary itself.
This chapter presents recommendations for the assessment and treatment of the sexual concerns of childhood sexual abuse (CSA) survivors, based on empirical literature and clinical practice. A thorough sexual history should always include inquiry into childhood sexual experiences. The assessment should provide the therapist with at least a rudimentary understanding of how the sexual abuse has impacted the patient's sexuality. Some of the hypotheses to examine are provided by the empirical literature. One of the mainstays of couples sex therapy is the four-session assessment in which the couple is seen for one session, then each partner is seen individually, and then the couple is seen together again. This protocol can be applied to couples in which at least one partner has a history of CSA. The sexual concerns of CSA survivors need to be addressed directly in treatment.
The aim of the present study is to define the sociodemographic and clinical characteristics of applicants for gender-affirming surgery at a single Italian institute, officially accredited as the referral unit for gender dysphoria in the Piedmont region. The study population comprised 196 transgender patients (136 trans females and 60 trans males) who met the criteria for gender dysphoria (GD; DSM-5 American Psychiatric Association, 2013). The subjects were asked to supply detailed information about general demographic characteristics, personal relationships, and traumatic events. Our data showed that participants who had experienced traumatic events sought assistance at an older age, had a lower level of education and a higher rate of unemployment, and had taken cross-sex hormonal therapy without a doctor's prescription at a higher frequency than those without experience of traumatic events. In order to better understand the role of trauma in the lives of transgender people, further research is needed in order to expand on our findings and make the proper adjustments to psychological treatment to improve patients’ well-being.
Background: Childhood abuse in the early lives of gender variant people has been under-reported, although higher psychiatric morbidity, particularly depression and suicidality, than in the general population is more widely recognised. There are increasing numbers of people seeking advice and treatment for gender dysphoria (GD) some of whose experiences of depression and childhood abuse may be additional treatment considerations. Aim: To illuminate the issues relating to childhood abuse, depression and GD via case examples underpinned by a summary review of the relevant literature, for their combined relevance to therapeutic practice and service provision. Methods: A review of relevant online literature was conducted and two case examples were developed subsequently to capture the core review themes from a practice perspective. Results: Nine studies met the inclusion criteria. Gender variant children and adolescents may experience abuse by peers and teachers, as well as parents and caregivers. Emotional abuse and neglect may have more adverse consequences than more active forms of abuse. Conclusions: This is an under-researched area, and inconsistencies of design, definition, measurement and controls were evident in the literature. While no clear association between depressive vulnerability and childhood abuse could be found, prevalence of such abuse was high. A case is made for clients with GD to have the opportunity to explore the influence and meaning of their adverse childhood experiences on their social and psychological development, and for additional training and education for practitioners.
This commentary considers some of the limitations of the review paper spearheaded by the Gender Identity Research and Education Society (GIRES) that appears in this issue. Its most notable limitation is selectivity, i.e., the failure to cite papers that might challenge the general thrust of the argumentation that gender identity disorder (transsexualism) is caused primarily, if not exclusively, by biological factors. The covert idea that a biological etiology should somehow afford more human rights for trans people is likely a flawed one.
Two monozygotic female twin pairs discordant for transsexualism are described. These reports double the number of such case studies in the current scientific literature. Interviews with the twins and their families indicated that unusual medical and life history factors did not play causal roles. However, inspection of medical records for one transsexual twin suggested that some early life experiences may have exacerbated tendencies toward male gender identification. In both pairs, the twins' gender identity differences emerged early, consistent with, but not proof of, co-twin differences in prenatal hormonal influences. The identification of additional discordant MZ female twin pairs can advance biological and psychological understanding of transsexualism. Suggestions for future research, based upon findings from these two twin pairs and from studies of female-to-male transsexuals, are provided.
Fifty-three women outpatients participated in short-term therapy groups for incest survivors. This treatment modality proved to be a powerful stimulus for recovery of previously repressed traumatic memories. A relationship was observed between the age of onset, duration, and degree of violence of the abuse and the extent to which memory of the abuse had been repressed. Three out of four patients were able to validate their memories by obtaining corroborating evidence from other sources. The therapeutic function of recovering and validating traumatic memories is explored.
Using scales specifically developed for this purpose, the present study examined university women's retrospective reports of childhood sexual, physical, and psychological abuse as they related to three types of current psychosocial dysfunction. Multivariate analysis revealed that, as hypothesized, history of psychological abuse was uniquely associated with low self-esteem, physical abuse was linked to aggression toward others, and sexual abuse was specifically related to maladaptive sexual behavior. This analysis also indicated that although there were unique effects of each type of abuse, physical and emotional abuse were often present together--a combination associated with generalized psychosocial problems.
The charts of 100 nonpsychotic female patients in a psychiatric emergency room were reviewed to locate references to history of sexual molestation: 50 charts were selected at random from emergency room files, and 50 charts had been written by clinicians asked to query abuse history. A substantially higher rate of sexual abuse was found for patients who had been directly asked about sexual molestation (70%) than for the random sample (6%). Further analysis linked molestation history to suicidality, substance abuse, sexual difficulties, multiple psychiatric diagnoses, and axis II traits or disorders--especially borderline personality. Severe abuse and multiple abusers best predicted psychiatric sequelae.
Forty male and 40 female crisis center clients, evenly divided in terms of molestation history, were examined for possible long-term sequelae of sexual abuse. Although molestation during childhood was associated with previous suicide attempts and with elevated symptomatology on the Trauma Symptom Checklist, no differences between males and females were found on these variables.
Objective
To ascertain the prevalence of childhood sexual abuse (CSA) in a community sample of Australian women.
Design
Retrospective study, done in 1994, of cross‐sectional data on the prevalence of CSA, collected as part of a larger two‐stage case‐control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls.
Participants
710 Women randomly selected from Australian federal electoral rolls.
Results
• One hundred and forty‐four women (20%) had experienced CSA.
• In 14 of these 144 women (10%), the abuse involved either vaginal or anal intercourse (i.e., 2% of the sample population experienced such abuse).
• The mean age at first episode of CSA was 10 years, and most (71%) of the women were aged under 12 years at the time.
• Perpetrators of the abuse were usually male (98%) and usually known to the child; 41% were relatives.
• The mean age of abusers was 34 years, with a median age difference of 24 years from that of the abused individual.
• Only 10% of CSA experiences were ever reported to the police, a doctor or a helping agency (e.g., community organisations, such as sexual assault services).
Conclusion
The high rates of CSA (estimated to be 20% of all women) and low rates of reporting (10%) indicate the need for general practitioners and other health professionals to be aware that a history of such abuse may be common in women in the general population.
Forty-five selfdefined female-to-male transsexuals were interviewed as part of a wide ranging sociological field study about female-to-male transsexuals. The data in this study are unusual in that they were obtained outside of any clinical settings. Questions were asked about childhood experiences of physical, sexual and emotional abuse. Sixty percent reported one or more types of severe child abuse. In the course of discussing other issues, participants also reported having experienced many of the commonly cited initial and long-term effects of child abuse, including fear, anxiety and depression, eating disorders, substance abuse, excessive aggression, and suicide ideation and attempts. It was not possible to determine to what extent the sources of these complaints lay in child abuse, in gender dysphoria, in some combination of the two, or elsewhere. While no information was solicited about dissociative responses to child abuse, I have speculated, as have some of the participants themselves, that, in some cases, transsexualism may be an adaptive extreme dissociative swival response to severe child abuse.
This overview examines the nature, prevalence, and impact of child sexual abuse. Associations and potential risk factors are identified, thus showing that child sexual abuse is not randomly distributed through the population. Finally, we discuss the ways in which clinicians and researchers have conceptualised the impact of child sexual abuse. A social and developmental model is outlined.
Interviewed 45 self-defined female-to-male transsexuals (aged 22–53 yrs) as part of a wide ranging sociological field study that examined Ss' childhood experiences of physical, sexual, and emotional abuse. 60% reported 1 or more types of severe child abuse. Ss reported having experienced many commonly cited initial and long-term effects of child abuse, including fear, anxiety and depression, eating disorders, substance abuse, excessive aggression, and suicide ideation and attempts. It was not possible to determine to what extent the sources of these complaints lay in child abuse, in gender dysphoria, in some combination of the two, or elsewhere. Preliminary results suggest that, in some cases, transsexualism may be an adaptive extreme dissociative survival response to severe child abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study provides evidence that some adults who claim to have recovered memories of sexual abuse recall actual events that occurred in childhood. One hundred twenty-nine women with documented histories of sexual victimization in childhood were interviewed and asked about abuse history. Seventeen years following the initial report of the abuse, 80 of the women recalled the victimization. One in 10 women (16% of those who recalled the abuse) reported that at some time in the past they had forgotten about the abuse. Those with a prior period of forgetting—the women with recovered memories—were younger at the time of abuse and were less likely to have received support from their mothers than the women who reported that they had always remembered their victimization. The women who had recovered memories and those who had always remembered had the same number of discrepancies when their accounts of the abuse were compared to the reports from the early 1970s.
Clinical reports suggest that many adults who engage in self-destructive behavior have childhood histories of trauma and disrupted parental care. This study explored the relations between childhood trauma, disrupted attachment, and self-destruction, using both historical and prospective data.
Seventy-four subjects with personality disorders or bipolar II disorder were followed for an average of 4 years and monitored for self-destructive behavior such as suicide attempts, self-injury, and eating disorders. These behaviors were then correlated with independently obtained self-reports of childhood trauma, disruptions of parental care, and dissociative phenomena.
Histories of childhood sexual and physical abuse were highly significant predictors of self-cutting and suicide attempts. During follow-up, the subjects with the most severe histories of separation and neglect and those with past sexual abuse continued being self-destructive. The nature of the trauma and the subjects' age at the time of the trauma affected the character and the severity of the self-destructive behavior. Cutting was also specifically related to dissociation.
Childhood trauma contributes to the initiation of self-destructive behavior, but lack of secure attachments helps maintain it. Patients who repetitively attempt suicide or engage in chronic self-cutting are prone to react to current stresses as a return of childhood trauma, neglect, and abandonment. Experiences related to interpersonal safety, anger, and emotional needs may precipitate dissociative episodes and self-destructive behavior.
In the last two decades, there has been a tremendous increase in the study of gender identity. The process by which an individual comes to assume a masculine or feminine sense of identity is most dramatically observed in those rare instances in which gender identity develops contrary to one's biological sex. Until recently, research has focused on biological males who reject their maleness and prefer to live their lives as females. This article, however, deals with biologically normal females who from an early age reject their femaleness, show a progressive, uninterrupted preference for the masculine role, and reject all that is feminine. These tomboys remain fixed in their cross-gender identification, and in late adolescence or young adulthood seek medical attention for sex reassignment surgery. This article summarizes the material obtained by an extensive review of the world literature, from which 80 cases of female transsexualism were found. The cases were reviewed systematically, using a 102-item instrument. Part I deals with the introduction, methodology, source material, prevalence and male:female ratio, family history and sociological data, natural history, and sexual behavior.
To present accounts of the prevalence of childhood sexual abuse (CSA) and social, family, and related factors that are associated with increased risk of CSA, using data gathered during an 18-year longitudinal study of a New Zealand birth cohort.
A birth cohort of more than 1,000 children born in Christchurch (New Zealand) was studied prospectively to the age of 16 years. At age 18, retrospective reports of CSA were obtained.
Of the cohort, 10.4% (17.3% of females and 3.4% of males) reported having experienced CSA before the age of 16 years. Rates of severe abusive experiences involving intercourse were lower: 5.6% of females and 1.4% of males reported abuse involving attempted or completed intercouse. Multivariate analyses that the risk of CSA was elevated among females (p < .0001), those exposed to high levels of marital conflict (p < .005), those reporting low parental attachment (p < .001), those reporting high levels of paternal overprotection (p < .005), and those with parents who reported alcoholism/alcohol problems (p < .05). The level of prediction of CSA from childhood and family factors was not sufficient to identify individuals at risk of CSA with any degree of accuracy.
CSA was not an uncommon experience in this cohort. Those most likely to be exposed to CSA were girls reared in families in families characterized by high levels of marital conflict and impaired parenting and in families having parents with adjustment problems.
To ascertain the prevalence of childhood sexual abuse (CSA) in a community sample of Australian women.
Retrospective study, done in 1994, of cross-sectional data on the prevalence of CSA, collected as part of a larger two-stage case-control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls.
710 Women randomly selected from Australian federal electoral rolls.
One hundred and forty-four women (20%) had experienced CSA. In 14 of these 144 women (10%), the abuse involved either vaginal or anal intercourse (i.e., 2% of the sample population experienced such abuse). The mean age at first episode of CSA was 10 years, and most (71%) of the women were aged under 12 years at the time. Perpetrators of the abuse were usually male (98%) and usually known to the child; 41% were relatives. The mean age of abusers was 34 years, with a median age difference of 24 years from that of the abused individual. Only 10% of CSA experiences were ever reported to the police, a doctor or a helping agency (e.g., community organisations, such as sexual assault services).
The high rates of CSA (estimated to be 20% of all women) and low rates of reporting (10%) indicate the need for general practitioners and other health professionals to be aware that a history of such abuse may be common in women in the general population.
Reliable and valid instruments are vital to assess the course and outcome of psychiatric disorders. This paper describes the development of BASIS (Behaviour and Symptom Identification Scale), a self-report assessment instrument for assessing functioning of psychiatric inpatients, and provides validating data for its use in a psychiatric hospital. The instrument was administered to 677 newly admitted patients. For approximately half of the sample, patients' nearest relatives provided parallel ratings of the patient. Interviews were repeated three to six weeks after admission and again six months after discharge. Test-retest reliability was found to be comparable to that for a standardized symptom checklist (SCL-90). Analyses of validity pointed to the instrument's capability in discriminating diagnostic groups, item correlations with similar symptom dimensions on other assessment measures, and correlations with relative's assessments of patients on the same measure. In conclusion, BASIS appears to be a promising tool for psychiatric inpatient evaluation studies.
A subset of research exploring the long-term impact of child sexual abuse (CSA) has examined the adult interpersonal functioning of female survivors. The present review discusses empirical findings and critical methodological issues related to this important but often overlooked aspect of adult adjustment. Though characterized by several methodological limitations, this literature, as a whole, suggests that early sexual abuse represents a risk factor for a range of interpersonal dysfunction among female survivors, including problems with intimate partner relations, disturbed sexual functioning, and difficulties in the parental role. Suggested methodological improvements for future research include new approaches to the measurement of CSA and interpersonal variables, the need for comprehensive assessment of significant third variables, and the use of more representative sampling strategies.
Long-term effects of child abuse in the psychiat-ric outpatient sample. Unpublished manuscript
- B Segal
- R Weideman
- D Gehring
- Crockett
Segal B, Weideman R, Gehring D, & Crockett D (1994) Long-term effects of child abuse in the psychiat-ric outpatient sample. Unpublished manuscript, Univer-sity of British Columbia at Vancouver, Canada.