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Revista de Psicologia, Ciències de l’Educació i de l’Esport
ISSN: 1138-3194
Copyright © 2016
www.revistaaloma.net
Correspondence:
Prof. Dr. Mark Griffiths
International Gaming Research Unit, Psychology Division,
Nottingham Trent University, Burton Street, Nottingham,
NG1 4BU
mark.griffiths@ntu.ac.uk
Video Gaming and Gender Dysphoria: Some Case Study Evidence
Summary. Video gaming has become an established area of psychological research over the last two decades. Over
the past few years there has been increasing research into online gender swapping, showing that for many groups
or individuals it can have positive psychological benefits (e.g., as a way to explore gender roles and boundaries in
a safe environment). To date, no research has ever examined online gender swapping among individuals with
gender dysphoria – people with acknowledged gender-identity issues. Using four case studies, this exploratory study
examined the role of gaming in the life of individuals seeking treatment for gender dysphoria. The main objectives
were to use exemplar case studies to highlight that gaming – in some circumstances – appears to be a functional
way of dealing with gender identity issues, and that gender swapping in gaming may help such individuals to come
to terms with their gender dysphoria. Recommendations for further research are suggested along with the limita-
tions of the data collected.
Key words: video gaming; Online gaming; Online videogames; Gender dysphoria; Transsexualism; Case series
Jocs de vídeo i disfòria de gènere: Alguns estudis de casos
Resum. Durant les últimes dues dècades, els videojocs han anat ocupant un camp establert de la investigació
psicològica. En els últims anys hi ha hagut un augment de la investigació sobre el canvi de gènere online, mostrant
que per a molts grups o individus això pot tenir beneficis psicològics (per exemple, com una manera d’explorar les
funcions i els límits de gènere en un entorn segur). Fins a la data, cap investigació ha examinat el canvi de gènere
online en els individus amb disfòria de gènere - persones amb problemes d’identitat de gènere. Utilitzant quatre
estudis de cas, aquest estudi exploratori va examinar el paper del joc en la vida dels individus que busquen trac-
tament per disfòria de gènere. Els objectius principals eren d’usar estudis de casos exemplar per mostrar que jugar
jocs online pot ser - en algunes circumstàncies - una manera funcional de tractar amb problemes d’identitat de
gènere, i que el canvi de gènere en els jocs poden ajudar aquests individus a millorar la disfòria de gènere. Es dis-
cuteixen les limitacions de les dades recollides i es suggereixen recomanacions per a futures investigacions.
Paraules clau: jocs de vídeo; jocs en línia; videojocs en línia; disfòria de gènere; transsexualitat; sèries de casos
Video Gaming and Gender Dysphoria:
Some Case Study Evidence
Mark D. Griffiths1, Jon Arcelus2,3 and Walter Pierre Bouman2
1 Nottingham Trent University
2Nottingham National Centre for Gender Dysphoria, Nottingham (United Kingdom)
3Division of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences,
University of Nottingham (United Kingdom)
Received: 19-04-2016
Accepted: 02-06-2016
2016, 34(2), 59-66
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Mark D. Griffiths, Jon Arcelus and Walter Pierre Bouman
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2016, 34(2)
Introduction
Video gaming has attracted increasing research interest
over the last two decades (Griffiths, Kiraly, Pontes &
Demetrovics, 2015). This has included much research
into both the positives and negatives of gaming and
into various topics such as gaming motivation (e.g.,
Kahn et al. 2015; Yee, 2006), the psychosocial conse-
quences of gaming (Kowert et al., 2015), female gaming
and gender differences in gaming (e.g., Lewis & Grif-
fiths, 2011; McLean & Griffiths, 2013; Todd, 2012), the
personality characteristics of gamers (e.g., Spekman et
al., 2013), and game transfer phenomena (Ortiz de
Gortari & Griffiths, 2015). One area that has received
relatively little research attention is online gender
swapping during gaming. This area is briefly reviewed
in the next section.
Gender swapping in online gaming
Huh and Williams have defined in-game gender swap-
ping as «a difference between the gender reported by the
player in the survey from the gender of the player’s main
character in the game» (p.161). To date, very few studies
have examined gender swapping in online gaming.
Using secondary polling data from online gaming fo-
rums, Griffiths, Davies and Chappell (2003) reported
that of 10,350 players at the Everlore fan site, 15% had
engaged in gender swapping with their main in-game
character. They also reported a similar finding among
8,694 players at the Allakhazam fan site, with 15.5%
reporting that they had gender swapped their main
in-game character (and more specifically, 14.5% males
and 1% were females who had changed gender of their
lead character (prior to playing the game). In a survey
study on 540 Everquest gamers, Griffiths, Davies and
Chappell (2004) reported that 60% had gender swapped
their online in-game characters. The apparent preva-
lence of gender swapping was probably much higher
in this study because the question related to the gender
swapping of any online game character rather than
just each player’s main character. In a small explora-
tory survey, Hussain and Griffiths (2008) examined
why people engage in gender swapping in a self-select-
ing sample of 119 online gamers (mean age of 28.5
years). They reported that 57% of gamers had engaged
in gender swapping (any character, not just their main
character), and that males adopting an online female
persona believed a number of positive social implica-
tions could result from becoming female characters in
male-oriented gaming environments. The study also
reported that significantly more females than males
had gender swapped their character – mainly to avoid
unsolicited male attention to their female characters.
Some females appeared to gender swap purely out of
interest to see what would happen in the game (as a
personal experiment), while others claimed that they
were treated more favourably by male gamers when
they played as male characters. Others reported that
gender swapping enabled them to play with aspects of
their identities that would not be possible to explore
in real life. Other reasons for gender swapping were
that (i) female characters had better in-game statistics,
(ii) some specific tools were only available to female
characters, (iii) the class of character was sometimes
only available in one gender, (iv) they played for fun,
and/or (v) they wanted a departure from what they
would normally do in the game (i.e., they did it for a
change in their usual playing behaviour).
In an ethnographic study of female EverQuest play-
ers, Taylor (2003) also reported that some players en-
gaged in gender swapping (although did not report
how common it was). However, she noted:
«One of the more interesting aspects to consider is the
way the game may allow access to gender identities that
are often socially prohibited or delegitimised offline –
simultaneously sexy and powerful or masculine and
beautiful identities. Women in EverQuest are constantly
playing with traditional notions of femininity and [they]
reformulate gender identities through aspects of the space
that are directly tied to its nature as a game» (p.27).
Using survey data, Huh and Williams (2010) exam-
ined gender swapping in EverQuest II. Unlike in the few
previous studies, they reported that gender swapping
was less common among female players and that the
phenomenon overall was rare. They also reported that
homosexual players were more likely than heterosex-
ual players to gender swap while gaming online. Males
who played as female characters were no more likely
to engage in stereotypically female acts than males that
played as male characters. However, they did note that
females who played male characters displayed a degree
of hyper-masculine behaviour. The authors concluded
that there may be less gender identity exploration or
challenging of gender norms than had been reported
in previous literature.
In a small qualitative study, Todd (2012) examined
the relationship between gender and gaming among
eight mature New Zealand female gamers (all 30 years
of age or older) and how they negotiated their ‘real-life’
identities with their ‘virtual’ gaming identities. Based
on the experiences of the women interviewed, Todd
concluded that although within gaming spaces gender
swapping is a normative practice, these acts of ‘gender-
bending’ do little to challenge notions of gender.
Beyond online gaming, Hegland and Nelson (2002)
noted that the Internet more generally can be used as
a tool for expressing gender identity because it allows
identities to cross cultural boundaries instantly and
without regard for real physical space. They examined
30 cross-dressing websites and argued that for most
cross-dressers who visited the websites found their
primary medium of expression in these online fora.
The websites guided users and nurtured their ability to
create a feminine identity, and helped them to pass as
women in the offline public world. More generally,
cross-dressers used the Internet to participate in the
larger cultural dialogue on gender.
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Video Gaming and Gender Dysphoria: Some Case Study Evidence 61
2016, 34(2)
Osborne (2012) has noted that online role-playing
games (MMORPGs) provide a structure within which
gamers enact the gender and sexuality of their avatars.
She conducted a survey to study how role-playing
gamers perceived and performed their avatars’ genders
and sexualities in online games. A qualitative analysis
of the data suggested that those gamers who displayed
empathy with and examination of their avatars’ gen-
ders and sexualities, and who experienced a sense of
belonging within the game structure, were able to form
positive interpersonal relationships that allowed them
to accept others’ expressed identities.
There have been studies of how gamers and fans play
with sexuality, gender, and the video game Minecraft on
YouTube (Potts, 2015), as well as papers discussing
whether the gaming industry should cater to marginal-
ized groups and develop games for groups for whom
there is little representation within games (e.g., gay and
transgendered characters) (Shaw, 2012). For instance,
there is now a short autobiographical game (http://www.
newgrounds.com/portal/view/591565) by Auntie Pixel-
lante called Dys4ia. This is a WarioWare-style game,
played only with the arrow keys, chronicling the experi-
ences of a trans woman as she addresses her own gender
dysphoria. Such videogames raise interesting questions
about how those individuals with gender dysphoria
utilize gaming as part of their identities. The next section
establishes a framework for the description of this study
with a discussion of the condition of gender dysphoria
and how it has been defined and conceptualised.
Gender Dysphoria
For an adult to meet the current criteria for a diagnosis
of transsexualism, the International Classification of
Diseases version 10 (ICD-10) says that the individual
must express the desire to live and be accepted as a
member of the opposite sex, usually accompanied by the
wish to make his or her body as congruent as possible
with the desired sex through surgery and cross-sex hor-
mones. This transsexual identity must have been present
persistently for a minimum of two years and not be a
symptom of another mental disorder or a chromosomal
abnormality (World Health Organisation, 1992).
The latest (fifth) edition of Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) of the American
Psychiatric Association (APA; 2013) uses the term gender
dysphoria to describe people who are uncomfortable
and/or distressed regarding their assigned gender, their
physical sex characteristics and/or their associated social
roles. Depending upon the intensity of this distress,
some individuals may wish to transition from one point
on a notional gender scale to another. The most com-
mon direction is from a man to a woman (individuals
known as trans women), or from a woman to a man
(individuals known as trans men) (Ahmad et al., 2013;
Coleman et al., 2012; Wylie et al., 2014). The distress
intrinsic to gender dysphoria may be focused around
anatomy, physiology, and/or being perceived and
treated as someone of a gender with which the person
does not identify (Bouman et al., 2010). However, for a
multitude of reasons, these diagnostic labels do not ap-
ply to all trans individuals, because some people do not
identify themselves either as men or women (Ahmad et
al., 2013; Bouman & Richards, 2013; Davies et al., 2013;
Richards et al., 2016; Wylie et al., 2014).
Similar to the DSM-5 (APA, 2013), it is expected that
the forthcoming edition of the ICD (ICD-11), due to be
released in 2017, will present a new diagnostic term to
include those who fall outside of the traditional gender
binary (Drescher, Cohen-Kettenis, & Winter, 2012). The
Wor ld He alth O rga nisa tion w ork ing gr oup h as re co m-
mended that the ICD-11 replace the term Transsexualism
with Gender Incongruence (Drescher et al., 2012) and
remove it from the mental and behavioural disorders
chapter. Gender incongruence denotes the incongruence
between a person’s gender identity and their assigned
sex and/or congenital primary and secondary sex char-
acteristics (Beek, Cohen-Kettenis, & Kreukels, 2016).
The terminology in this field has changed over the
years and the terms ‘transgender’ and ‘trans’ have been
used in the literature as umbrella terms to cover a wide
variety of atypical gender experiences and expressions
which may lead to permanent change of social gender
role but do not necessarily involve treatment with
cross-sex hormones or surgical intervention. A recent
study reported an overall meta-analytical prevalence
of transsexualism of 4.6 out of 100,000 individuals; 6.8
for trans women and 2.6 for trans men, figures which
are primarily based on studies looking at individuals
who seek clinical services (Arcelus et al., 2015).
However, recent population studies have reported a
significantly higher prevalence rate of atypical gender
experiences and expressions. Kuyper and Wijsen (2014)
examined self-reported gender identity and dysphoria
in a large Dutch population sample (N=8,064, aged 15-
70 years old), and found that 4.6% of people assigned
male at birth and 3.2% of people assigned female at birth
reported an ‘ambivalent gender identity’ (defined as an
equal identification with another sex and with the sex
assigned at birth). Furthermore, 1.1% of people assigned
male at birth and 0.8% of people assigned female at birth
reported an ‘incongruent gender identity’ (defined as
stronger identification with another sex than with the
sex assigned at birth). More recently, Van Caenegem et
al. (2015) reported similar results based on two popula-
tion-based surveys in Flanders (Belgium) examining the
prevalence of ‘gender incongruence’ (defined as identi-
fying more strongly with the other sex than with the
sex assigned at birth) and ‘gender ambivalence’ (defined
as identifying equally with the other sex as with the sex
assigned at birth). Their findings showed gender am-
bivalence was present in 2.2% of male and 1.9% of fe-
male participants, whereas gender incongruence was
found in 0.7% of men and 0.6% of women.
Background and objectives to the present study
The present study has its origins in initial observations
made by the second and third authors that a number of
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Mark D. Griffiths, Jon Arcelus and Walter Pierre Bouman
62
2016, 34(2)
gender dysphoric clients presenting at their clinic re-
ported that they gender-swapped while playing online
games. After meeting with the first author, who has been
conducting research in the gaming studies field for three
decades, the first author suggested that the second and
third authors revisit their case files and re-evaluate the
extent to which gender swapping within online gaming
had become a strategy in helping to deal with their of-
fline gender identity, and to write them up as case stud-
ies (as no study in the gaming field has ever examined
online gaming among those with gender dysphoria). As
this is an exploratory study, there were no hypotheses,
and since the case records were re-evaluated retrospec-
tively, the authors could only report information that
was in the case files (information that was gathered
prior to undertaking a study focussed on gaming and
gender dysphoria). The main objectives were to use
exemplar case studies to highlight that gaming – in some
circumstances – appears to be a functional way of deal-
ing with gender identity issues and that gender swapping
may help individuals to come to terms with the fact that
they feel they were biologically born a different gender
from that which they hope to become.
Method
The following case studies relate to four people who
attended an assessment at the National Centre for
Gender Dysphoria in Nottingham. The Centre, which
is part of the UK National Health Service (NHS) offers
assessment and treatment to individuals with gender
dysphoria free at the point of access. Patients are usu-
ally referred by their general practitioner. The assess-
ment involves information gathering by two independ-
ent gender specialists in two separate and independent
assessment meetings. In order for a person to be ac-
cepted into the treatment program, following their
assessment, they have to: (i) fulfil the diagnostic crite-
ria for Transsexualism in the ICD-10 (World Health
Organization, 1992), (ii) undertake social role transition
including name change and the provision of addi-
tional documentary evidence to support social gender
role transition, and (iii) be absent of any major co-
morbid mental health problems, which will make
transitioning towards their experienced gender diffi-
cult. The treatment program consists of cross-sex
hormone prescription and monitoring, psychological
support as required, voice coaching, and facial hair
removal referral for trans women. Following a success-
ful period within the treatment program (usually be-
tween 1 and 2 years) people may be referred for sex
re-assignment surgery if they so wish.
The data presented below are in the form of four
brief case study reports, as examples of the increasing
number of patients describing online video gaming
behaviour, using material relating to the issue of gam-
ing excess, addiction, and the context in which the
gaming occurred in people referred to the Centre. All
of the individuals described are given pseudonyms and
the contents of their histories are anonymised.
Results
Case study 1: Mary
Mary is a 26-year old natal male who fully transitioned
to the female social role six months prior to the present
study. Consequently, the feminine pronoun will be used
in this case study to refer to her. She described an early
history of being isolated as a child and not having very
many friends in primary and secondary school. As a
young person she was not interested in sports, but pre-
ferred reading, particularly fantasy and science-fiction
genre books. From a very early age, she hated wearing
jeans and other male clothing and fantasised about
wearing skirts and girls’ clothes. From the age of 14 years
she spent up to 5 hours a day in an online gaming forum.
There, she always took on a female persona with a female
name, and she had people refer to her with female pro-
nouns and would play online games with female avatars.
At first, she said she was not sure why she did this but
that she always enjoyed the female characters more than
the male characters, and she enjoyed being treated as a
female. She very much enjoyed dressing her avatars in
their female outfits. She explained that this behaviour
felt right to her. In her real life (and prior to puberty),
she remembers being teased for looking like a girl, and
people used to ask her if she was a boy or a girl. She said
that people would tease her as she enjoyed «more girly
things», like playing with dolls.
She gradually retreated more and more to the online
gaming world to the point where one of her online
friends became concerned that she was becoming «ob-
sessed» and losing touch with «real life». At this point
Mary was using two personae online, one male and one
female, although she consistently used the female per-
sona more frequently than the male one. Mary’s friends
told her that she needed to stop playing online games.
She became upset about this and decided to drop the
male persona while making the female persona more
ambiguous and androgynous. However, she experienced
an overarching feeling when she was 16 years old that
she just wanted to tell everybody that she felt she was
a girl. Up until that point, she had only explored this
side of her persona online, as she did not feel it was
possible in the real world. She explained that she
started feeling happier in the online world than in her
real world, as she could be herself. This developed into
spending more time in online gaming and isolating
herself further socially. She lost most of her friends, her
grades dropped and she only communicated with her
one online girlfriend. She ended up struggling with her
A-level results during this period.
After not doing very well in her A-levels (i.e., ad-
vanced educational qualifications in the UK), Mary
trained as a mechanic (almost totally a male occupation
in the UK) because she still lived full-time as a male.
She tried to make more friends and started going to
Warhammer meetings, but even then there was still
very limited interaction with other people. Then, Mary
met a trans woman online and she started to explore
her trans feelings. Following conversations with her
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Video Gaming and Gender Dysphoria: Some Case Study Evidence 63
2016, 34(2)
trans friend, she decided that she wanted to explore
her female side, and she started to cross-dress at home.
She said that it felt right and explained that this was a
feeling that she had not experienced before. From that
point onward, Mary decided to come out to her parents
as a trans woman. She was surprised to find out that
they were very supportive. Mary was then assessed at
the Centre, and was started on cross-sex hormones.
She is now doing much better socially and has started
a college ‘access to higher education’ course. Looking
back, Mary said that it was thanks to the online game
that she did not become depressed. She explained: «I
was able to be myself in the online world and by doing so
I found out who I really was».
Case study 2: ‘Mark’
Mark is a 20-year old natal female who first attended
for an assessment in the female role. However, he would
like to be known as male and with the name of Mark.
He has a background of autistic spectrum disorder, has
suffered from depression, and has a long history of
deliberate self-harm. When he was young, he played
with stereotypically female toys that his parents gave
him such as My Little Pony. He described himself as a
loner with no friends. As he got older, he became more
and more interested in videogames. When he was
around seven years old, he said he really enjoyed play-
ing on both the Dreamcast and PlayStation videogame
consoles, enjoying adventure games and playing vide-
ogames as a male character. He said that playing as a
male character «felt right» and that playing as a female
character made little sense to him. He said that during
this period, his parents would dress him in typical fe-
male clothing, which he hated. At secondary school,
Mark preferred to wear jeans and more stereotypical
male clothing. He disliked wearing skirts and refused
to wear them as part of his school uniform.
While he was at secondary school, his gaming
habit further developed and he increasingly began to
play adventure role-playing games, particularly World
of Warcraft, in which his identity would always be male.
He liked to imagine that other people would think of
him as male in the game. His gaming handle (i.e., his
name) became ‘Mark’, and he now considers this as his
male name (both online and offline). He very much
preferred questing as a male character in the online
games he played. Mark remembered that when he was
14 years old he would look at his body and feel that it
– and in particular his genitals – were not right. Con-
sequently, he would engage in deliberate self-harm to
punish himself for looking and feeling so ugly. About
a year prior to the present study, Mark started to ask
people – including his parents in the real world – to
call him Mark, and to use the male pronoun. Mark
binds his breasts and has done so for the last 4 years.
He attended the Centre for assessment for his gender
dysphoria. He explained that he wanted to be male
and therefore wanted to take cross-sex hormones, such
as testosterone. Ultimately, it was his online gaming
experiences that led him to feel comfortable as a male.
Case study 3: ‘Paul’
Paul is a 31-year old natal male who would like to be
female, but he is still living full-time as a male. He is
married and has two children. Paul started cross-
dressing (using his sister’s clothes) at the age of 12. In
the beginning, there was a sexual component to his
cross-dressing activity. Gradually he started presenting
more and more in a female role, but at the time he did
not have any understanding as to why he did so. He
felt confused and different to his friends. He described
himself as shy and quiet, and he had few friends of
either gender. He loved playing videogames, particu-
larly Super Mario Kart and Zelda. He also played football
with friends. Paul trained as a personal trainer and at
this point he started drinking alcohol excessively as a
way of «fitting in» and «and being [accepted by] lads».
He explained that during this «very confusing» period
for him, he developed a sense of escapism when he
played Oblivion and other similar online role-playing
games, mostly in the third-person. When he started
playing as a female, he felt right and that it was natu-
ral. He liked the fact that other online gamers thought
he was a woman, and he would always play as a female
character and in a female role. He liked interacting
online with people and he said that the gaming made
him feel good about himself.
This was virtually the only expression of Paul’s
imagined gender at this point. He did not have the
confidence to even extend his gender swapping to
multi-playing. He got married in his early twenties and
when living with his wife he continued to cross-dress
in secret at home and wear female underwear. At this
point he liked the way it felt and looked, but he got
no sexual gratification from cross-dressing. He would
very occasionally go out in full female role and he
described this as feeling good, but a bit scary. He at-
tended the Centre asking for help in coming out and
in reaching a better understanding of his gender iden-
tity. He continues to play video games as a female
character as a way of expressing his experienced gender
in a safe environment. However, he is still uncertain
about fully transitioning to being female.
Case study 4: ‘Harry’
Harry is a 23-year old natal male who presented for an
assessment as a male. He sees himself as female but has
not yet transitioned. From about the age of 6, he would
play with his older brothers and always adopted a fe-
male role in the imaginary games they played. At that
early age, he had already informed his brothers that
he was «a girl», and he had very few friends. On his
birthdays, he would always wish to wake up one day
and be a girl, but it never came true. Puberty came as
a shock to him, and it was at this stage of his life that
he described strong dysphoric feelings towards his body
that he tried to «blank out» and suppress. He became
depressed and starting self-harming as a way of coping
with his negative feelings about himself. He isolated
himself from other people and developed social anxi-
ety. At this point, he retreated into role-playing games
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Mark D. Griffiths, Jon Arcelus and Walter Pierre Bouman
64
2016, 34(2)
such as Final Fantasy and Dragon Age, but he avoided
online role-playing games because he felt they would
be too scary. There were strong themes of escapism in
his gaming. When he had a choice he would always
play female characters as he said that this felt better
and more comfortable for him than reality. He said he
was able to escape even more into the video game if
he was playing a female character.
As a result of playing video games continuously up
to 12 hours a day as a way to cope with his feelings, his
education suffered badly. However, he explained that
the excessive gaming enabled him to stop self-harming.
He hardly left his house due to his social anxiety and
depression, and his GP subsequently referred him to a
therapist. It was then that Harry disclosed his trans
feelings. Harry ended up telling his parents about his
gender dysphoria six months prior to the present study.
They were shocked, but his mother has been supportive.
However, his father remains bewildered and finds.
Harry’s desire to be female difficult to accept. Harry
would like to transition, but his social anxiety does not
allow him to. He still plays video games obsessively and
is housebound. He is unsure what the future will bring.
As far as social gender role expression is concerned,
Harry only ever engaged in wearing female clothing
when he was a young boy, whilst playing imaginary
role-playing games with his brothers. There is an over-
all sense that he is stuck in his life and that playing
video games excessively is his only way of coping with
the distressing thoughts he has.
Discussion
The four case studies outlined in the present paper are
only a selected sample of the number of cases attending
a national clinic for people with gender dysphoria. They
are in no way atypical of the clients that have sought
help at the Centre. However, these individual accounts
were specifically selected to demonstrate the different
ways that video gaming may help people with gender
dysphoria come to terms with their gender identity. For
example, gaming can be used among trans people as a
psychological tool to increase one’s awareness of gender
identity and/or as part of the self. Gaming may therefore
be a useful way to express one’s experienced gender
identity in a safe, non-threatening, non-alienating, non-
stigmatizing, and non-critical environment. This appears
to mirror other the findings of other studies outside of
the online gaming environment. For instance, using
virtual ethnography and discourse analysis within two
online Israeli arenas (a newsgroup and an online forum),
Marciano (2014) examined the ways that trans indi-
viduals manoeuvre between their online and offline
worlds as a way of negotiating their gender identity and
to overcome offline impediments. The results suggested
that trans individuals used the online world as either a
preliminary, complementary, and/or alternative medium
which gave them more space to negotiate their gendered
status – a pattern that was also found among the case
studies in the present study.
Articles published in the mass media have reported
that online games such as World of Warcraft provide a
creative space that allows gamers that might be ques-
tioning aspects of their identity to explore their lives
as different individuals. Some have even gone as far as
to argue that this could help gamers transform their
‘offline’ identity, as is the case with some trans gamers
(Dale, 2014). This was also demonstrated in the case
studies described in the present study. Other authors
(e.g., Zoonen, 2002; Fahs & Gohr, 2012) assert that the
online medium offers an infinite space for development
and resistance to traditional gender roles, and that
online interaction enables a transgression of the di-
chotomous categories of male and female, constructing
non-binary (or even genderless) social identities and
relationships. However, although such anonymous
online communities may provide trans individuals
with the power to subvert their physical sex (Laukkanen
2007), such categorisation brings with it often «harsh,
hegemonic performance expectations and pressures» (Fahs
& Gohr, 2012; p.27).
The case studies presented here also demonstrated
the different functions gaming has for trans people
(e.g., the function of «testing out» their gender feelings).
For instance, some can use gaming to ‘come out’ to
other people, by initially coming out in the online
community, which is perceived as a safe environment,
and then gradually coming out in real life. As it does
for many cisgendered individuals gaming can provide
trans people with psychological benefits and a sense
of escapism. This is even more relevant among trans
people, as it may be the only time that they feel they
can be themselves, allowing them to feel happy and
relaxed and to achieve a sense of completeness. This
could develop into a powerful coping skill that might
keep these individuals from resorting to unhealthy
behaviours such as self-harming. This is particularly
important in this population, as research shows a
strong association between being trans and mental
health problems, particularly depression and self-harm
as a way to manage one’s trans feelings (Claes et al.,
2015; Davey et al., 2015; Hepp, Kraemer, Schnyder,
Miller, & Delsignore, 2005; Marshall et al., 2016; Nutt-
brock et al., 2010; Operario & Nemoto, 2005). This is
not surprising, as the discomfort and distress about
assigned gender and body dissatisfaction (Witcomb et
al., 2015; Jones et al., 2016) may lead to a sense of
hopelessness, which can bring with it low mood, self-
injury and even suicide (Dhejne et al., 2011).
Although gaming appears (at least initially) to be a
positive and beneficial activity for many trans people,
there is also the risk that staying within the world of
the game becomes too much of a secure and safe en-
vironment. This can create a vicious circle where the
trans person does not wish to move out of the secure
online world and back into reality. Spending an increas-
ing amount of time on online gaming carries the risk
of developing a gaming dependence or addiction
(Lopez-Fernandez et al., 2014; Pontes & Griffiths, 2015).
This may not only affect one’s personal relationships,
06_Griffiths_34(2)_57-66.indd 64 27/10/16 10:37
Video Gaming and Gender Dysphoria: Some Case Study Evidence 65
2016, 34(2)
work and/or study, but may also impair real life social
gender role transition, as in many cases the individual
is expected to socially transition before they can be
considered for treatment.
The present study is not without its limitations. The
number of participants (n=4) was small, and although
the cases studied were typical of those with gender
dysphoria attending the clinic, they are unlikely to be
representative of those with gender dysphoria more
generally. The case studies reviewed may be perceived
by some researchers as ‘anecdotal’ because the data were
not collected for this specific study but were retrospec-
tively collated. The insights concerning both positive
and negative aspects of gaming by those with gender
dysphoria would need to be confirmed using larger and
more representative samples. For a trans individual, the
online gaming environment is perceived as «safe», but
further research is needed to establish what distinctive
elements of online gaming help to raise gender aware-
ness (or not, as the case may be). The present study
cannot answer such questions as none of the individu-
als in the present study was specifically asked about their
gaming experiences (because the original case notes
taken by the therapists were not specifically concerned
with gaming but were a general case assessment). Con-
sequently, only one of the individuals specifically de-
scribed their motives and relationship with online
gaming and/or their avatars. It could be that some in-
dividuals with gender dysphoria suffer negative experi-
ences of gaming in the long run because the individual
may simply not be able adopt such a role in real life.
With the rates of gender dysphoria attending
clinical services increasing significantly (de Vries et al.,
2015), future research should investigate (i) the rates
and of gaming addiction among this population as well
as its function, and (ii) the rates of gender dysphoria
among game addiction as coming out may help their
addiction. The game industry may want to consider
how they can use games as a way of helping trans
people being more accepted within society by develop-
ing game industry may want to observe how their
games can prepare and assist individuals to transition
socially. Online games also provide a safe environment
that gives people access to a platform where they can
discuss and experiment with gender identity.
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