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Gender Dysphoria and Intellectual Disability

Gender Dysphoria and Intellectual Disability. Dr Georgina Parkes Consultant Psychiatrist Welwyn and Hatfield. What is gender identity?. Psychological concept of self as masculine or feminine regardless of anatomic sex.

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Gender Dysphoria and Intellectual Disability

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  1. Gender Dysphoria and Intellectual Disability Dr Georgina Parkes Consultant Psychiatrist Welwyn and Hatfield

  2. What is gender identity? • Psychological concept of self as masculine or feminine regardless of anatomic sex. • GENDER roles men and women play socially constructed not biologically determined. • IDENTITY fact of person or thing as an unchanging property throughout existence. • Flexible evolving concept throughout life

  3. Commonly used terms • Gender dysphoria • gender identity disorder • transsexualism • primary • secondary • cross-dressing • transvestite

  4. DSM V • Has its own chapter separate from sexual dysfunction and paraphillias. • 1. Gender Dysphoria replaces Gender Identity Disorder • Removing term disorder reducing stigma • 2. separate criteria for children; adolescents and adults together.

  5. DSM V continued • 3. Symptoms present for >6 months • 4. New categories of Other specified Gender Dysphoria • And Unspecified Gender Dysphoria • Replace GIDNOS • Also new specifiers DSD/ living full time • sexual orientation has been removed.

  6. Gender identity disorder ICD(10) • Classified under disorders of adult personality and behaviour. • diagnostic guidelines are given for GID of childhood. • Transexualism: present for>2 years • exclusions

  7. AETIOLOGY • No universally accepted theory. • Cultural differences: e.g. rates of previous marriage; New Zealand • Biological: hypothalamus Zhou et al 1995 and LeVay 1991. • Family Constellations Stoller 1968 • Loss of attachment figure in early childhood

  8. Aetiology continued • Other trauma inc. abuse • The earlier the trauma the more rigid the organisation of the atypical gender identity • Parent’s wish for child of opposite gender. • Most likely multifactorial • rarity explained by need for number of factors to be present simultaneously at a critical period in development.

  9. Aetiology in ID • Case studies and case series have shown high rates of childhood sexual abuse • Also sexual assault as an adult • Difficulty coming to terms with sexual orientation which is seen as rigidity around gender roles (seen in children without ID age 3 to 5) therefore a developmental factor here.

  10. Aetiology continued • Seen as an escape/ anger control • Wanting to become someone else to be more accepted by society • Absence of fulfilling sexual relationship • Associated with aggression in some case studies • Higher prevalence in those with ASD (rigidity of gender roles)

  11. Epidemiology • Baird et al 1% • Varies hugely averages out at around 1 in 18,000 • Originally male to female ratios were thought to be 8:1, now some clinics 1:1. • Higher rates in ID • Higher rates in ASD

  12. Gender dysphoria and ID prevalence • Bedrad et al • Surveyed 32 people with ID re sexual and gender identity • 4 (12.5%) had gender dyphoria • Unexpected finding • Known to professionals for many years and only 1 had voiced this before.

  13. ASD and gender dysphoria • De Vries et al 2010 • 204 children • Used DISCO on 26 suspected had ASD • 16 confirmed (7.8%) • Of those 2 had ID • Mean IQ 82 in ASD group and 104 in Non ASD group.

  14. ASD and gender Dysphoria • Extreme male brain papers • Trans men have significantly higher autistic traits on self report AQ than general population. • Postulate unable to assimilate with females so drift towards male peer group and due to rigidity of thinking become gender dysphoric

  15. No difference in AQ trans women • BUT 6 (3%) of the 198 in the study were diagnosed with ASD already. • Extreme male brain theory??

  16. GID and Learning Disability • Many case studies some with ASD • An audit of referrals to GID unit Portman clinic 10 young people had learning disabilities. • Parkes et al 2008 retrospective case notes review of 13 cross dressing to CONSENT • 12 with ID. One ASD and borderline

  17. Parkes et al 2008 continued • 12 males, 1 female • 62% (n=8) CSA • 7 gender dysphoric: • 3 met criteria for GID: • 1 living full time • 3 unhappy with being gay -seeking SRS • 1 wanted to male and female at the same time

  18. 2 TF • 1 escape anger be someone else • 1 not enough info • 2 unclear to themselves

  19. GID in children • rare • more common in boys cross gender play/ clothes more acceptable in girls • Developmental/ developmental lag in gender constancy • Wishes of parents play a role • 15% continue into adolescence to seek SRS • Higher % than gen popn resolve in gay/lesbian

  20. Conclusions • Higher rates than in general population • Higher rates in ASD • Longer assessments, attention to assessment of developmental issues needed • May need psycho education and information • May need counselling to address abuse and assault issues

  21. Conclusions cont • Are seen frequently in Mainstream Gender clinics and given treatments- capacity and capability issues • Need help to access main stream services and to support cross dressing, lifestyle • Need help to develop personal identity

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