Presentation on theme: "Gender Dysphoria and Intellectual Disability"— Presentation transcript:
1 Gender Dysphoria and Intellectual Disability Dr Georgina ParkesConsultant PsychiatristWelwyn 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 transsexualismprimarysecondarycross-dressingtransvestite
4 DSM VHas its own chapter separate from sexual dysfunction and paraphillias.1. Gender Dysphoria replaces Gender Identity DisorderRemoving term disorder reducing stigma2. 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 DysphoriaAnd Unspecified Gender DysphoriaReplace GIDNOSAlso new specifiers DSD/ living full timesexual 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 yearsexclusions
7 AETIOLOGY No universally accepted theory. Cultural differences: e.g. rates of previous marriage; New ZealandBiological: hypothalamus Zhou et al 1995 and LeVay 1991.Family Constellations Stoller 1968Loss 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 identityParent’s wish for child of opposite gender.Most likely multifactorialrarity explained by need for number of factors to be present simultaneously at a critical period in development.
9 Aetiology in IDCase studies and case series have shown high rates of childhood sexual abuseAlso sexual assault as an adultDifficulty 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 societyAbsence of fulfilling sexual relationshipAssociated with aggression in some case studiesHigher prevalence in those with ASD (rigidity of gender roles)
11 Epidemiology Baird et al 1% Varies hugely averages out at around 1 in 18,000Originally male to female ratios were thought to be 8:1, now some clinics 1:1.Higher rates in IDHigher rates in ASD
12 Gender dysphoria and ID prevalence Bedrad et alSurveyed 32 people with ID re sexual and gender identity4 (12.5%) had gender dyphoriaUnexpected findingKnown to professionals for many years and only 1 had voiced this before.
13 ASD and gender dysphoria De Vries et al 2010204 childrenUsed DISCO on 26 suspected had ASD16 confirmed (7.8%)Of those 2 had IDMean IQ 82 in ASD group and 104 in Non ASD group.
14 ASD and gender Dysphoria Extreme male brain papersTrans 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 ASDAn 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 CONSENT12 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 time3 unhappy with being gay -seeking SRS1 wanted to male and female at the same time
18 2 TF1 escape anger be someone else1 not enough info2 unclear to themselves
19 GID in childrenraremore common in boys cross gender play/ clothes more acceptable in girlsDevelopmental/ developmental lag in gender constancyWishes of parents play a role15% continue into adolescence to seek SRSHigher % than gen popn resolve in gay/lesbian
20 Conclusions Higher rates than in general population Higher rates in ASDLonger assessments, attention to assessment of developmental issues neededMay need psycho education and informationMay need counselling to address abuse and assault issues
21 Conclusions contAre seen frequently in Mainstream Gender clinics and given treatments- capacity and capability issuesNeed help to access main stream services and to support cross dressing, lifestyleNeed help to develop personal identity