Attachment patterns and complex trauma in a sample of adults diagnosed with gender dysphoria

Background In recent years, people diagnosed with Gender Dysphoria (GD) were object to various psychological evaluations from several different perspectives. Occurrence of early relational traumas is a recurring finding in GD literature, showing how trans children were victims of different forms of maltreatment within the caregiving contest (Kersting et al., 2003; Veale et al., 2010, 2016). Similarly, on the social level, studies highlighted discrimination and isolation at school and within peer groups, implying a harmful impact on trans youth’s physical and psychological health (Clements-Nolle et al., 2006; Grant et al., 2011). In contrast, a loving caregiving was considered as a protective factor against discriminations. A recent study of our group (Lingiardi et al., submitted) confirmed, in an Italian sample, the elevated frequency of early traumatic experiences, along with a high prevalence of disorganized mental states with regard to attachment. However, the literature on attachment among transsexual individuals is still limited. It is noteworthy that the choice to explore attachment and trauma is not motivated by an etiopathological quest, rather it is an attempt to describe the intrapsychic and relational aspects of the stigmatization to which trans children can be exposed. Aim(s) I. To explore the distribution of mental representations with regard to attachment in a group of adults diagnosed with gender dysphoria and to confront it with a cisgender group; II. To explore and evaluate trauma history among our participants and to confront the results with the cisgender group, with regard to: (a) Occurrence of multiple forms of maltreatment, and (b) Intensity and frequency of traumatic experiences; III. To explore the frequency of loving caregiving in the two groups; IV. To confront subgroups: (a) Trans men with cisgender males and females, and (b) Trans women with cisgender males and females, with regard to attachment and early relational trauma; V. To confront trans women and trans men subgroups with regard to attachment and early relational trauma. Methods Ninety-five adults diagnosed with gender dysphoria (74 trans women; 21 trans men) were compared with eighty-seven cisgender adults. The Adult Attachment Interview (AAI) was administered to both samples for the assessment of current state of mind. The Complex Trauma Questionnaire (ComplexTQ) was completed by clinicians in order to evaluate early relational trauma. Main Outcome Measures The Adult Attachment Interview (AAI) is a semi-structured interview which explores adult’s mental representations of attachment while discussing childhood experiences. AAI scoring system is based on the participant’s ability to produce coherent narratives regarding childhood experiences with caregivers, thus classifying interviewee as Secure/Autonomous (F), Dismissing (Ds), Preoccupied with respect to attachment (E), or “Cannot classify” category (CC) when a global breakdown in the organization of discourse arises. An interview may also be assigned an Unresolved/disorganized state of mind (Ud) concerning past abuse or loss in association with a best- fitting primary classification. The Complex Trauma Questionnaire (ComplexTQ) is a 70-item scale for the retrospective assessment of multi-type maltreatment, measuring lack of care (physical and emotional neglect), abuse (psychological, physical, and sexual abuse), and other traumatic experiences, such as rejection, role reversal, exposure to domestic violence, separations, and losses. The questionnaire assesses adverse experiences from childhood to usage of 14 years separately involving maternal, paternal, and other attachment figures. The clinician version requires approximately 15–20min to complete and scores for presence and frequency of traumatic experiences in each domain are automatically provided by the software. Results Data revealed significant differences regarding the distribution of attachment patterns between trans people and the cisgender sample. The two samples also differentiated regarding the exposure to complex trauma in childhood and the intensity of multi-type maltreatment experienced. Finally, within the trans sample, we did not find significant differences between trans women and trans men, neither with respect to attachment nor to early relational trauma. Conclusion Our findings underline the traumatic history and the disorganization of attachment which characterise the experiences of our trans sample, both in trans women and trans men participants. These results highlight the need for intervening in reduce the stigma and discrimination among gender non-conforming people, both in families and in social groups, and particularly helping trans youth to overcome traumatic experiences which could lead to dangerous outcomes (e.g. self-harm and suicidality).