The co-occurrence between gender dysphoria and autism in trans youth: a critical commentary through a single case study

Introduction: In recent years, a higher incidence of traits that seem to be related to Autism Spectrum Conditions (ASC) in individuals with Gender Dysphoria (GD) and of gender variant traits in autistic users, compared to the general population have been highlighted. Therefore, several studies investigated the possible co-occurrence between these two conditions and the consequences in terms of assessment and treatment. Methods: A literature review were conducted to investigate the co-occurrence of GD and ASC. Then, through a single case this co-occurrence is investigated in deep. Autistic traits and gender variant behaviors are evaluated and described at the beginning of the treatment, after a year, and at the end of the treatment. Results: From the literature review different criticisms can be made: the diagnoses of both conditions are often not accurate, the tools used to evaluate autistic traits and gender dysphoria often are not appropriate and methodological criticalities are found on the studies that investigate the co-occurrence. Relying on the account of a trans adolescent followed in a psychoanalytic psychotherapy, more critical aspects are pointed out. Autistic traits can be better understood as massive defenses related to high discomfort of the GD, like social and relational problems, complex perception of the body and difficult behavioral patterns. Conclusion: This study underlines the need to deepen this co-occurrence, to avoid incurring in incorrect and hasty diagnoses and to focus on some aspects of GD and ASC that need attention and knowledge, in order to better define the guidelines for a correct assessment and treatment. The medicalization and a tendency to pathologize these conditions have led to a simplistic overlap while a more complex view and investigation are needed.