Autism Spectrum Disorder and Gender Incongruence: Analysis of Clinical Functioning Profiles and Body Image Perception

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by social and communication deficits, repetitive behaviors and restricted interests. In recent years, the scientific community has shown particular interest in understanding whether and how individuals with ASD may experience incongruent experiences regarding their gender assigned at birth. Although the challenges in the evaluation of cognitive and emotional aspects related to gender identity in these individuals, recent literature data highlight an increased co-occurrence between ASD and Gender Incongruence (GI). Similarly, recent studies estimate higher prevalence rates of ASD and autistic traits in the population with GI compared to those observed in the general population. Based on these findings, several authors have hypothesized a possible correlation between ASD and GI. Specific Aims: The main objective of the present study is to investigate gender identity, body image perception, and eating behaviors in the population with ASD. An additional objective of our study is to correlate in our sample ASD symptoms and the presence of GI with abnormal eating behaviors and alterations in body image perception. Materials and Methods: 30 subjects with ASD (mean age=18, M:F at birth = 15:8) were recruited. The following criteria were adopted as exclusion criteria: Intellectual disability (IQ < 70), poor verbal skills, presence of a genetic syndrome and other known psychopathological conditions associated. We evaluate cognitive functioning, adaptive functioning, metacognitive skills, autistic symptoms, body perception, eating behavior and gender incongruence. Results: Preliminary results show that in our sample a total of 25% presented GI. Of those, 4% identify as transgender, 21% as nonbinary. Independent samples t test analyses revealed that subjects with ASD and GI experience greater discomfort regarding their appearance and body perception (p=0.010), as well as a higher tendency to have a lower self-esteem (p=0.032) and a greater Interpersonal insecurity (p=0.004). Additionally, in this group we found a higher level of autistc symptoms (p=0.009), lower general adaptive functioning skills (p=0.036) and a higher rate of repetitive and restricted behaviors and interests (p=.0.024). Conclusions: The present study provides preliminary evidence of a significant association between ASD symptoms, gender incongruence (GI), and disturbances in body image perception and eating behaviors. Our findings indicate that individuals with ASD and GI exhibit greater body image dissatisfaction, lower self-esteem, and increased interpersonal insecurity, which may contribute to a heightened vulnerability to mental health challenges. Furthermore, the association between ASD and GI appears to be linked to more pronounced autistic symptoms, lower adaptive functioning, and increased repetitive and restricted behaviors. These results underscore the importance of adopting a multidimensional approach in the clinical assessment and support of individuals with ASD, particularly those experiencing gender incongruence.