Psychopathological disorders in a sample of adolescents experiencing Gender Incongruence relating to services of Child Neuropsychiatry: the possible mediating role of personality profiles and autistic traits

Introduction: In recent years, an increasing number of adolescents diagnosed with Gender Incongruence (GI) or Gender Dysphoria (GD) have accessed Child and Adolescent Neuropsychiatry services. Literature indicates a high prevalence of internalizing psychopathologies, self-harm, and suicide risk in this population, alongside significant co-occurrence with Autism Spectrum Disorder (ASD). While difficulties in mentalization have been proposed as a link between GD and ASD, the underlying mechanisms of ASD traits in GI remain unclear. Objectives: This study aims to: (1) Describe psychopathological disorders in adolescents diagnosed with GD; (2) Assess the presence of ASD traits in a subset of this population; (3) Analyze relationships among GD, body image, personality traits, and mentalization abilities. Methods: The sample comprised 50 adolescents diagnosed with GD (ages 12-18). Psychological and global functioning were evaluated through structured interviews, questionnaires, and family consultations, assessing depression, anxiety, self-harm, suicidality, body image, emotional regulation, mentalization, and personality. A subset underwent assessment for ASD traits using the ADOS-2 test. Results: Mood disorders (72%), anxiety (66%), and neurodevelopmental disorders (26%) were the most prevalent conditions. ASD traits were identified in 14% cases, predominantly among AFAB individuals. Personality traits (SWAP-200) correlated with body image and mentalization indices: borderline traits were linked to body dissatisfaction and hypomentalization, while schizoid traits were associated with positive body perception. Negative body image was related to challenges in mentalization, including difficulties in emotion processing and reflective uncertainty. Mediation and moderation analyses were conducted. Conclusions: The findings align with existing literature on the psychological profile of adolescents diagnosed with GD and provide prevalence data on personality traits within this group. They highlight the need for a therapeutic approach centered on mentalization, which accounts for personality clusters and the global functioning levels of patients. Particular attention should be given to Cluster A traits, suggesting a potential link with neurodevelopment and emphasizing the importance of personalized therapeutic interventions.