Comorbidity of Asperger syndrome and gender identity disorder – Review

This is a case study of a 35-year-old woman who had Asperger syndrome and gender dysphoria. The authors discuss her psychological profile in detail.

They believe that her gender dysphoria developed because she had Asperger’s syndrome.

They say:

“…we noticed over-developed logical thinking and accentuation of logical-abstract abilities, as well as an imbalance of low emotionality and a high level of instrumental, non-emotional attributes including activity, lack of emotionality and perseverance. These characteristics are generally associated with masculinity and may have led to a subjective consciousness in our patient of being male. In this regard, primary cognition and perception in AS (Asperger’s syndrome) may be interpreted as masculine attributed and pave the way to the development of the female-to-male GID (gender identity disorder). The adaptation of the male gender identity, from early life on, possibly enabled the patient to better integrate the lack of emotionality and the accentuated logical-abstract abilities. The extremely high level of masculinity can be interpreted as an additional compensatory effort to accentuate the biologically absent male side.

Taking this into account, we believe that over the years, our patient has developed GID as a consequence of adopting male emotional and cognitive traits due to AS. Following this argument, GID in this patient could be regarded as a sequel to AS.”

Although the authors think the gender dysphoria was caused by Asperger’s, they believe that because there is no treatment for Asperger’s, gender dysphoria in Asperger’s should still be treated as a “primary GID.”

The patient did well with cross-gender living and the clinic treated her for GID following international standards.

The authors refer to the theory that autism is caused by an extreme male brain and connect it to their case study.

They also refer to the “well-known exaggerated masculinity in female-to-male GID patients.”

Because of the above, the authors hypothesized that gender dysphoria could develop in a woman with Asperger’s because Asperger’s syndrome is associated with behaviors we consider masculine. Their theory fits the person in this case study. It might make sense for other trans men.

The problem with this theory, however, is that it does not explain trans women with Asperger’s.

Asperger’s syndrome is more common than would be expected among boys and men with gender dysphoria, too. There is no logical way to understand why men with extra masculine brains and behaviors would believe that they were women and want to transition.

This way of looking at the connection between Asperger’s syndrome and gender dysphoria might lead therapists to assume that a woman with Asperger’s syndrome was correct when she said she had gender dysphoria, but a man with Asperger’s syndrome was confused.

It is, of course, possible that trans men and trans women with Asperger’s syndrome want to transition for different reasons.

On the other hand, it seems simpler to think that whatever links Aspergers and gender dysphoria in men is the same thing as what links them in women.

More About the Patient from the Study:

The patient was not diagnosed with Asperger’s in her childhood, although she had some inconsistencies in her social relationships and was very interested in details and structured and geometric entities. At age 33 she asked to be examined for Aspergers; she was diagnosed with Aspergers in 2001.

The patient remembered always wanting to be a boy. She chose male playmates (although she seems to have mostly not had playmates), liked football, and acted like a tomboy. She “insisted on being a boy and refused girl’s clothing.” She had heterosexual platonic partnerships that did not work out due to her lack of social skills.

At age 34 the patient sought treatment for gender dysphoria. She was diagnosed with GID by two of the authors of the study in 2003.

The study discusses all the tests they gave her and the results. Her intelligence scores were in the upper average range with no discrepancies between verbal and performance measures. She did poorly on a test of executive function; apparently this is common in people with Asperger’s syndrome.

For a test called the Personal Attitudes Questionnaire (PAQ) she scored as less feminine and more masculine than male controls. According to the authors, “This fits the profile of patients with Asperger syndrome and is consistent with female-to-male GID.”

She also had a low score on a test of attractivity/self-confidence; the authors say this is consistent with the “body image distortions described by patients with gender identity syndrome.”

Original Article:

Comorbidity of Asperger syndrome and gender identity disorder by Kraemer B, Delsignore A, Gundelfinger R, Schnyder U, Hepp U in Eur Child Adolesc Psychiatry. 2005 Aug;14(5):292-6.

Interesting note: The patient was diagnosed with Asperger’s syndrome by the daughter of Hans Asperger.

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  1. Pingback: Gender dysphoria in Asperger’s syndrome: a caution – Review | TRANS RESEARCH

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