Psychiatric comorbidity among patients with gender identity disorder – Partial Review

This study looked at the patients at a Japanese clinic for gender identity disorder to see if they had any other mental health issues. They did not find a high rate of autism spectrum disorders (ASDs).

This is not a review of the full study, just the information related to ASD.

Out of 579 patients that they treated, only 4 were diagnosed with Asperger’s disorder and there were no other cases of autism spectrum disorders.

In other words, less than 1% of this group had an ASD.

All of the patients with Asperger’s were born male.

This data is worth noting because it is so different from results in other countries. Are patients with autism not referred to the GID clinic in Japan? Is autism being diagnosed the same way in the different studies? Are adult patients less likely to have ASD than children and teenagers with gender dysphoria?

This data also highlights the fact the gender dysphoria and autism spectrum disorders are connected in males, not just females – in fact, in this case, they were connected only in males.

There is a theory that having an “extreme male brain” makes some girls with autism develop gender dysphoria. While that could still be true, it does not explain why males with autism would feel that they are females.

Instead of an “extreme male brain,” there might be some other mechanism that connects autism and gender dysphoria in both trans women (born male) and trans men (born female).

Another interesting aspect of the data was that they diagnosed 96% of the patients they saw with GID. Of the 24 patients who were not diagnosed with GID, half had severe psychological disorders like schizophrenia. Eight were excluded for homosexuality and four were excluded for transvestic fetishism.

I am not sure why they diagnosed such a high percentage of their patients with GID. Perhaps by the time people are referred to their clinic, they have been diagnosed by other doctors. It might also be somehow related to the definition of GID or the process of diagnosis.

I am assuming they excluded the gay patients because the patients discovered that they did not have GID and that the clinic is not excluding all gay patients. Most people with GID are attracted to people of their birth sex.

Other important results from the abstact:

“Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579).”

The horrifying part has been bolded. I’m putting off talking about it until another day when I can deal with it.

I’ll just add that the authors suggested that “the harsh circumstances in which most GID patients have lived in Japan might influence the high rate of suicidal ideation or self mutilation in GID patients.”

Original Article:

Psychiatric comorbidity among patients with gender identity disorder by Masahiko Hoshiai MDYosuke Matsumoto MD, PhDToshiki Sato MD, PhDMasaru Ohnishi MD, PhDNobuyuki Okabe MDYuki Kishimoto MDSeishi Terada MD, PhD, and Shigetoshi Kuroda MD, PhD in Psychiatry and Clinical Neurosciences Volume 64, Issue 5, pages 514–519, October 2010.

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