Attachment Patterns in Children and Adolescents With Gender Dysphoria.

Kasia Kozlowska,Geoffrey R Ambler,Ann M Maguire,Georgia Mcclure,Catherine Chudleigh

doi:10.3389/fpsyg.2020.582688

Kasia Kozlowska, Geoffrey R Ambler + Show 3 more

Open Access

https://doi.org/10.3389/fpsyg.2020.582688

Copy DOI

Abstract

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.

Highlights

Over the last few decades, in Western clinical practice, children with gender dysphoria have emerged as a poorly understood clinical population with increasing presentations to health services (Zucker, 2017; MeyerBahlburg, 2019)
We used dynamic-maturational model (DMM) linguistic analysis of attachment interviews to examine patterns of attachment/self-protective strategies in children presenting with gender dysphoria and non-clinical children matched on age- and biological sex, and drawn from a broad range of socioeconomic status (SES)
Whilst children from the non-clinical group were mostly classified into the normative attachment strategies, children with gender dysphoria were mostly classified into the at-risk attachment strategies

Summary

Introduction

Over the last few decades, in Western clinical practice, children (including adolescents) with gender dysphoria have emerged as a poorly understood clinical population with increasing presentations to health services (Zucker, 2017; MeyerBahlburg, 2019). John Bowlby, the father of attachment theory, used the analogy of branching train tracks in a railway yard to think about developmental pathways and patterns of adaptation and maladaptation (Bowlby, 1973a). He conceptualized the problems of troubled children as emerging from a complex interplay between genetic factors, experience—the intrauterine experience, the quality of the child’s attachment relationships, the family experience, and the impact of adverse childhood experiences (ACEs)—and sociopolitical and cultural factors. Prospective, population-based studies have shown that poorquality attachment relationships (at-risk patterns of attachment) are a risk factor for psychopathology later in life (Sroufe, 2005)

Objectives

Results

Conclusion