Gender self-identification and intra-family relations of children with disorders of sex development

Abstract

The birth of a child with disorders of sex development (DSD) requires a long term surveillance and treatment strategy conducted by a multidisciplinary group of professional physicians, with a mandatory understanding of the psychosocial problems of the child and parents.Materials and methods. For the period from 2014 to 2018, a diagnosis of gender identity was conducted in 20 children and adolescents with DSD aged from 1.5 to 17 years. For the definition of gender identity, the methodology of Homunculus, gender socialization — the method of spontaneous drawing of Wartegg, internal family relations — the method My family, the method of structured interviews were used. The assessment of intra-family relations was conducted in comparison with the control group, which consisted of 28 families in which healthy children were raised. A molecular cytogenetic study was conducted for all patients with DSD before psychological evaluation.Results and discussion. Among the examined children, chromosomal DSD was diagnosed in 6 (35.29 %), 46,XY DSD — in 13 (65.0 %) and 46,XX DSD — in 1 (5.0 %) patients. Diagnosis of DSD was established for children of different ages ­ from birth to 16 years, on average, 7,26 [1,50; 13,00] years. In 60,0 % of children over the age of 7 years, signs of disorders of gender identity were detected, significantly more in children aged 7—12 (p < 0.05). Disordersof gender identity developed significantly more often in children who were registered in the female civil society — at 57.14 %. In the group of children with 46, XY DSD, signs of gender identity impairment were observed at 69.23 %, which is significantly more frequent than in patients with chromosomal DSD — in 50.0 % of cases (p < 0.05). In 25.0 % of families, children have often been criticized, and parents are negatively assessed, which impaired the formation of a child’s gender identity. 54.25 % of families with a child having DSD did not seek to give birth to subsequent children because of fear of genetic disorders in them. The frequency of divorces in the families of children with DSD increases with the age of children and the largest (30.0 %) in the group of patients olderthan 12 years (p < 0.05), which is significantly more in comparison with the control group (p < 0.05). Violations of intra-family relations in families of children with DSD are significantly more frequent than in the control group families (p < 0.05).Conclusions. The psychological support of children with DSD and their families is an important component of comprehensive medical and social rehabilitation.