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Personality and Attachment in Transsexual Adults

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Abstract

The main aim of this study was to investigate the associations between personality features and attachment patterns in transsexual adults. We explored mental representations of attachment, assessed personality traits, and possible personality disorders. Forty-four individuals diagnosed with gender identity disorder (now gender dysphoria), 28 male-to-female and 16 female-to-male, were evaluated using the Shedler–Westen assessment procedure-200 (SWAP-200) to assess personality traits and disorders; the adult attachment interview was used to evaluate their attachment state-of-mind. With respect to attachment, our sample differed both from normative samples because of the high percentage of disorganized states of mind (50% of the sample), and from clinical samples for the conspicuous percentage of secure states of mind (37%). Furthermore, we found that only 16% of our sample presented a personality disorder, while 50% showed a high level of functioning according to the SWAP-200 scales. In order to find latent subgroups that shared personality characteristics, we performed a Q-factor analysis. Three personality clusters then emerged: Healthy Functioning (54% of the sample); Depressive/Introverted (32%) and Histrionic/Extroverted (14%). These data indicate that in terms of personality and attachment, GD individuals are a heterogeneous sample and show articulate and diverse types with regard to these constructs.

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Notes

  1. According to SAIFIP protocols, gender reassignment surgery (GRS) is the set of surgical procedures that radically and irreversibly remove internal and external genitals and reproductive organs, irreversibly intervene on mammary structure for both MtFs and FtMs, and reconstruct genitals. It includes mastectomy, mastoplasty, penectomy, orchiectomy, vaginoplasty, metoidioplasty and phalloplasty.

  2. AMS was trained at the AAI Training Institute of Rome, 1990, by M. Main and E. Hesse; VN and AF were trained at the AAI Training Institute of Rome, 2007, 2011, by N. Dazzi and D. Jacobvitz.

  3. Organized states of mind may suggest a possible good elaboration of the traumatic experience.

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  • Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (1993). A psychometric study of the Adult Attachment Interview: Reliability and discriminant validity. Developmental Psychology, 29, 870–880.

    Article  Google Scholar 

  • Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2009). The first 10,000 Adult Attachment Interviews: Distributions of adult attachment representations in clinical and non-clinical groups. Attachment and Human Development, 11, 223–263.

    Article  PubMed  Google Scholar 

  • Bartlett, M. S. (1950). Test of significance in factor analysis. British Journal of Statistical Psychology, 3, 77–85.

    Article  Google Scholar 

  • Birkenfeld-Adams, A.S. (1999). Quality of attachment in young boys with gender identity disorder: A comparison to clinic and nonreferred control boys. Unpublished doctoral dissertation, York University, Downsview.

  • Blagov, P., & Westen, D. (2007). Under the Axis II radar: Clinically relevant personality constellations that escape DSM-IV diagnosis. Journal of Nervous and Mental Disease, 195, 477–483.

    Article  PubMed  Google Scholar 

  • Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247–261.

    Article  PubMed  Google Scholar 

  • Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616–623.

    Article  PubMed  Google Scholar 

  • Block, J. (1961). The Q-sort method in personality assessment and psychiatric research. Springfield, IL: Charles C Thomas Publisher.

    Book  Google Scholar 

  • Block, J. (1978). The Q-sort method in personality assessment and psychiatric research. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Carlson, E., Yates, T., & Sroufe, L. A. (2009). Development of dissociation and development of the self. In P. Dell, J. O’Neil, & E. Somer (Eds.), Dissociation and dissociative disorders (pp. 39–52). New York: Routledge.

    Google Scholar 

  • Caspi, A. (1998). Personality development across the lifespan. In N. Eisenberg (Ed.), Handbook of child psychology (Vol. 3). Social, emotional, and personality development (pp. 311–388). New York: Wiley.

    Google Scholar 

  • Cassibba, R., Sette, G., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2013). Attachment in the Italian way: In search of specific patterns of infant and adult attachments in Italian typical and atypical samples. European Psychologist, 18, 47–58.

    Article  Google Scholar 

  • Chianura, L., Palleschi, L., & Felici, N. (2014). The twenty years long experience of the “San Camillo-Forlanini” Public Hospital Corporation SAIFIP (Centre for the Treatment of Gender Identity Disorders and Sex Reassignment Therapy) in Rome. Salute e Società, 2, 109–126.

    Article  Google Scholar 

  • Coates, S., & Wolfe, S. M. (1995). Gender identity disorder in boys: The interface of constitution and early experience. Psychoanalytic Inquiry, 15, 6–38.

    Article  Google Scholar 

  • Cohen-Kettenis, P. T. (2005). Gender identity disorders. In C. Bilberg (Ed.), A clinician’s handbook of child and adolescent psychiatry (pp. 695–725). Cambridge, MA: Cambridge University Press.

    Google Scholar 

  • Cohen-Kettenis, P. T., & Gooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research, 46, 315–333.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., & van Goozen, S. H. (1997). Sex reassignment of adolescent transsexuals: A follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 263–271.

    Article  PubMed  Google Scholar 

  • Colizzi, M., Costa, R., Pace, V., & Todarello, O. (2013). Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. Journal of Sexual Medicine, 10, 3049–3058.

    Article  PubMed  Google Scholar 

  • Colizzi, M., Costa, R., & Todarello, O. (2015). Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real? Psychiatry Research, 30, 173–180.

    Article  Google Scholar 

  • Colli, A., Tanzilli, A., Dimaggio, G., & Lingiardi, V. (2014). Patient personality and therapist responses: An empirical investigation. American Journal of Psychiatry, 171, 102–108.

    Article  PubMed  Google Scholar 

  • Colvin, C. R., Block, J., & Funder, D. C. (1995). Overly positive self-evaluations and personality: Negative implications for mental health. Journal of Personality and Social Psychology, 68, 1152–1162.

    Article  PubMed  Google Scholar 

  • de Vries, A. L. C., & Cohen-Kettenis, P. T. (2013). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. In J. Drescher & W. Byne (Eds.), Treating transgender children and adolescents: An interdisciplinary discussion (pp. 7–26). New York: Routledge.

    Google Scholar 

  • de Vries, A. L. C., Doreleijers, T. A. H., Steensma, T. D., & Cohen-Kettenis, P. T. (2011a). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52, 1195–1202.

    Article  PubMed  Google Scholar 

  • de Vries, A. L. C., Kreukels, B. P. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2011b). Comparing adult and adolescent transsexuals: An MMPI-2 and MMPI-A study. Psychiatry Research, 186, 414–418.

    Article  PubMed  Google Scholar 

  • de Vries, A. L. C., Steensma, T. D., Cohen-Kettenis, P. T., VanderLaan, D. P., & Zucker, K. J. (2016). Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child and Adolescent Psychiatry, 25, 579–588.

    Article  PubMed  Google Scholar 

  • Di Lallo, J. J., Jones, M., & Westen, D. (2009). Personality subtypes in disruptive adolescent males. Journal of Nervous and Mental Disease, 197, 15–23.

    Article  Google Scholar 

  • Doorn, C. D., Poortinga, J., & Verschoor, A. M. (1994). Cross-gender identity in transvestites and male transsexuals. Archives of Sexual Behavior, 23, 185–201.

    Article  PubMed  Google Scholar 

  • Drescher, J., & Byne, W. (2012). Gender dysphoric/gender variant (GD/GV) children and adolescents: Summarizing what we know and what we have yet to learn. Journal of Homosexuality, 59, 501–510.

    Article  PubMed  Google Scholar 

  • Dutra, L., Bureau, J. F., Holmes, B., Lyubchik, A., & Lyons-Ruth, K. (2009). Quality of early care and childhood trauma: A prospective study of developmental pathways to dissociation. Journal of Nervous and Mental Disease, 197, 383–390.

    Article  PubMed  PubMed Central  Google Scholar 

  • Erickson-Schroth, L. (2013). Update on the biology of transgender identity. Journal of Gay and Lesbian Mental Health, 17, 150–174.

    Article  Google Scholar 

  • Farina, B., Speranza, A. M., Dittoni, S., Gnoni, V., Trentini, C., Maggiora Vergano, C., & Liotti, G. (2013). Memories of attachment hampers EEG connectivity. European Archives of Psychiatry and Clinical Neuroscience, 6, 9–22.

    Google Scholar 

  • Fisher, A. D., Bandini, E., Casale, H., Ferruccio, N., Meriggiola, M. C., Gualerzi, A., … Stomaci, N. (2013). Sociodemographic and clinical features of gender identity disorder: An Italian multicentric evaluation. Journal of Sexual Medicine, 10, 408–419.

    Article  PubMed  Google Scholar 

  • Gazzillo, F., Lingiardi, V., Peloso, A., Giordani, S., Vesco, S., Zanna, V., … Vicari, S. (2013). Personality subtypes in adolescents with eating disorders. Comprehensive Psychiatry, 54, 702–712.

    Article  PubMed  Google Scholar 

  • George, C., Kaplan, N., & Main, M. (1985). The adult attachment interview. Unpublished manuscript, University of California at Berkeley.

  • Gómez-Gil, E., Vidal-Hagemeijer, A., & Salamero, M. (2008). MMPI-2 characteristics of transsexuals requesting sex reassignment: Comparison of patients in prehormonal and presurgical phases. Journal of Personality Assessment, 90, 368–374.

    Article  PubMed  Google Scholar 

  • Haraldsen, I. R., & Dahl, A. A. (2000). Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults. Acta Psychiatrica Scandinavica, 102, 276–281.

    Article  PubMed  Google Scholar 

  • Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58, 259–261.

    Article  PubMed  Google Scholar 

  • Hesse, E. (1999). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 395–433). New York: Guilford Press.

    Google Scholar 

  • Hesse, E. (2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 552–598). New York: Guilford Press.

    Google Scholar 

  • Heylens, G., Elaut, E., Kreukels, B. P. C., Paap, M. C. S., Cerwenka, S., Richter-Appelt, H., … De Cuypere, G. (2014). Psychiatric characteristics in transsexual individuals: A multi-centre study in four European countries. British Journal of Psychiatry, 204, 151–156.

    Article  PubMed  Google Scholar 

  • Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Kaiser, H. F. (1974). An index of factorial simplicity. Psychometrika, 39, 31–36.

    Article  Google Scholar 

  • Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2007). Transgender health concerns. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual, and transgender populations (pp. 473–505). New York, NY: Springer.

    Chapter  Google Scholar 

  • Lawrence, A. A. (2010a). Sexual orientation versus age of onset as bases for typologies (subtypes) of gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2010b). Societal individualism predicts prevalence of nonhomosexual orientation in male-to-female transsexualism. Archives of Sexual Behavior, 39, 573–583.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2013a). Men trapped in men’s bodies: Narratives of autogynephilic transsexualism. New York, NY: Springer.

    Book  Google Scholar 

  • Lawrence, A. A. (2013b). More evidence that societal individualism predicts prevalence of nonhomosexual orientation in male-to-female transsexualism. Archives of Sexual Behavior, 42, 693–695.

    Article  PubMed  Google Scholar 

  • Lawrence, A., & Zucker, K. J. (2012). Gender identity disorders. In M. Hersen & D. C. Beidel (Eds.), Adult psychopathology and diagnosis (6th ed., pp. 601–635). Hoboken, NJ: Wiley.

    Google Scholar 

  • Lingiardi, V., Shedler, J., & Gazzillo, F. (2006). Assessing personality change in psychotherapy with the SWAP-200: A case study. Journal of Personality Assessment, 86, 36–45.

    Article  Google Scholar 

  • Liotti, G. (2004). Trauma, dissociation and disorganized attachment: Three strands of a single braid. Psychotherapy: Theory, Research, Practice, Training, 41, 472–486.

    Article  Google Scholar 

  • Lothstein, L. (1979). The aging gender dysphoria (transsexual) patient. Archives of Sexual Behavior, 8, 431–444.

    Article  PubMed  Google Scholar 

  • Lyons-Ruth, K., & Jacobvitz, D. (2008). Attachment disorganization: Genetic factors, parenting contexts, and developmental transformation from infancy to adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 666–697). New York, NY: Guilford Press.

    Google Scholar 

  • Madeddu, F., Prunas, A., & Hartmann, D. (2009). Prevalence of Axis II disorders in a sample of clients undertaking psychiatric evaluation for sex reassignment surgery. Psychiatric Quarterly, 80, 261–267.

    Article  PubMed  Google Scholar 

  • Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M. T. Greenberg, D. Cicchetti, & E. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). Chicago: University of Chicago Press.

    Google Scholar 

  • Main M., Goldwyn R., & Hesse, E. (2002). Adult attachment rating and classification systems. Version 7.1. Unpublished manuscript, Department of Psychology, University of California, Berkeley.

  • Murphy, D. J., Pope, C., Frost, J., & Liebling, R. E. (2003). Women’s views on the impact of operative delivery in the second stage of labour: Qualitative interview study. British Medical Journal, 327, 1132.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nieder, T. O., Herff, M., Cerwenka, S., Preuss, W. F., Cohen-Kettenis, P. T., De Cuypere, G., et al. (2011). Age of onset and sexual orientation in transsexual males and females. Journal of Sexual Medicine, 8, 783–791.

    Article  PubMed  Google Scholar 

  • Ovesey, L., & Person, E. S. (1999). Gender identity and psychosexual pathology in men: A psychodynamic analysis of homosexuality, transsexualism, and transvestism. In E. S. Person (Ed.), The sexual century (pp. 91–109). New Haven, CT: Yale University Press.

    Google Scholar 

  • Powers, A., & Westen, D. (2009). Personality subtypes in patients with panic disorder. Comprehensive Psychiatry, 50, 164–172.

    Article  PubMed  Google Scholar 

  • Robins, R. W., John, O. P., Caspi, A., Moffitt, T. E., & Stouthamer-Loeber, M. (1996). Resilient, overcontrolled, and undercontrolled boys: Three replicable personality types. Journal of Personality and Social Psychology, 70, 157–171.

    Article  PubMed  Google Scholar 

  • Russ, E., Bradley, R., Shedler, J., & Westen, D. (2008). Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes. American Journal of Psychiatry, 165, 1473–1481.

    Article  PubMed  Google Scholar 

  • Shedler, J., & Westen, D. (2007). The Shedler–Westen assessment procedure (SWAP): Making personality diagnosis clinically meaningful. Journal of Personality Assessment, 81, 41–55.

    Article  Google Scholar 

  • Shedler, J., Westen, D., & Lingiardi, V. (2014). La valutazione della personalità con la SWAP-200. Milano: Raffaello Cortina.

    Google Scholar 

  • Simon, L., Zsolt, U., Fogd, D., & Czobor, P. (2011). Dysfunctional core beliefs, perceived parenting behavior and psychopathology in gender identity disorder: A comparison of male-to-female, female-to-male transsexual and nontranssexual control subjects. Journal of Behavior Therapy and Experimental Psychiatry, 42, 38–45.

    Article  PubMed  Google Scholar 

  • Smith, Y. L., van Goozen, S. H., & Cohen-Kettenis, P. T. (2001). Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 472–481.

    Article  PubMed  Google Scholar 

  • Smith, Y. L., van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine, 35, 89–99.

    Article  PubMed  Google Scholar 

  • Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 582–590.

    Article  PubMed  Google Scholar 

  • Thompson-Brenner, H., Eddy, K. T., Franko, D. L., Dorer, D. J., Vashchenko, M., Kass, A. E., & Herzog, D. B. (2008a). A personality classification system for eating disorders: A longitudinal study. Comprehensive Psychiatry, 49, 551–560.

    Article  PubMed  Google Scholar 

  • Thompson-Brenner, H., Eddy, K. T., Satir, D. A., Boisseau, C. L., & Westen, D. (2008b). Personality subtypes in adolescents with eating disorders: Validation of a classification approach. Journal of Child Psychology and Psychiatry, 49, 170–180.

    Article  PubMed  Google Scholar 

  • Vitelli, R., & Riccardi, E. (2011). Gender identity disorder and attachment theory: The influence of the patient’s internal working models on psychotherapeutic engagement and objective. A study undertaken using the Adult Attachment Interview. International Journal of Transgenderism, 12, 241–253.

    Article  Google Scholar 

  • Westen, D., & Harnden-Fisher, J. (2001). Personality profiles in eating disorders: Rethinking the distinction between Axis I and Axis II. American Journal of Psychiatry, 158, 547–562.

    Article  PubMed  Google Scholar 

  • Westen, D., & Shedler, J. (1999a). Revising and assessing Axis II, Part I: Developing a clinically and empirically valid assessment method. American Journal of Psychiatry, 156, 258–272.

    PubMed  Google Scholar 

  • Westen, D., & Shedler, J. (1999b). Revising and assessing Axis II, Part II: Toward an empirically based and clinically useful classification of personality disorders. American Journal of Psychiatry, 156, 273–285.

    PubMed  Google Scholar 

  • Westen, D., & Shedler, J. (2000a). A prototype matching approach to personality disorders: Toward DSM-V. Journal of Personality Disorders, 14, 109–126.

    Article  PubMed  Google Scholar 

  • Westen, D., & Shedler, J. (2000b). Toward a diagnostic system for adolescent personality pathology, I: Reliability and validity of a Q-sort instrument. Unpublished manuscript, Boston University.

  • Westen, D., & Weinberger, J. (2004). When clinical description becomes statistical prediction. American Psychologist, 59, 595–613.

    Article  PubMed  Google Scholar 

  • Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York, NY: Guilford Press.

    Google Scholar 

  • Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D., & Choi, K. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex and Marital Therapy, 38, 151–189.

    Article  PubMed  Google Scholar 

  • Zucker, K. J., & Green, R. (1992). Psychosexual disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 33, 197.

    Article  Google Scholar 

  • Zucker, K. J., Wood, H., & VanderLaan, D. P. (2014). Models of psychopathology in children and adolescents with gender dysphoria. In B. C. Kreukels, T. D. Steensma, & A. C. de Vries (Eds.), Gender dysphoria and disorders of sex development: Progress in care and knowledge (pp. 171–192). New York, NY: Springer.

    Chapter  Google Scholar 

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Acknowledgements

The authors thank Luca Chianura and all the SAIFIP clinical staff for their collaboration for the research.

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  1. Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 86, 00185, Rome, Italy

    Vittorio Lingiardi, Guido Giovanardi, Alexandro Fortunato, Valentina Nassisi & Anna Maria Speranza

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  1. Vittorio Lingiardi
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  2. Guido Giovanardi
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Lingiardi, V., Giovanardi, G., Fortunato, A. et al. Personality and Attachment in Transsexual Adults. Arch Sex Behav 46, 1313–1323 (2017). https://doi.org/10.1007/s10508-017-0946-0

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