Skip to main content

Advertisement

Log in

Psychological characteristics of Italian gender dysphoric adolescents: a case–control study

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

Gender dysphoria (GD) is associated with clinically significant distress and impairment in social, scholastic, and other important areas of functioning, especially when early onset is reported. The aim of the present study is to assess the psychopathological features associated with GD in adolescence, comparing a group of gender dysphoric adolescents (GDs) with a group of non-referred adolescents (NRs), in terms of body uneasiness, suicide risk, psychological functioning, and intensity of GD.

Methods

A sample of 46 adolescents with GD and 46 age-matched NRs was evaluated (mean ± SD age = 16.00 ± 1.49 and 16.59 ± 1.11 respectively, p > 0.05). Subjects were asked to complete the Body Uneasiness Test (BUT) to explore body uneasiness, the Youth Self Report (YSR) to measure psychological functioning, the Multi-Attitude Suicide Tendency Scale (MAST) for suicide risk, and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) for GD assessment.

Results

Adolescents with GD reported significantly higher levels of body uneasiness (BUT-GSI, F = 380.13, p < 0.0001), as well as a worse psychological functioning (YSR, F = 13.06 and p < 0.0001 for “total problem scale” and F = 12.53, p = 0.001 for “internalizing” scale) as compared to NRs. When YSR subscales were considered, GDs showed significantly higher scores in the “withdrawal/depression”, “anxiety/depression”, and “social problems” (all p < 0.0001). In addition, GDs showed significantly higher levels in the “attraction to death” and “repulsion by life” scales and lower scores in the “attraction to life” scale (all p < 0.0001). Finally, GIDYQ-AA score was significantly lower (meaning a higher level of gender dysphoria symptoms) in GDs vs. NRs (p < 0.0001).

Conclusions

GD adolescents reported significantly higher body dissatisfaction and suicidal risk compared to NRs. In addition, results confirmed a significant impairment in social psychological functioning in adolescents with GD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). DSM-5 tm, Washington DC

    Book  Google Scholar 

  2. De Vries AL, Steensma TD, Cohen-Kettenis PT, VanderLaan DP, Zucker KJ (2015) Poor peer relations predict parent-and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis. Eur Child Adolesc Psychiatry 25(6):579–588

  3. Fisher AD, Ristori J, Bandini E, Giordano S, Mosconi M, Jannini E, Greggio N, Godano A, Manieri C, Meriggiola C (2014) Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG. J Endocrinol Investig 37:675–687

    Article  CAS  Google Scholar 

  4. Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N (2015) Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child Adolesc Psychiatry Ment Health 9:1

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Marshall E, Claes L, Bouman WP, Witcomb GL, Arcelus J (2016) Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. Int Rev Psychiatry 28:58–69

    Article  PubMed  Google Scholar 

  7. Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, Diamond DA, Vance SR (2012) Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 129(3):418–425

  8. Grossman AH, D’Augelli AR (2007) Transgender youth and life-threatening behaviors. Suicide Life Threat Behav 37:527–537

    Article  PubMed  Google Scholar 

  9. Reisner SL, Conron KJ, Tardiff LA, Jarvi S, Gordon AR, Austin SB (2014) Monitoring the health of transgender and other gender minority populations: validity of natal sex and gender identity survey items in a US national cohort of young adults. BMC Public Health 14:1

    Article  Google Scholar 

  10. Arcelus J, Claes L, Witcomb GL, Marshall E, Bouman WP (2016) Risk factors for non-suicidal self-injury among trans youth. J Sex Med 13:402–412

    Article  PubMed  Google Scholar 

  11. Shiffman M, VanderLaan DP, Wood H, Hughes SK, Owen-Anderson A, Lumley MM, Lollis SP, Zucker KJ (2016) Behavioral and emotional problems as a function of peer relationships in adolescents with gender dysphoria: a comparison with clinical and nonclinical controls. Psychology of Sexual Orientation and Gender Diversity © 2015. American Psychological Association, Washington, DC, pp 27–36

    Google Scholar 

  12. Steensma TD, Zucker KJ, Kreukels BP, VanderLaan DP, Wood H, Fuentes A, Cohen-Kettenis PT (2014) Behavioral and emotional problems on the Teacher’s Report Form: a cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm Child Psychol 42:635–647

    Article  PubMed  Google Scholar 

  13. Ciocca G, Niolu C, Déttore D, Antonelli P, Conte S, Tuziak B, Limoncin E, Mollaioli D, Carosa E, Gravina G (2016) Cross-cultural and socio-demographic correlates of homophobic attitude among university students in three European countries. J Endocrinol Investig 1–7

  14. Bandini E, Maggi M (2014) Transphobia. In: Corona G, Jannini E, Maggi M (eds) Emotional, physical and sexual abuse. Springer, New York, pp 49–59

  15. Lingiardi V, Nardelli N (2014) Negative attitudes to lesbians and gay men: persecutors and victims. Springer, Corona

    Google Scholar 

  16. van de Grift TC, Cohen-Kettenis PT, Steensma TD, De Cuypere G, Richter-Appelt H, Haraldsen IR, Dikmans RE, Cerwenka SC, Kreukels BP (2016) Body satisfaction and physical appearance in gender dysphoria. Arch Sex Behav 45:575–585

    Article  PubMed  Google Scholar 

  17. van de Grift T, Cohen-Kettenis P, Elaut E, De Cuypere G, Richter-Appelt H, Haraldsen I, Kreukels B (2016) A network analysis of body satisfaction of people with gender dysphoria. Body Image 17:184–190

    Article  PubMed  Google Scholar 

  18. Jones BA, Haycraft E, Murjan S, Arcelus J (2016) Body dissatisfaction and disordered eating in trans people: a systematic review of the literature. Int Rev Psychiatry 28:81–94

    Article  PubMed  Google Scholar 

  19. Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, Ferruccio N, Meriggiola MC, Manieri C, Gualerzi A (2014) Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med 11:709–719

    Article  CAS  PubMed  Google Scholar 

  20. Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, Fanni E, Amato A, Bettini E, Mosconi M, Dèttore D, Ricca V, Maggi M (2016) Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-years follow-up data. J Clin Endocrinol Metab 101:4260–4269

    Article  CAS  PubMed  Google Scholar 

  21. Becker I, Nieder TO, Cerwenka S, Briken P, Kreukels BP, Cohen-Kettenis PT, Cuypere G, Haraldsen IRH, Richter-Appelt H (2016) Body image in young gender dysphoric adults: a European multi-center study. Arch Sex Behav 45:559–574

    Article  PubMed  Google Scholar 

  22. Bandini E, Fisher AD, Castellini G, Lo Sauro C, Lelli L, Meriggiola MC, Casale H, Benni L, Ferruccio N, Faravelli C (2013) Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness. J Sex Med 10:1012–1023

    Article  PubMed  Google Scholar 

  23. Ålgars M, Santtila P, Sandnabba NK (2010) Conflicted gender identity, body dissatisfaction, and disordered eating in adult men and women. Sex Roles 63:118–125

    Article  Google Scholar 

  24. Ciocca G, Limoncin E, Cellerino A, Fisher AD, Gravina GL, Carosa E, Mollaioli D, Valenzano DR, Mennucci A, Bandini E (2014) Gender identity rather than sexual orientation impacts on facial preferences. J Sex Med 11:2500–2507

    Article  PubMed  Google Scholar 

  25. Cuzzolaro M, Vetrone G, Marano G, Battacchi M (1999) BUT, Body Uneasiness Test: a new attitudinal body image scale. Psichiatria dell’infanzia e dell’adolescenza 66:417–428

    Google Scholar 

  26. Cuzzolaro M, Vetrone G, Marano G, Garfinkel P (2006) The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale. Eat Weight Disord 11:1–13

    Article  CAS  PubMed  Google Scholar 

  27. Marano G, Cuzzolaro M, Vetrone G, Garfinkel P, Temperilli F, Spera G, Dalle Grave R, Calugi S, Marchesini G, Group QS (2007) Validating the Body Uneasiness Test (BUT) in obese patients. eating and weight disorders-studies on anorexia. Bulim Obes 12:70–82

    CAS  Google Scholar 

  28. Orbach I, Milstein I, Har-Even D, Apter A, Tiano S, Elizur A (1991) A Multi-Attitude Suicide Tendency Scale for adolescents. J Consult Clin Psychol 3:398

    Google Scholar 

  29. Osman A, Barrios FX, Panak WF, Osman JR, Hoffman J, Hammer R (1994) Validation of the multi-attitude suicide tendency scale in adolescent samples. J Clin Psychol 50:847–855

    Article  CAS  PubMed  Google Scholar 

  30. Baiocco R, Ioverno S, Cerutti R, Santamaria F, Fontanesi L, Lingiardi V, Baumgartner E, Laghi F (2014) Suicidal ideation in Spanish and Italian lesbian and gay young adults: the role of internalized sexual stigma. Psicothema 26:490–496

    PubMed  Google Scholar 

  31. Baiocco R, Ioverno S, Lonigro A, Baumgartner E, Laghi F (2015) Suicidal ideation among Italian and Spanish young adults: the role of sexual orientation. Arch Suicide Res 19:75–88

    Article  PubMed  Google Scholar 

  32. Achenbach TM (1991) Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles: Department of Psychiatry, University of Vermont

  33. Frigerio A, Cattaneo C, Cataldo M, Schiatti A, Molteni M, Battaglia M (2004) Behavioral and emotional problems among Italian children and adolescents aged 4 to 18 years as reported by parents and teachers. Eur J Psychol Assess 20:124–133

    Article  Google Scholar 

  34. Deogracias JJ, Johnson LL, Meyer-Bahlburg HF, Kessler SJ, Schober JM, Zucker KJ (2007) The gender identity/gender dysphoria questionnaire for adolescents and adults. J Sex Res 44:370–379

    Article  PubMed  Google Scholar 

  35. Prunas A, Mognetti M, Hartmann D, Bini M (2013) La valutazione della disforia di genere: la versione italiana del gender identity/gender dysphoria questionnaire. Rivista di Sessuologia Clinica.

  36. Dèttore D, Ristori J, Antonelli P, Bandini E, Fisher A, Villani S, de Vries A, Steensma T, Cohen-Kettenis P (2015) Gender dysphoria in adolescents: the need for a shared assessment protocol and proposal of the AGIR protocol. J Psychopathol 21:152–158

    Google Scholar 

  37. De Vries AL, Doreleijers TA, Steensma TD, Cohen-Kettenis PT (2011) Psychiatric comorbidity in gender dysphoric adolescents. J Child Psychol Psychiatry 52:1195–1202

    Article  PubMed  Google Scholar 

  38. De Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT (2011) Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8:2276–2283

    Article  PubMed  Google Scholar 

  39. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ (2008) The treatment of adolescent transsexuals: changing insights. J Sex Med 5:1892–1897

    Article  PubMed  Google Scholar 

  40. Kuiper B, Cohen-Kettenis P (1988) Sex reassignment surgery: a study of 141 Dutch transsexuals. Arch Sex Behav 17:439–457

    Article  CAS  PubMed  Google Scholar 

  41. Vocks S, Stahn C, Loenser K, Legenbauer T (2009) Eating and body image disturbances in male-to-female and female-to-male transsexuals. Arch Sex Behav 38:364–377

    Article  PubMed  Google Scholar 

  42. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ III, Spack NP, Tangpricha V, Montori VM (2009) Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94:3132–3154

    Article  CAS  PubMed  Google Scholar 

  43. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfäfflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K (2011) Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend 13:165–232

    Article  Google Scholar 

  44. Steensma TD, Kreukels BP, de Vries AL, Cohen-Kettenis PT (2013) Gender identity development in adolescence. Horm Behav 64:288–297

    Article  PubMed  Google Scholar 

  45. Aitken M, VanderLaan DP, Wasserman L, Stojanovski S, Zucker KJ (2016) Self-harm and suicidality in children referred for gender dysphoria. J Am Acad Child Adolesc Psychiatry 55:513–520

    Article  PubMed  Google Scholar 

  46. Asscheman H, Giltay EJ, Megens JA, van Trotsenburg MA, Gooren LJ (2011) A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 164:635–642

    Article  CAS  PubMed  Google Scholar 

  47. Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M (2011) Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One 6:e16885

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Khatchadourian K, Amed S, Metzger DL (2014) Clinical management of youth with gender dysphoria in Vancouver. J Pediatr 164:906–911

    Article  CAS  PubMed  Google Scholar 

  49. Skagerberg E, Parkinson R, Carmichael P (2013) Self-harming thoughts and behaviors in a group of children and adolescents with gender dysphoria. Int J Transgend 14:86–92

    Article  Google Scholar 

  50. Aitken M, Steensma TD, Blanchard R, VanderLaan DP, Wood H, Fuentes A, Spegg C, Wasserman L, Ames M, Fitzsimmons CL (2015) Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med 12:756–763

    Article  PubMed  Google Scholar 

  51. Fisher AD, Bandini E, Casale H, Ferruccio N, Meriggiola MC, Gualerzi A, Manieri C, Jannini E, Mannucci E, Monami M (2013) Sociodemographic and clinical features of gender identity disorder: an Italian multicentric evaluation. J Sex Med 10:408–419

    Article  PubMed  Google Scholar 

  52. Zucker KJ, Wood H, Singh D, Bradley SJ (2012) A developmental, biopsychosocial model for the treatment of children with gender identity disorder. J Homosex 59:369–397

    Article  PubMed  Google Scholar 

  53. Olson J, Forbes C, Belzer M (2011) Management of the transgender adolescent. Arch Pediatr Adolesc Med 165:171–176

    Article  PubMed  Google Scholar 

  54. Robles R, Fresán A, Vega-Ramírez H, Cruz-Islas J, Rodríguez-Pérez V, Domínguez-Martínez T, Reed GM (2016) Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. Lancet Psychiatry 3:850–859

    Article  PubMed  Google Scholar 

  55. Fisher AD, Castellini G, Ristori J, Casale H, Giovanardi G, Carone N, Fanni E, Mosconi M, Ciocca G, Jannini E, Ricca V, Lingiardi V, Maggi M (2016) Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers. J Endocrinol Investig 1–11.

  56. Ciocca G, Tuziak B, Limoncin E, Mollaioli D, Capuano N, Martini A, Carosa E, Fisher AD, Maggi M, Niolu C (2015) Psychoticism, immature defense mechanisms and a fearful attachment style are associated with a higher homophobic attitude. J Sex Med 12:1953–1960

    Article  PubMed  Google Scholar 

  57. Baams L, Beek T, Hille H, Zevenbergen FC, Bos HM (2013) Gender nonconformity, perceived stigmatization, and psychological well-being in Dutch sexual minority youth and young adults: a mediation analysis. Arch Sex Behav 42:765–773

    Article  PubMed  Google Scholar 

  58. Wallien MS, Veenstra R, Kreukels BP, Cohen-Kettenis PT (2010) Peer group status of gender dysphoric children: a sociometric study. Arch Sex Behav 39:553–560

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Maggi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the institution’s Ethics Committee.

Informed consent

All patients have provided their written informed consent to participate to the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fisher, A.D., Ristori, J., Castellini, G. et al. Psychological characteristics of Italian gender dysphoric adolescents: a case–control study. J Endocrinol Invest 40, 953–965 (2017). https://doi.org/10.1007/s40618-017-0647-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-017-0647-5

Keywords

Navigation