Autistic Traits and Gender Incongruence: Clinical perspectives from specialized psychiatric centres in Italy
S. Leo, E. Zuliani, C. Gesi, A. C. Omboni, G. Gallo, F. Riva, L. Pasquarelli, B. M. Dell’OssoIntroduction
Scientific evidence is increasingly supporting the existence of a link between gender dysphoria (GD), or gender incongruence (GI), and autism spectrum disorder (ASD). It has been shown that transgender individuals, on average, present higher rates of ASD and ASD traits compared to cisgender individuals, which may complicate the diagnostic process for GD/GI and reduce access to care. Thus, this population may require a tailored clinical approach. However, the impact of ASD and ASD traits on GD/GI manifestations remains poorly understood.
Objectives
The study aims to assess the co-occurrence of ASD and GD/GI symptoms and to explore their mutual relationship among transgender individuals and other cisgender groups.
Methods
Adults (age 18-59) with a diagnosis of GI/GD and/or ASD were enrolled. A group of healthy subjects were also recruited through social media. All participants filled a set of self-rating scales, including Utrecht Gender Dysphoria Scale (UGDS-DS), Body Uneasiness Test (BUT), Camouflaging Autistic Traits Questionnaire (CAT-Q), Autism Spectrum Quotient (AQ) and Empathy Quotient (EQ). Clinical and socio-demographical data were also obtained through clinicians’ interviews. The overall sample was divided in four groups: 1) cisgender autistic individuals (ASD group, n=31), 2) transgender individuals without ASD traits (AQ<29 and EQ>30) (GD group, n=35), 3) transgender individuals presenting ASD traits (AQ>29 and EQ <31) or ASD diagnosis (GD+ASD group, n=22), 4) healthy subjects (CTL group, n=71).
Results
Nearly half of transgender individuals (38.6%) presented ASD traits or diagnosis. They were older at GD/GI diagnosis, underwent less gender affirming procedures, had higher masking behaviours and suffered more from depressive symptoms compared to GD group. Group comparison by means of ANOVA are provided in table 1. Across the overall sample, AQ (B=5.44, p=0.015) and Global Severity Index of BUT scale (B=3.11, p<0.001) were predictive of higher UGDS-DS scores.
Main effect of groups on psychometric scales scores. Table 1. Long description.