The Impact of Social and Family Constellations on the Development of Gender Nonconforming Children

Professor Dianna Kenny

The University of Sydney

Gender dysphoria is implicitly viewed as an intensely private matter, as a duel between an individual’s psyche and soma. This has given rise to the transactivist notion of “being born into the wrong body”. This simple, solipsistic conception is very far from reality.

Many factors are associated with gender dysphoria and it behoves those working in the field to understand its multifactorial aetiology, which includes (i) genetic factors as evinced, for example, by higher concordance of transgenderism among monozygotic compared with dizygotic twins (van Beijsterveldt, Hudziak, & Boomsma, 2006); (ii) neuroanatomical factors related to the sexual differentiation of the genitals and the brain (Swaab, 2007); (iii) developmental disorders, in particular autism spectrum disorder (Glidden, Bouman, Jones, & Arcelus, 2016; van der Miesen, Hurley, Bal, & de Vries, 2018); (iv) neuropsychiatric morbidity (Bao & Swaab, 2011); (v) endocrine factors (Bejerot, Humble, & Gardner, 2011); (vi) psychological factors, in particular, child maltreatment (Bandini et al., 2011); (vii) and sociocultural factors (Aydt & Corsaro, 2003; Basu, Zuo, Lou, Acharya, & Lundgren, 2017; Saketopoulou, 2011).

Although biological factors are important, we need to investigate the context in which gender dysphoria arises and the reasons for the exponential increase in cases observed over the past decade, an increase tantamount to a psychic epidemic. These include family constellation, parental gendered behaviours and attitudes, child maltreatment, and cultural factors. Gender dysphoria might be better understood as a relational process rather than an inherent property of the individual. Illuminating the interactional dynamics in which young children assert that they are transgender rather than unthinkingly affirming their cross-gender assertions is confronting for all concerned, including parents, doctors, therapists, and transactivists.

Fortunately, there are studies in the developmental psychology literature about factors that influence gender development in traditional families (McHale, Updegraff, Helms-Erikson, & Crouter, 2001; Pierrehumbert et al., 2009; Sumontha, Farr, & Patterson, 2017; Tenenbaum & Leaper, 2002) that can inform and guide research in families with a transgender child. There is an emergent literature on gender dysphoria that is exploring family dynamics, the interpersonal quality of parent-child (Zucker, Wood, Singh, & Bradley, 2012) and sibling relationships (Rust, Golombok, Hines, Johnston, & Golding, 2000), and parental gender attitudes and behaviours (Dawson, Pike, & Bird, 2016) in families with a transgender child (Riley, Sitharthan, Clemson, & Diamond, 2011) although the literature is still sparse in this respect.

One study of traditional families found that preadolescent children who are anxiously attached to their mothers or who had a preoccupied form of insecure attachment to their mothers experienced lower gender contentedness and fewer gender-typical feelings compared with securely attached children (Cooper et al., 2013). What effect would a parent who preferred a child of the opposite sex have on a child’s gender identity? Such a question could usefully be explored in families with a transgender child.

A study of sibling effects on gender development and identification found that boys and girls with same-sexed older siblings were more sex-typed than same-aged, same-sexed singleton children, who, in turn, were more sex-typed than children with opposite-sex siblings. Having an older brother was associated with more masculine behaviours in both younger male and female siblings (Rust et al., 2000). In a three-year longitudinal study of first-born sibling influences on second-born children, McHale et al (2001) reported that elder siblings influenced the gender role attitudes and behaviours in their younger siblings, but that parents exerted more influence over gender role in first-borns compared with second-born siblings. These findings raise interesting questions, for example, whether an abusive elder brother may figure disproportionately in the family constellations of later-born sisters who eventually transition from FtM.

Childhood maltreatment is frequently found in the medical histories of gender dysphoric individuals, with one study reporting that 25 percent of a sample of 109 adult MtF transgender persons disclosed child maltreatment (Bandini et al., 2011), with more serious maltreatment being associated with higher body dissatisfaction. How does an abusing parent affect the gender development of a child, and what other factors pertain to the development of cross gender identification, for example, abuse from a same-sex parent which we could hypothesize could direct the child to identify with the non- abusing, opposite-sex parent?

“Parents are critical mediators of the experiences of their gender variant children…”(Gray, Sweeney, Randazzo, & Levitt, 2016, p. 123), as indeed are siblings, peers, and the wider ecological context in which children grow and learn, including gender clinics, social media, and purported experts. The influence of all these factors on the gender dysphoric child are not well understood. Accordingly, great care needs to be exercised and thorough assessments conducted before making irreversible changes to their developing bodies.

References

Aydt, H., & Corsaro, W. A. (2003). Differences in children’s construction of gender across culture: An interpretive approach. American Behavioral Scientist, 46(10), 1306-1325.

Bandini, E., Fisher, A. D., Ricca, V., Ristori, J., Meriggiola, M. C., Jannini, E. A., . . . Maggi, M. (2011). Childhood maltreatment in subjects with male-to-female gender identity disorder. Int J Impot Res, 23(6), 276-285. doi: 10.1038/ijir.2011.39

Bao, A.-M., & Swaab, D. F. (2011). Sexual differentiation of the human brain: Relation to gender identity, sexual orientation and neuropsychiatric disorders. Frontiers in Neuroendocrinology, 32(2), 214-226. doi: https://doi.org/10.1016/j.yfrne.2011.02.007

Basu, S., Zuo, X., Lou, C., Acharya, R., & Lundgren, R. (2017). Learning to be gendered: Gender socialization in early adolescence among urban poor in Delhi, India, and Shanghai, China.Journal of Adolescent Health, 61(4, Supplement), S24-S29. doi: https://doi.org/10.1016/j.jadohealth.2017.03.012

Bejerot, S., Humble, M. B., & Gardner, A. (2011). Endocrine disruptors, the increase of autism spectrum disorder and its comorbidity with gender identity disorder–a hypothetical association. Int J Androl, 34(5 Pt 2), e350. doi: 10.1111/j.1365-2605.2011.01149.x

Cooper, P. J., Pauletti, R. E., Tobin, D. D., Menon, M., Menon, M., Spatta, B. C., . . . Perry, D. G. (2013). Mother-child attachment and gender identity in preadolescence. Sex Roles, 69(11- 12), 618-631.

Dawson, A., Pike, A., & Bird, L. (2016). Associations between parental gendered attitudes and behaviours and children’s gender development across middle childhood. European Journal of Developmental Psychology, 13(4), 452-471.

Glidden, D., Bouman, W. P., Jones, B. A., & Arcelus, J. (2016). Gender dysphoria and autism spectrum disorder: A systematic review of the literature. Sexual Medicine Reviews, 4(1), 3-14.

Gray, S. A. O., Sweeney, K. K., Randazzo, R., & Levitt, H. M. (2016). “Am I Doing the Right Thing?”: Pathways to Parenting a Gender Variant Child. Fam Process, 55(1), 123-138. doi: 10.1111/famp.12128

McHale, S. M., Updegraff, K. A., Helms-Erikson, H., & Crouter, A. C. (2001). Sibling influences on gender development in middle childhood and early adolescence: A longitudinal study.Developmental Psychology, 37(1), 115-125.

Pierrehumbert, B., Santelices, M. P., Ibanez, M., Alberdi, M., Ongari, B., Roskam, I., . . . Borghini, A. (2009). Gender and attachment representations in the preschool years: Comparisons between five countries. Journal of Cross-Cultural Psychology, 40(4), 543-566.

Riley, E. A., Sitharthan, G., Clemson, L., & Diamond, M. (2011). The needs of gender-variant children and their parents: A parent survey. International Journal of Sexual Health, 23, 181-195.

Rust, J., Golombok, S., Hines, M., Johnston, K., & Golding, J. (2000). The role of brothers and sisters in the gender development of preschool children. Journal of Experimental Child Psychology, 77(4), 292-303.

Saketopoulou, A. (2011). Minding the gap: Intersections between gender, race, and class in work with gender variant children. Psychoanalytic Dialogues, 21(2), 192-209.

Sumontha, J., Farr, R. H., & Patterson, C. J. (2017). Children’s gender development: Associations with parental sexual orientation, division of labor, and gender ideology. Psychology of Sexual Orientation and Gender Diversity, 4(4), 438-450.

Swaab, D. F. (2007). Sexual differentiation of the brain and behavior. Best Pract Res Clin Endocrinol Metab, 21(3), 431-444. doi: 10.1016/j.beem.2007.04.003

Tenenbaum, H. R., & Leaper, C. (2002). Are parents’ gender schemas related to their children’s gender-related cognitions? A meta-analysis. Developmental Psychology, 38(4), 615-630.

van Beijsterveldt, C., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35(6), 647-658.

van der Miesen, A. I. R., Hurley, H., Bal, A. M., & de Vries, A. L. C. (2018). Prevalence of the wish to be of the opposite gender in adolescents and adults with autism spectrum disorder. Archives of Sexual Behavior. doi: 10.1007/s10508-018-1218-3

Zucker, K. J., Wood, H., Singh, D., & Bradley, S. J. (2012). A developmental, biopsychosocial model for the treatment of children with gender identity disorder. Journal of homosexuality, 59(3), 369-397.

Roberto D'Angelo

Roberto D'Angelo is a psychiatrist and psychoanalyst in private practice in Sydney, Australia.

This Post Has 5 Comments

  1. Thanks for this post. You raise some very important questions. Understanding how we arrive at a sense of our own identity both in health and pathological conditions is crucial. IMO identity emerges out of a combination of biological, social and psychological factors ( including unconscious ones) and is not given at birth. So as you say permanently altering the developing body in response to a conflict between psyche and soma is problematic in the extreme.

  2. With respect, I think equally problematic however is a disproportionately high focus on “reasons not to” and a disproportionately low or in some cases zero focus on abnormally high suicide and depression rates of transgender youth. I think the social and other numerous ills caused by unaddressed gender dysphoria well outweigh any social ills caused by an early alteration of a body.
    And, academic meanderings aside, at the end of the day, these kids need to be kept alive, surely.

  3. I have not seen any convincing evidence to date that transitioning actually reduces the suicide rate in trans populations. The actual suicide rate amongst trans persons in western countries is in fact unknown. There are some studies which suggest that trans individuals experienced less suicidal ideation after medical and surgical transition, however, there is no evidence, at this point in time, that this actually translates into a reduction in the number of deaths by suicide. In fact, one of the most robust follow-up studies in Sweden (Dhejne et al 2011) found that the rate of death by suicide remains very high post medical and surgical transition. The reasons for this are unclear, however, this does raise questions about the degree to which transition will prevent deaths by suicide.

    All of this aside, many of us have seen the apparent dramatic improvements in mood and psychological well-being post-transition, as reported in the literature. Our experience is that this is sometimes a “honeymoon period” which fades over time. In fact, Dhejne et. al. (2011) found that the mortality rate (including death by suicide) of post-op trans persons only began to diverge from the general population at 10 years or more post-transition. My experience is that difficulties can resurface many years later and often these are the original difficulties that the person hoped transitioning would address. These include interpersonal issues, problems with intimacy, unresolved trauma and abuse, and ongoing self-hatred. At this point, there can sometimes be profound grief at the realization that transitioning did not address these issues in any way and there are often significant losses associated with the surgery, the fracturing of family and social relationships and sometimes, but not always, regret about the irreversible changes that have been made. It is for these reasons that I would urge caution, careful consideration, and extensive psychological exploration involving the young person and their family, before proceeding to medical and surgical transition.

    I would also add that suicidality is something that psychology and psychotherapy work with and manage in the context of many different problems and patient groups. Gender-affirming medical treatment is often presented as the only way to prevent suicide amongst trans youth when there is, in fact, a range of ways that suicidality can be worked with and managed through psychological interventions.

  4. Thanks for this post. Re: abuse – I have also witnessed a number of female clients who appear to have transitioned following experiencing or witnessing abuse from their opposite sex parents. I think some of the adolescent girls we are seeing in clinics at the moment are identifying with their abusers. I have come to wonder whether this (over?) identification might be happening within society more broadly – if we are to agree that society is patriarchal and particularly oppressive of women, then one ‘solution’ for the oppression (subconscious of course) might be to (try to) identify out of it?

  5. Ann,
    Academic meanderings, as you so disparagingly refer to my piece, often provide the basis for hypothesis development and testing, surely a better and more productive path than mindless acceptance of ill-conceived mantras perpetrated by those who wish to align with political correctness rather than open scientific enquiry..
    Please re-read your comparative statement about social ills and alterations to young bodies, and reflect on the ethics of such a position in the absence of evidence.

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