👤 Dissociation, and Gender Dysphoria 🌀
The Role of Proper Assessment in Care.
It’s like a subtle shift, that’s barely noticeable yet profoundly significant. Suddenly, the vignette that acted like blinders, softening my view of the world, fades away. The world snaps into focus. Sounds that once felt distant, muffled, and indistinguishable become crisp and clear. I can understand words again. I hear the hum of the air conditioner, the rustling of leaves outside, even the faint creak of the floor beneath my feet. My body feels cooler, like I’ve been released from an internal heat—perhaps the confusion I experienced in that state. Only then do I wonder how much time has actually passed…This is what it feels like when I return—from the place my mind goes when Im in “distress.”
As a child, my mind would retreat to shield me from the chaos, the rage, the violence. It protected me from being screamed at, hit, shoved, slapped, and punched. From being called a dirty faggot, a queer, and told I wasn’t good enough. From being told I would get AIDS and deserved it. It protected me from being raped and sold like an object.
In those moments, my mind learned to take me away, to retreat somewhere safer. Dissociation became my shield. My mind would float away to a place where the pain, the words, the chaos couldn’t reach me.
It was a survival mechanism I learned at a very small age. I score high on the ACE (Adverse Childhood Experiences) test, which measures abuse, neglect, and dysfunction in childhood. These experiences are strongly linked to the development of dissociative symptoms later in life.
The Burden of Dissociation 😞🌀
Dissociation wasn’t a choice for me—it was my brain’s way of protecting itself from what it perceived as unbearable. It was my way of detaching from the chaos around me, to survive.
But I never had a name for it. I didn’t realize I had been dissociating for so much of my life. It was just... how I was. I thought feeling disconnected, detached, or even numb at times was normal. At times I struggled to feel connected to my own body—sometimes slightly out of sync, like I was watching myself from the outside.
And with others? I see now how my past relationships didn’t benefit from the layer of misunderstandings, distrust, and emotional distance it sometimes caused. How could I let people in when I wasn’t even fully present for myself?
Dissociative Experiences: Depersonalization and Derealization 🧠🌫️👤
People with depersonalization-derealization disorder (DPDR) often struggle to describe their experiences.
In depersonalization, the sense of self feels distorted or distant—as if one is detached from their own thoughts, body, or emotions. It’s like observing oneself from the outside. In derealization, the external world feels strange, dreamlike, or unreal, as though one is viewing it through a veil. Both experiences create an unsettling sense of detachment, even while the individual remains aware that their perceptions are altered.
These phenomena highlight how dissociation acts as a defense mechanism, allowing individuals to psychologically distance themselves from overwhelming stress or trauma, but at the cost of a profound disconnection from their own sense of reality.
The Connection Between Dissociation and Gender Dysphoria 🧠🌈❓
Many individuals experiencing depersonalization-like symptoms prior to transitioning may interpret their disconnect from their body as gender dysphoria. Over time, the feelings of depersonalization can mimic gender dysphoria, especially in a cultural context where transgender identity narratives are prominent.
The narrative can become intertwined with the distress of feeling out of sync with one's own body. For some, the distress of feeling disconnected from their body can lead them to seek validation and acceptance through a transgender identity, even if the root cause is dissociative.
A small study conducted by David P. Walling PhD, Jean M. Goodwin MD, MPH & Collier M. Cole PhD examining the Dissociative Experiences Scale (DES) in a population of transsexual individuals suggests that dissociative symptoms may play a significant role in the experience of gender dysphoria.
The study found that approximately 10% of subjects had DES scores above 30, indicating a subpopulation of gender-dysphoric individuals who may have underlying dissociative disorders. Yet, dissociation is often overlooked in gender-affirming care protocols, with clinicians focusing solely on gender identity issues rather than exploring underlying psychological factors.
The study's findings are concerning, especially when considering the possible connection between dissociative experiences and gender dysphoria. Depersonalization—feeling disconnected from one's own body—may lead someone to misinterpret this experience as a gender mismatch. In today's society, where the transgender narrative is so pervasive, this disconnect can easily be entangled with the idea of gender dysphoria.
The Dangers of Hasty Gender-Affirming Treatment ⚠️🏥⏳
One of the most pressing issues in current gender-affirming care is the lack of comprehensive screening for underlying psychological conditions, such as dissociation, before moving toward transition. For individuals presenting with gender incongruence, dissociative symptoms may often go unnoticed or unaddressed. This is problematic because dissociation—whether in the form of depersonalization or derealization—can deeply affect a person’s understanding of their body and identity, leading to a misinterpretation of their distress as gender dysphoria.
To address this issue, I feel its critical that clinicians incorporate simple screening tools like the DES into their evaluation process. Rather than quickly moving toward gender-affirming treatments, clinicians should prioritize a holistic understanding of a patient’s psychological state, including the possibility of dissociative experiences.
Incorporating dissociative experience screenings into the early stages of gender dysphoria evaluation would ensure a more comprehensive, thoughtful approach to care. Clinicians should take the time to discuss these symptoms with their patients, helping them understand whether their experiences of gender incongruence stem from dissociative symptoms rather than gender identity conflict before making any decisions about transitioning.
Ultimately, the goal should be to help people live authentically—free from confusion and without rushing into treatment that might not address the full spectrum of their experiences.
Friends have died from cancer because their doctors misdiagnosed.