Childhood Trauma Survivor Misdiagnosed as Transsexual with Gender Dysphoria

[Beth Andrea]

I will note that "our" transition was relatively slow, mainly because I did not want to permanently change the body to fit my self-image; long hair, earrings, and nail polish are not permanent modifications.

Once we began to consider hormones, it was several months with my the*a list and Others to make sure everyone was on board with the effects of hurt (both emotional and physical)

Oh, you should have heard the chaos when we were prescribed testosterone for depression! And the howling when we actually tried it! Obviously no one wanted THAT...but when we tried phyto-E, that made everyone (even the males) very...pleased. After that (and once we were actually on HRT) there's been no disagreement or reluctance to transition. Just the thought brings fits of giggles within.

So yeah, for our System, transitioning is A Good Thing (tm).

[MelissaAnn]

Virginia
I am so sorry for you honey. I to know all too well of the physical, mental and sexual abuse as a child. It is an unconscionable thing that these people perpetrate on us. I cannot imagine how hard this is been on you. Although going through this trauma as a child I did not develop a split personality. Nobody knows the hell that we have been through everybody's experiences are different and we cope in different ways. Just by reading this thread has helped me tremendously because I know I'm not alone. The recovery from trauma like this is very long and hard. It's very hard to comprehend why individuals would do this to a child. For longest time I questioned what I did to cause this to happen to me. After years and years of therapy. I did learn that it wasn't me that did anything wrong. It was them, and it's just so hard to imagine than an actual family members would do this to me.

It's simply amazing the way the mind works at protecting ourselves. Although I don't have a split personality,  I was able to block most of the trauma out for a long time. And after a while it just kept coming back, like just when I was getting comfortable. There was this knock at the door and I'd open it and all the trauma would come rushing back at me. There has been attempts at self-mutilation and suicide. Addiction to pain medication was one way that I tried to ease the pain.

Through my cognitive therapist and then my gender therapist, I have come to learn serenity. It's really amazing how the different parts of your system have come together to help you heal and live more happily. I wish you nothing but happiness and joy that you deserve and please give your wife a huge hug for me. She is an amazing person. I'm very impressed with her still standing by your side. After everything you've been through me. The Angels always look upon you and help guide you on your path. Be well and be safe.

Hugs,

Melissa Ann

[Bunter]

@ Virginia, I believe that is some cases there might be an etiology like the one you describe, but I have a problem with the sweeping generalizations that you draw from that.

The diagnosis DID is highly controversial http://en.wikipedia.org/wiki/Dissociative_identity_disorder It also seems to be used as an umbrella term that covers different types of dissociative disorders, from forgetfulness, daydreaming up to multiple personality disorder. While milder dissociation is very common, developing alters, or a full fledged multiple system is very rare. The numbers range from 0,01% in the 1980s, up to 1-3% now. It is mainly a US diagnosis that is rarely found in the EU where the prevalence seems to be more 0,01%.

Having multiple alters can still co-exist with being trans. A while ago I talked to a trans man who was diagnosed with actual Multiple Personality Disorder, and who after a longer therapy transitioned. He seems to be very stable now, with less alters than before. His therapist didn't see the disorder as a reason not to transition as long as the whole thing was undertaken very slowly and with a lot of therapy.

"The child's attempt to understand and rationalize what happened to them can lead to gender confusion."
I agree that trauma can cause confusion of all kinds. But I don't share the assumption that the causal route is: straight child gets abused and turns either gay or trans.

For example, there are many cases when a gendervariant or gay child or teen (i.e. someone who had already some self-awareness of being gay or gendervariant) was raped, and after that got highly conflicted about their sexual identity, trying to get rid of the gayness. They often feel guilty, like they have brought about the rape by being gay. Some are trying to become straight by reparative therapy and so on (see for example Peterson Toscanos Blog). Only later they understand that the rape was not cause by them being gay.
Similarly, a young trans child who gets raped might develop a massive problem with their identity and try to become cis.

Why am I writing all this? I want to offer some alternative interpretations to counter the very narrow and moralistic narratives that exist in the US when it comes to LGBT and trauma. When therapists have only that one narrative in their minds to interpret the experiences of LGBT survivors, it can cause massive additional harm. What they do in fact is use the very real trauma that LGBT youth experienced, to cater to their normative narrative "straight cis child gets abused and turns either gay or trans." (and not the other way around).

I know you don't mean it that way, and differentiate between "real" transsexuality and "mistaken" transsexuality. It's just that you can't be sure if it's one or the other only by looking at trauma.

[Virginia]

MelissaAnn, I am touched beyond words by your encouragement and sympathy.

[Virginia]

@ Bunter
I have not received a reply to the PM I sent to you a week ago (11-7) about your most recent post. I wanted to give you ample time to respond off line, but need to take a minute to clarify a few things you mentioned so I can move on with this.

"there might be an etiology like the one (I) describe."
There is; I am example of it. By the statistics you quote (1-3%), DID is about as "rare" as the percentage of the population that is transgender (2-5%). The SOC requirement for therapy prior to recommending any sort of transition exists because of the high likelihood a person's need to express themself as there GNAAB is the result of a psychological condition rather than them being transgender.

I found the reference to an encyclopedia citation on DID to be deprecating. Stating that "full fledged multiple system is very rare" and referring to someone who was diagnosed with "actual Multiple Personality Disorder" to be extremely demeaning. Dissociative identity disorder is NOT an "umbrella term" that includes daydreaming. It is a serious psychological disorder resulting from severe childhood trauma. It is primarily a US diagnosis because the country uses the DSM-V for psychiatric diagnosis and that is the terminology used to describe the symptomology. The rest of the world uses the ICD-10, which describes a nearly identical symptomology as "Multiple Personality Disorder" (MPD). Much of the controversy over DID centers on false memories and Freud's theories that the mind can only have one personality but many identities.

The human mind's reaction to trauma is extremely predictable, so much so that terrorists and prison guards employ these same psychological techniques to break down those in their control. The correlation between childhood trauma and DID is so strong, it is standard practice to assume a patient with DID has been traumatized until it can be proven they were not. There was no mention in this thread of trauma in and of itself being the "causal route" of a person's gender or sexuality.

Gender and sex are two very different things and the affects childhood trauma can have on each of them are entirely different. You cannot draw conclusions about the influence rape may have on one from the other.

A person with DID having male and female alters has no more to do with their being transgender than trauma does with a person's sexuality or gender. Beth Andrea shared quite openly her experience that multiple alters can co-exist with being transsexual. Transition is not an option for systems of cisgender male and female alters like mine. The solitary Self cannot win when one part of self gains at another's expense.

Both of our experiences clearly show the devastating consequences a therapist who only has one narrative can have on their patient. The internet is flooded with information about "alternative interpretations to counter the very narrow and moralistic narratives that exist in the US when it comes to LGBT and trauma." I posted my thread because of the lack of information about other reasons a person may need to express themselves as their GNAAB. Posting your views in a thread about the misdiagnosis of my DID as transgenderism was cruel, inappropriate and invalidating to my sense of self.

[PurpleWolf]

Very interesting thread!!!

[PurpleWolf]

For those who are interested in this topic, this was an interesting read also!

https://di.org.au/transgender-multiplicity/

[PurpleWolf]

THIS!!!

https://genderanalysis.net/2017/06/depersonalization-in-gender-dysphoria-widespread-and-widely-unrecognized/

By Zinnia Jones!

I'm going to list some descriptions of certain feelings, and I'd like for any trans or gender-questioning readers to think about whether they've felt anything similar to this over the course of their lives.

- A sense of detachment or estrangement from your own thoughts, feelings, or body: "I know I have feelings but I don't feel them"
- Feeling split into two parts, with one going through the motions of participating in the world and one observing quietly: "There is this body that walks around and somebody else just watches"
- Feeling as if you have an "unreal" or absent self: "I have no self"
- Experiencing the world as distant, dreamlike, foggy, lifeless, colorless, artificial, like a picture with no depth, or less than real
- Being absorbed in yourself and experiencing a compulsive self-scrutiny or extreme rumination
- Having an ongoing and coherent dialogue with yourself
- Feeling like a veil or glass wall separates you from the world
- Emotional or physical numbness, such as a feeling of having a head filled with cotton
- Lacking a sense of agency – feeling flat, robotic, dead, or like a "zombie"
- Inability to imagine things
- Being able to think clearly, but feeling as if some essential quality is lacking from your thoughts or experience of the world
- A sense of disconnectedness from life, impeding you from creative and open involvement with the world


"Depersonalization symptoms can also occur in the context of untreated gender dysphoria, yet this is not widely recognized among the public or in most literature on transness and transitioning. Descriptions of depersonalization-like experiences feature prominently in many trans people's recountings of their lives prior to transition, and these symptoms can heavily impact their general quality of life. But with very little attention given to depersonalization as a discrete symptom experienced by many with gender dysphoria, some trans people may struggle to recognize that this could be an indicator of dysphoria, and may not be aware that they could find relief via transitioning."

[Virginia]

Thank you for posting these excellent links, PurpleWolf.
There is a tremendous crossover in body dysmorphia, dissociative disorders and trangenderism that MUST be understood to avoid misdiagnosis and ensure EACH patient receives proper treatment.

[Lucca]

DID may not be "rare," but how often is it that someone is diagnosed with gender dysphoria, goes through or comes very close to starting a transition, and is then discovered to have had DID the whole time, receives different treatment, and then the gender dysphoria goes away and the person detransitions?

I understand that it happens, but based on everything I've read, the rate of detransition or transition regret is very small, and most of that is due to societal pressure rather than misdiagnosis. Do you actually think that there are a large amount of transgender people who really have DID and should not have transitioned in the first place?

[Virginia]

DID may not be "rare," but how often is it that someone is diagnosed with gender dysphoria, goes through or comes very close to starting a transition, and is then discovered to have had DID the whole time, receives different treatment, and then the gender dysphoria goes away and the person detransitions?

I personally know of several. But transgenderism and DID affect single digit percentages of the population. It's hard to imagine society ever having enough interest in either group to conduct serious studies as there are for cancer, heart disease, etc...

Do you actually think that there are a large amount of transgender people who really have DID and should not have transitioned in the first place?

I do not believe that, Lucca, and it was never a premise of my post although people keep putting those words in my mouth whenever I discuss my experience me. Nothing I have said is applicable to a person who is transgender, whether they have DID or not.
I DO believe there are more people with DID than who are transgender
That it is the norm for people with DID to have opposite gender alters in their systems
And that to the tragic disservice of people with DID, Gender Dysphoria resulting from Transgenderism has become the "Go To" diagnosis for people with a need to express themself as more than one gender.

[Lucca]

How do you determine whether someone has DID or whether they are transgender, then? Based on what I've read, DID has very different symptoms than being transgender does, to the extent that I'm not sure how they're being confused. Like, what am I supposed to do to prove that I "really" am transgender and don't have DID? If there were a lot of people whose gender dysphoric symptoms could be treated without transitioning, I'd think we'd either see a much larger range of accepted, working non-transitional treatments for dysphoric people, or we'd see a much higher regret/failure rate for transition. The way you phrase it, saying DID is more common than transgenderism, you make it sound like %50-%60 of people with dysphoria aren't actually transgender, and shouldn't transition, and if they do it will result in a bad outcome. The statistics don't bear that out.

[Virginia]

I am going to do my best to address each of your questions, Lucca:

"How do you determine whether someone has DID or whether they are transgender, then? Based on what I've read, DID has very different symptoms than being transgender does, to the extent that I'm not sure how they're being confused."

The short answer is whether transition helps a person's condition rather than hurts it. The difficulty in determining whether someone has DID or whether they are transgender, is that DID is a "disorder of secrecy." Victims had to hide what they were doing from their perpetrator. As such DID masks itself as a variety of physical/physiological disorders or a persons feelings and memory of their abuse may be contained in one of their alters. Sometimes an opposite gender alters need to express themself can be so strong they will insist they are transgender.

Transsexuality shares many symptoms with DID and other trauma related disorders resulting from sexual abuse. Transsexuals also experience gender dypshoria, sexual confusion and the feeling of having been born in the wrong body for as long as they can remember. They were bullied and did not fit in with other children who were the same assigned at birth gender. Transsexuals often struggle with the idea they are transsexual, are survivors of childhood sexual and psychological abuse, and suffer from the very same psychological conditions DID uses to mask itself (depression, PTSD, bipolar disorder and schizophrenia). Transsexual people can even have Dissociative Identity Disorder. My female alter, Flytrap, started a thread for people who are DID with opposite gender alters (both transgender and cisgender) at: https://www.susans.org/forums/index.php/topic,218553.0.html

It can take years of therapy for a person to "slip" or feel "safe" enough to let down the wall enough that it becomes apparent they have DID (average time a person is in the medical system before receiving a diagnosis of DID is 10 years). In my case I was in therapy 2 1/2 years before the time/memory loss, night terrors and flashbacks associated with DID began. That was the missing link that made it clear to my Psychologist my female alter's need to express herself had been misdiagnosed as transgender Gender Dysphoria.


"The way you phrase it, saying DID is more common than transgenderism...The statistics don't bear that out."
Actually, they do. 1% to 3% of the population have Dissociative Identity Disorder according to The International Society for the Study of Trauma and Dissociation. About the same as the number of people who are gay/bisexual.
http://www.isst-d.org/downloads/guidelines_revised2011.pdf

Only 0.6% were estimated to be transgender in the Williams Institute's landmark 2016 study.
http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf

"you make it sound like %50-%60 of people with dysphoria aren't actually transgender, and shouldn't transition, and if they do it will result in a bad outcome."
Sadly people jump to this conclusion but they are not my words. The purpose of this and all my posts is to make people aware there are other reason besides being transgender they may need to express themself as another gender. NOT to invalidate anyone's transgender identity.

"If there were a lot of people whose gender dysphoric symptoms could be treated without transitioning, I'd think we'd either see a much larger range of accepted, working non-transitional treatments for dysphoric people, or we'd see a much higher regret/failure rate for transition."
The stigmas associated with having a mental illness are strong. The transgender community fought hard to make it clear that GD, not transsexual, is a disorder. Unfortunately this is not the case with DID. The only effective option at this time is therapy combined with psychotic medications. I suspect the rates of failed transition/transition regret are low not because of transition, but because the required screening therapy prior to transition prevents many people for whom transition is not right from transitioning in the first place.

Our couple's psychologist explained to my wife and me her biggest red flag I had experienced childhood abuse was my insistence on how perfect my childhood was. When the time/memory loss, night terror and flashbacks began, it became clear I had developed DID because of this abuse. My greatest concern through it all has been my Gender Therapist's insistence I was a transsexual in denial and her relentless encouragement that I transition, when I was CLEAR, from day one, that as right as it felt to express myself as a woman, it felt equally WRONG. I am 100% unmistakable cisgender male, would NEVER want it to be any other way. How could it not have seemed odd that there was no learning curve for me to be woman? That I had absolutely NO problems fitting into society as a woman and people saw me as a woman the first time my female alter walked out the door... a  year before I even started hormones?

[Lucca]

You've quoted statistics about how common DID and transgenderism are compared to each other, but haven't yet provided evidence on how common a misdiagnosis of being transgender and subsequent later diagnosis of DID is. You've suggested that there's a problem with over diagnosing transgenderism when it should have been diagnosed as DID, but then say that the reason that the regret rate for transition is so low that most people with DID instead of transgenderism have it detected before they transition, in which case there shouldn't be a problem.

Perhaps most importantly, in what way do you actually want this to effect the transgender community? Am I supposed to go through 10 years of therapy to prove I don't have DID before having any transgender treatments approved?

Again, regardless of how common DID is in relation to transgenderism, the regret/failure/detransition rate for transition is very low, and most of the regret that does exist is more about societal bullying than being wrong about being transgender. It's an effective treatment for people who report symptoms of gender dysphoria. I'm sorry you had a bad experience personally, but I don't see any evidence that there's anything wrong with the current treatment plan, by and large.


EDIT: Oh, also, you cut out a huge part of the quote where I start with "The way you phrase it", and stuck it somewhere else. That completely changes what I actually said.

[PurpleWolf]

Erm, Lucca... I think Virginia is just speaking of his own experience and he has the right to speak about it. He is not trying to undermine anyone else's here.

[Lucca]

How is it only his personal experience when he's suggesting significant changes in how we diagnose people?

[Virginia]

Nothing I have said applies to the transgender community, Lucca.

It would be up to your therapist to determine if and when any transgender treatments were approved to treat your condition. In my case I was given a letter to begin a full transition level HRT regimen 3 months after I started therapy. Hormones were a Godsend but it drove my GT crazy they didn't send me down the mountain on a toboggan wanting to transition. She never could comprehend it had nothing to do with giving my brain the right chemicals. The peace came from chemical castration and meeting my need as a trauma victim to know I could never hurt anyone the way my parents hurt me. 

It's hard for a person to see anything wrong with the current treatment plan when it doesn't negatively impacted them. If I could hope for some effect from my posts, it would be to enlighten people with a need to express themself as another gender that there are other reasons for this besides being transgender.

[SoupSarah]

If I could bring some emotional clarity from a personal perspective: Or "why this is important to me.".

I joined "susans.org" about 18 months ago, as I had intense feelings of being born in the wrong body. To all intents and purposes I had Gender Dysphoria. Therefore I made the incorrect self diagnosis that I MUST be transsexual. This feeling was so strong that I even came out to my wife of 25 years - The single hardest thing I have ever done. At that point in my life I thought the only way forward was to transition.
Due to medical issues, I did not pursue therapy straight away (too long to go into, but important to wait until they were cleared up first) but I did investigate my GD and posting and reading on here was one of the sources of my information.
I started to realise that that "MY Experience" of GD was not really similar to the majority of the people posting. It had the same symptoms, intensity and pain - but something did not gel. You see, I had a strong "other" my male side who was scared stiff of transistioning, did not feel GD and just wanted to stop these feelings. If at this point I had seen a therapist or psychiatrist and they said I was transsexual then I had no other explanation and would have no other option but to pursue this route to see if it was the answer.
So, out of desperation I wrote a post on here, explaining how I had this duality of experience and no "past-experience" that is when someone kindly pointed out that there may be another explanation. An explanation that I had not ever considered, that I was actually mentally ill.
Exploring DID symptoms and it's causes, it became almost obvious to me that this was actually a better fit than being transsexual. It explained why my experiences did not align with others on here. When I talked with my wife, and said I may be multiple, she just looked at me and said, "well yes honey, I know they are different people I have been living with them for years"!
My point is, I am not transsexual, but the overriding impetus at the time in my head was that this was the only explanation. That my experience of transsexuality was different to the "norm" did not matter as I had little in the way of alternative.
Now, this is where it starts to get dangerous. I met with a psychiatrist - explained the people inside my head. How one is only female, the other male etc etc. He nodded sagely and agreed that I might be dissociative. However, his boss the head of our mental health services did not agree. He arranged a meeting with me, told me straight off the bat that "You are not a dissociative, what you describe is a transsexual in denial". He went on to explain that he had never met anyone disassociated and to be that way would require a very, very specific set of circumstances and criteria that I just did not meet. He strongly suggested that I take gender therapy. Not once, but for over an hour of the meeting. At least a dozen times he said "so, gender therapy, good idea? yes?". It was only on the prompt of a question when he asked me "how does it feel when I dress up female,", that things turned around. I had (and have) no idea how my female part "feels" when she dresses. I can remember her dressing, but for how she feels? I only have her notes.
I remember clearly the psychiatrist stopping dead in his tracks at this response. That is not the response of a MTF in denial.
We then went on to explore my childhood - I was adamant that there was no childhood abuse, however I did know that my female had some visions. Some vile, disgusting visions of a young boy being sexually abused. I did not want to share these, I have no connection to them. The product of a sick mind, I kept telling myself. The P questioned further - what does Sarah think about your childhood? Not being able to answer for her, and the only real reference to my childhood being these visions written down for me, I relented and shared. At that point the P changed tack, the pre-requisites for DID had been demonstrated in part. So my therapy was scheduled for trauma and not gender.

The fact is I do not know what my gender or sexuality is. I have not been a single person for the majority of my life. There is no way I could make a choice on what or how to transition. It would be akin to tossing a coin. The really scary fact is had I not been in a position to challenge, to say his initial theory of me was wrong in the first instance I would now be transitioning.

The fact that so few people regret their transition makes me believe that people like me are rare in society. But, even if one person goes through with a transition when they actually need another treatment, is like giving a lung cancer patient a replacement liver - pointless waste of time and damaging to the individual concerned.
It may be disingenuous of me to also point out that a surgically transitioning individual makes the medical establishment more money more quickly than someone requiring trauma therapy - there is not a financial impetus to diagnose DID. Though, of course that is straying into unethical practices and not somewhere there is any evidence for - but money motivates.

I came to susans looking for answers, looking at how I needed to deal with my gender dysphoria. Without people like virginia on here, keeping an eye out for "outliers" like me, I would have a different future and probably not a very long one. I understand the frustration within the general trans* community with conditions like this, but when your community is the first place people like me go to for help it is only human to be able to provide that support, love and direction. I, for one owe my life to the help I got here.

[PurpleWolf]

Now, this is where it starts to get dangerous. I met with a psychiatrist - explained the people inside my head. How one is only female, the other male etc etc. He nodded sagely and agreed that I might be dissociative. However, his boss the head of our mental health services did not agree. He arranged a meeting with me, told me straight off the bat that "You are not a dissociative, what you describe is a transsexual in denial". He went on to explain that he had never met anyone disassociated and to be that way would require a very, very specific set of circumstances and criteria that I just did not meet. He strongly suggested that I take gender therapy. Not once, but for over an hour of the meeting. At least a dozen times he said "so, gender therapy, good idea? yes?".

OMG..... !!! That is indeed scary...! Malpractice for sure.....!

Thank you for your post!!! It was excellent!

[Lucca]

Ok, see, that's a very clear explanation of why you have DID and aren't transgender, and it delves into diagnostic criteria that seperate DID from transgenderism. That's what I haven't seen from Virginia so far, with him mostly quoting statistics about how DID is more common and making vague statements about how therapists need to change how they diagnose people, without being more specific. If he had explained exactly what it is that seperates transgender people from those suffering from DID and what medical professionals can do determine which it is, then I might not have such a problem with it. Instead, it just sounds like he's saying basic symptoms of being transgender can be DID instead, so therapists and psychiatrists should be putting more roadblocks in our way.

As it stands, sure, if someone displays signs of memory blocks or placing cross-gender feelings into entirely seperate identities, then yeah, that's probably grounds for a DID diagnosis rather than gender transition. That's a pretty obvious difference that should be able to be detected in a few sessions, as it ultimately was in your case.