The impact of family constellations on the development of gender nonconforming/dysphoric children
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 (Celenza, 2014). Illuminating the interactional dynamics (Ehrenberg, 2010) 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.
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