Cooccurrence of autism spectrum disorder and gender dysphoria in childhood: analysis of the personal identity from a psychodynamic perspective

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with alterations in social interaction and communication, and restricted and repetitive patterns of behavior and interests. Gender Dysphoria (GD) refers to the incongruence between the gender identity and the sex assigned at birth, together with a strong and persistent desire to be of the opposite sex. During global personal identity construction, the development of sexual identity is essential. Objective: To analyze an adolescent clinical case of co-occurrence of ASD and GD from a psychodynamic understanding of his identity. Clinical Case: A 15-year-old male diagnosed with ASD and borderline intellectual capacity. He manifested feminine behaviors and interests in girlish games since preschool age, imitating female figures, and verbalizing the desire to be of the opposite sex. A multidisciplinary evaluation of the patient concluded that he presented a diffuse general identity with ambivalent gender identity. Therefore, he did not fulfill the requirements for hormone therapy. Psychological therapy was suggested to favor greater exploration and cognitive flexibility to develop a better-defined gender identity. Conclusions: In cases as ASD, where identity development is compromised, the affected subject often delays or does not consolidate sexual identity, leading to a diffusion of identity and gender, as in the reported case. The co-occurrence of ASD and GD requires a multidisciplinary evaluation that includes a complete assessment of the patient's global identity before considering any definitive therapeutic orientation regarding gender.