Gender Identity Through the Lens of Developmental Trauma

A look at the over-represented subgroups that comprise gender-distressed children reveals strong clues that developmental trauma may drive trans identification in kids. These clues include complaints common to both early-trauma and gender dysphoria populations (feelings of intense body-discomfort, self-disgust, self-rejection, and emotional pain) as well as matching difficulties in psycho-social functioning (unstable sense of self, poor emotion regulation, and self harm). Early life trauma is a huge predictor of mental health problems in general (overabundant in the trans population) and suicide in particular— constantly cited as the major risk to kids who identify as trans. Indeed, early traumas are confirmed in the emerging stories of many young detransitoners.

Children on the autism spectrum, adoptees, foster youth, and extremely gender non-conforming kids are the four groups most over represented in children who assert a trans identification. These groups indeed experience more trauma in early life, whether from being chronically misunderstood, not getting key relational needs met, experiencing shock, loss or grief, being rejected, bullied, or shamed, suffering despair or chronic fear, or feeling psychically alone. Developmental trauma, which occurs in infancy and childhood, has profound effects on the growing brain, which reaches 90% of adult size by age three. The right brain, which learns implicitly through modeling, and governs things like self regulation, self concept, embodiment, and basic trust, is developing preferentially during this time.

When traumatic events cause enough fear, sorrow, or dissociation to thwart normal neuropsychosocial development, the child will fail to acquire certain key right brain abilities. The lack of unacquired developmental skills then follows the child as he or she grows, experiencing being out of step with peers who have successfully developed. Ultimately, a sense of “I always blow it, I’m stupid, I’m a broken worthless loser” can lodge in the child’s self concept.

Similar to descriptions of gender dysphoria, victims of developmental trauma describe intense emotional pain (“dysphoria” – no qualifier), a shaky, fungible sense of self, not feeling fully real, impulsivity/risk taking, total lack of access to emotions or overwhelmingly intense emotions, poor self control, poor social skills, and truly brutal self-hate, often targeted to the body (cutting, self-starvation, self injury). Many formerly traumatized kids will dissociate under stress, and they commonly have a very critical inner voice: “You are repulsive, disgusting, evil. You will never fit in. You don’t deserve love.”

Feelings of self-hatred and self-rejection, common in trauma, can easily be morphed to fit the rubric of gender: “I hate my body; I cannot comfortably inhabit it because I’m trans.” Do clinicians who affirm children falsely concretize this painfully-somatic sense of lack, left by early trauma, as: “you are trans”?

Trauma-related sequelae, like emotional dysregulation, narcissism, and rage are also visibly present in adults who are trans rights activists (TRA). Indeed, specific developmental lacks are core to TRA demands such as lack of boundaries between self and other, in seeking to control others’ thoughts and words. The rage towards women, resulting in slurs such as TERF, coinciding with the desperate wish to merge with and be women, may indicate a lack of separation and individuation for TRA’s. Uncompleted developmental tasks leave a toddler-ish misapprehension of reality, still alive in the psyche of the adult. Such misapprehensions are normally confronted and revised relationally, by age three or four, assisted by a mother who can lovingly withstand the toddler’s negative emotions and engage the child in reality testing with patience and compassion.

On average, kids enter foster care before age three, so early relational trauma and neglect affect the vast majority. If such traumas underlie trans identification, this would explain why foster youth identify as trans fifteen times as often as kids at large. Adoptees, who suffer shock trauma and loss upon surrender, even at birth, are known to have statistically more mental health problems, due to this early blow. Autistic kids may feel excluded, frustrated, or misunderstood on a daily basis.

Gender non-conforming kids, who are likely to grow into gay adolescents and adults, may be shamed, rejected, bullied, or simply have an uncomfortable sense of being ‘different’ without yet knowing why. None of these children benefits from permanent feigning, endocrine disruption, or genital surgery— yet that is what they are getting. If gender can be a designated issue for developmental trauma, labeling someone trans at the first appointment is malpractice.

Shouldn’t we be willing to get to know an unhappy child, before assembly-lining them into sterility and brittle bones? Presenting issues are rarely the core problem of a distressed person. That’s what therapy is for! Indeed, in developmentally traumatized kids, puberty can reactivate great emotional distress, because our toddler-era right brain neural networks reconsolidate in our teen years. Perhaps this phenomenon contributes to Rapid Onset Gender Dysphoria.

Unlike medical transition, treatments for developmental trauma are both well-validated and extremely safe. Modalities include right-brain-focused therapies (Neurofeedback, NARM/“Neuro Affective Relational Model,” Somatic Experiencing, Sensorimotor Psychotherapy), gross-motor activities that require synchrony with others (dance, tennis, theatre, ‘catch’), and gradually feeling attuned to and attachment repair within a safe therapeutic relationship. These experiences can re-regulate a distressed right brain and bring a dissociative child back into their body. Dialectical Behavioral Therapy (DBT) can increase a youth’s ability to tolerate emotional distress, without becoming overwhelmed. DBT happens to be the gold-standard therapy for suicidal young adults with borderline personality disorder, also known as BPD, which is strongly related to early life trauma and frequently present in the population of gender distressed young people. Those who suffer from BPD also have an unstable sense of self, and struggle with self-harm and suicide.

And yet distressed, suicidal kids who identify as trans don’t receive DBT or developmentally informed therapeutic interventions. Instead, these miserable children have their first conclusion about the source of their problems reified by therapists, and their history and experience left unexplored. Standard practice for suicidal ideation in children is not implemented when gender is on the table. Why is this? Self hatred has nothing to do with innate identity. It always indicates psychological injury. Happy, stable people like themselves. Providing therapy first – as Sweden just mandated – could reduce a child’s dysphoria to sub-clinical levels, or eliminate it entirely. Therapy as a first line treatment is especially important for trans identified young people when we consider that eighty percent of trans-identified people have two or more mental health diagnoses in addition to gender dysphoria.

Historically, it is understood that other mental health conditions could lead to gender issues. This is completely ignored in most clinical practices today, however. Typically therapy helps the client explore their beliefs and assumptions, considering whether they hold water, and puts new ideas on the table, gradually assisting the client to become less sad and stuck, and more flexible and curious. In a therapeutic relationship, incomplete tasks of development will arise, as relational trust builds, so the client gets another chance to complete them. Therapists expose self-hating clients to a powerful new concept: “You are not your thoughts.”

Why, in approaching gender, is this precept reversed? Are we perhaps witnessing a multigenerational psychological enactment? An “intergenerational trauma 2.0,” with more shaky, less sure footed adults, both clinicians and parents, who are just as afraid of confronting intensely painful emotions as traumatized children are? When “do no harm” gets re-jiggered into “ask no questions,” is this a subconscious way for unskilled adults to avoid or deny intense psychological pain in kids? Can they be denying their own unmet needs, right brain deficits, or childhood pain? These are urgent questions.