An investigation of individuals with gender dysphoria in terms of theory of mind abilities

Aims: Gender Dysphoria (GD) is a state of severe distress caused by the incongruence between the gender experienced by the individual and the sex assigned at birth. The factors involved in the development of GD and gender identity are discussed in the biopsychosocial context and neurocognitive mechanisms are investigated. Recent studies reporting an increase in the co-occurrence of GD and Autism Spectrum Disorder (ASD) diagnoses suggest that Theory of Mind (ToM) skills are a neurocognitive mechanism involved in the development of GD. In our study, we aimed to compare individuals with GD with cisgender individuals of similar age and educational status in terms of affective and cognitive ToM abilities. Material and Method: In our study, 32 Male to Female (MtF) and 58 Female to Male (FtM) who applied to the GD Outpatient Clinic of Cerrahpaşa Faculty of Medicine, between July 2022 and May 2023 and were diagnosed with GD according to DSM-5 diagnostic criteria were included as the case group. 36 cisgender men and 62 cisgender women who agreed to participate in the study were taken as the control group. The participants completed the sociodemographic data form, the Utrecht Gender Dysphoria Scale (UGDS) appropriate to their biological sex, and the Autism Spectrum Quotient (AQ). All of the participants were administered the Reading the Mind in the Eyes Test (RMET), the Hinting Task (HT) and the Faux-Pas Recognition Test (FPRT) to assess their ToM abilities. Results: The AQ-total scores of GD and cisgender individuals were found to be similar in our study. When FtM, MtF, cisgender men, and cisgender women were evaluated separately, no significant difference was found between the AQ-total scores of the groups. The GD group and the cisgender group showed similar performance in the RMET and FPRT. However, the HT scores of the GD group were found to be significantly lower than those of the cisgender group. The HT scores of MtF individuals were found to be lower than those of cisgender men and cisgender women. Similarly, the HT performance of FtM individuals was found to be lower than cisgender men and cisgender women. The results of the linear regression analysis indicated that the HT performance had a significant effect on feelings of GD. Conclusion: Our findings suggest that individuals with GD have lower cognitive ToM performance than cisgender individuals. This difference in ToM performance may reflect the neurocognitive mechanism involved in the etiology of GD. Clinicians' understanding of this cognitive difference in individuals with GD may prevent difficulties that individuals with GD may experience during therapeutic interventions. It may reduce the avoidance of seeking support and communication problems of individuals with GD.