Meta Analysis of Personality Disorders & Autism In Gender Dysphoria

Meta Analysis of Personality Disorders & Autism In Gender Dysphoria

Abstract

Introduction: Gender dysphoria is a condition in which it’s etiology is not yet well understood. Characterizing co-occurring psychopathology in gender dysphoria can help shed light on potential psychological and biological mechanisms involved in its etiology. In this post, the prevalence of personality disorders, autism, and autistic traits in gender dysphoria is reported with combined data over seven studies assessing the prevalence of personality disorders in gender dysphoria, five studies assessing the prevalence of autism, and seven studies assessing the prevalence of autistic traits measured with the autism quotient and social responsiveness scale. 

Results: The most prevalent personality disorder was narcissistic (20%), followed by obsessive compulsive (15.4%), paranoid (14.6%), and borderline (10.4%), remaining personality disorders with a frequency below 10%. The frequency of having any personality disorder was 57.7%. The frequency of autism spectrum disorder was 25%. Persons with gender dysphoria scored moderately higher on the autism quotient than controls (d=0.53), however of the four studies with the autism quotient, two found no effect and two found medium-large effects. Persons with gender dysphoria reliably score much higher than controls on the social responsiveness scale (d=0.93).

Disorder	Prevalence in GD	Prevalence in genpop	GD vs Genpop
Any Personality Disorder	57.7	10.6	x5
Narcissistic Personality Disorder	20	1.4	x14
Obsessive-Compulsive PD	15.4	2.4	x6
Paranoid Personality Disorder	14.6	2.0	x5
Borderline Personality Disorder	10.4	1.4	x7
Histrionic Personality Disorder	9.3	1.5	x6
Avoidant Personality Disorder	8.6	3	x3
Antisocial Personality Disorder	6.4	1.3	x5
Schizoid Personality Disorder	6.4	1.16	x6
Schizotypal Personality Disorder	5	0.9	x6
Dependent Personality Disorder	4.3	0.62	x7
Autism Spectrum Disorder	25	2.5	x10
Autism Quotient	20.8	16.9	d=0.59
Social Responsiveness Scale	58	29.8	d=0.93

Reported personality disorder prevalence in general population of the average prevalence in the 6 studies whose results are reported in Lenzenweger (2008)

Reported autism prevalence from Xu et al. (2018)

Study	NPD	OcPD	PPD	AsPD	HPD	SzPD	StPD	AvPD	DPD	BPD	Any	N
Meybodi et al. (2014)	40	27	18	16	12	11	11	11	6	1	57	70
Anzani et al. (2020)	5	2	1	1	1	1	1	2	1	3	45	91
Madeddu et al. (2009)	6	3	0	0	4	1	0	2	1	3	26	50
Bodlund et al. (1993)	1	1	9	1	1	0	0	1	1	2	7	19
Ibrahim et al. (2016)	0	1	0	0	3	0	0	0	0	3		20
Duisin et al. (2014)	4	9	13	0	5	5	2	8	3	10	20	30
Hepp et al. (2005)											13	31
Total (n)	58	3	41	18	26	18	14	24	12	29	168	291
Total (%)	20	15.4	14.6	6.4	9.3	6.4	5	8.6	4.3	10.4	57.7

Study	Diagnosis of ASD	N
Skagerberg et al. (2015)	90	166
de Vries et al. (2010)	16	204
Shumer et al. (2016)	9	39
Heylens et al. (2018)	16	58
Stagg & Vincent (2019)	15	109
Total (n)	146	576
Total (%)	25
Study	Autism Quotient M	N	vs control*
Jones et al. (2011)	19	429	-0.05
Pasterski et al. (2013)	17	91	-0.02
Kung (2020)	23	308	d=0.63
Stagg & Vincent (2019)	29	109	d=1.2
Combined Mean	20.8	937	d=0.59
Study	SRS Mean	N	vs control
Skagerberg et al. (2015)	59	166	d=0.97
Heylens et al. (2018)	53	58	d=0.70
Yazkan et al. (2018)	70	25	d=1.2
Combined Mean	58	249	d=0.93

*for studies with no control sample, Cohen’s d was calculated using norms from Baron-Cohen et al. (2014)

1. Meybodi et al. (2014) The frequency of personality disorders in patients with gender identity disorder.

2. Hepp et al. (2005) Psychiatric comorbidity in gender identity disorder.

3. Anzani et al. (2020) Personality Disorders and Personality Profiles in a Sample of Transgender Individuals Requesting Gender-Affirming Treatments

4. Madeddu et al. (2009) Prevalence of Axis II Disorders in a Sample of Clients Undertaking Psychiatric Evaluation for Sex Reassignment Surgery

5. Bodlund et al. (1993) Personality traits and disorders among transsexuals

6. Ibrahim et al. (2016) Psychiatric comorbidities in transsexualism: Study of a Lebanese transgender population

7. Duisin et al. (2014) Personality Disorders in Persons with Gender Identity Disorder

8. Skagerberg et al. (2015) Brief Report: Autistic Features in Children and Adolescents with Gender Dysphoria

9. de Vries et al. (2010) Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents

10. Jones et al. (2011) Brief Report: Female-To-Male Transsexual People and Autistic Traits

11. Pasterski et al. (2013) Traits of Autism Spectrum Disorders in Adults with Gender Dysphoria

12. Shumer et al. (2016) Evaluation of Asperger Syndrome in Youth Presenting to a Gender Dysphoria Clinic

13. Heylens et al. (2018) The Co-occurrence of Gender Dysphoria and Autism Spectrum Disorder in Adults: An Analysis of Cross-Sectional and Clinical Chart Data

14. Kung (2020) Autistic traits, systemising, empathising, and theory of mind in transgender and non-binary adults

15. Stagg & Vincent (2019) Autistic traits in individuals self-defining as transgender or nonbinary

16. Yazkan et al. (2018) Autistic Traits and Executive Functions in Children and Adolescents With Gender Dysphoria

17. Lenzenweger (2008) Epidemiology of Personality Disorders

18. Xu et al. (2018) Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016

19. Baron-Cohen et al. (2014) Attenuation of Typical Sex Differences in 800 Adults with Autism vs. 3,900 Controls