Social Cognition in Gender Dysphoria

Social Cognition in Gender Dysphoria

Gender dysphoria is a condition in which it’s etiology is not yet well understood. Might its etiology involve disturbances to social cognition, and if so, how is social cognition disrupted? A review of studies on gender dysphoria relevant to social cognition [Table 1] reveals that theory of mind is largely impaired in gender dysphoria, with performance explaining 30-50% of the variance in gender dysphoric experiences, persons with gender dysphoria having poorer social skills, being more socially withdrawn, and having more social anxiety. In addition to impaired theory of mind, social behaviors similar to that of cluster B personality disorders are also found, including paranoia and narcissism. 


Table 1

Cloudfindings (2021a)

Prevalence of autism approximately 10x that of the general population; higher scores on autism quotient and social responsiveness scale; narcissistic, obsessive compulsive, paranoid, and borderline personality disorders prevalent in GD; by meta-analysis

Ceglie et al. (2014)

Lower scores on empathy quotient (EQ) (d=0.89 for FtM, 0.62 for MtF)

Kung (2020) 

Lower scores on short EQ in natal females with GD but not males (d=0.70 for FtM, 0.76 for NBAFAB, -0.38 for MtF, -0.29 for NBAMAB); lower RMET in all groups except NBAMAB (d=0.36, 0.32, 0.22, 0.03)

Warrier et al. (2020)

Lower scores on EQ in trans vs female and male controls (d=0.70, 0.32), lower scores on EQ in trans autistic people vs cisgender autistic females and males (d=0.81, 0.55)

Kallitsounaki et al. (2020)

RMET performance negatively correlated with gender dysphoria (r=-0.55, -0.70)

Settineri et al. (2016)

High rates of clinically significant paranoia (54.5%) and social introversion (27.3%) in gender dysphoria

Lingiardi et al. (2014)

34% of trans people fell into a “depressive/introverted” and 14% into a “histrionic/extraverted” personality style (the rest fell into a healthy personality style)

Wilkinson-Ryan & Westen (1999) 

Confusion about gender associated with pathological disturbance in social role behavior

Bergero-Miguel et al. (2016)

31.4% prevalence of social anxiety disorder in gender dysphoria

Karia et al. (2019)

Social alienation and paranoid features common in gender dysphoria

Littman (2018)

69.4% prevalence of social anxiety 44.3% social difficulties interacting with peers, 43.1% socially withdrawn (by parent report, which may be biased)

Perrotta (2021)

High prevalence of cluster b personality traits in gender dysphoria



  1. Cloudfindings (2021a) Meta Analysis of Personality Disorders & Autism In Gender Dysphoria

  2. Ceglie et al. (2014) Empathising and Systemising in Adolescents with Gender Dysphoria

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

  4. Warrier et al. (2020) Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals

  5. Kallitsounaki et al. (2020) Links Between Autistic Traits, Feelings of Gender Dysphoria, and Mentalizing Ability: Replication and Extension of Previous Findings from the General Population

  6. Settineri et al. (2016) Personality Assessment in Gender Dysphoria: clinical observation in psychopathological evidence

  7. Lingiardi et al. (2014) Personality and Attachment in Transsexual Adults

  8. Wilkinson-Ryan & Westen (1999) Identity Disturbance in Borderline Personality Disorder: An Empirical Investigation

  9. Bergero-Miguel et al. (2016) Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain

  10. Littman (2018) Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria

  11. Karia et al. (2019) Paranoia in patients with gender dysphoria: A clinical exploration

  12. Perrotta (2021) Etiological factors and comorbidities associated with the “Gender Dysphoria”: Definition, clinical contexts, differential diagnosis and clinical treatments

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