Gender dysphoria:
: prevalence, pathways and experiences of people with autism traits

  • Katrin Lehmann

Student thesis: Doctoral Thesis


Background: High numbers of individuals with autism traits are attending
specialist gender services in Northern Ireland (N.I). The GIFTS (Gender
Identity- Finding and Transforming Services) study examined the autism
trait prevalence, mental health needs, care pathways and lived experiences
of treatment seeking adolescents and adults.
Methods: GIFTS was a mixed methods study, using cross-sectional survey
methodology, in depth interviews and pathways to care methodology to
examine the lived experiences of individuals with gender dysphoria. While
primarily focused on treatment seeking people, GIFTS also contained a
small community sample outside specialist gender services.
Results: Combined autism screening tools highlighted an autism trait
prevalence of 17.2%. Over 50% of participants presented with high risk of
suicidality, anxiety and previous experiences of multiple childhood traumatic
events. There was a statistically significant difference between individuals
with autism traits and other participants related to anxiety, depression and
childhood trauma. Autism traits were associated with poorer mental health.
Individuals with autism traits requested treatments like other participants.
Interview date highlighted impression management and camouflaging
strategies used by participants when they present to services. There was
significant mistrust in services. The experience of gender services was
dependent on an “an authentic presentation” and this was more challenging
for non-binary individuals. Referral prior to lengthy waiting lists was a
significant factor in the service experience of participants.
Conclusions: GIFTS was the first ever study examining the needs of
individuals living with gender related distress and autism traits in N.I. Many
individuals with autism traits attending gender services are likely to have
autism traits. Future planning for service delivery should incorporate
strategies and environmental changes, which facilitate engagement for
those with social communication difficulties. The needs of non-binary
individuals have to be considered carefully in view of their marginalization in
clinical services and in the wider society.
Date of AwardJul 2020
Original languageEnglish
SponsorsPublic Health Agency Northern Ireland
SupervisorMichael Rosato (Supervisor), Gerard Leavey (Supervisor) & Hugh Mc Kenna (Supervisor)


  • Public Health
  • Ageing
  • Northern Ireland

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