Quality of attachment in young boys with gender identity disorder: A comparison to clinic and nonreferred control boys

Previous research has shown that boys referred clinically for gender identity problems manifest, on average, a greater degree of general psychopathology than do sibling and normal controls. The extent of this psychopathology appears to be commensurate with that of boys referred for other clinical problems who are demographically comparable. Furthermore, boys diagnosed with gender identity disorder (GID) have been found to be prone to separation anxiety or distress and also to have mothers who exhibit a greater degree of psychopathology than mothers of nonreferred boys.

A review of the literature regarding quality of attachment in nonreferred samples and in high-risk and clinical samples revealed that insecure attachment was found to be associated with general psychopathology or behavioural problems, with separation anxiety or distress, and with maternal psychopathology. Since GID and insecure attachment have both been found to be associated with general psychopathology, separation anxiety or distress, and maternal psychopathology, it seemed reasonable to test the hypothesis that boys with GID would exhibit insecure attachment.

The present study was designed to explore further the role of the gender disturbed boy's relationship with his mother utilizing the conceptual framework of ethological attachment theory. This study investigated whether boys with GID differed significantly from nonreferred control boys in terms of behavioural disturbance, security distress, and quality of attachment. In addition, this study investigated whether clinical control boys differed significantly from nonreferred control boys in terms of the same variables of interest.

The three groups of boys were administered the Separation Anxiety Test. Mothers of the boys were asked to complete the Child Behavior Checklist. Quality of attachment was assessed using a modified Strange Situation.

This study provided further evidence that boys with GID manifest signs of separation anxiety and distress, complementing the previous data regarding associated psychopathology. Insecure attachments were found to be overrepresented in boys with GID. However, boys referred for other clinical problems also showed high rates of insecure attachments. It was concluded that an insecure attachment might be conceptualized as a nonspecific risk factor in the development of GID.

Limitations of the study, implications for treatment, theory and research, and directions for future research were discussed.