Adult attachment and Reflective Function in Trans Adults Pre and Post Sex Reassignment Surgery

The quality of attachment relationships experienced in early childhood has important consequences on the development of Reflective Functioning -RF (Fonagy & Target, 2001). This ability is connected to the representation of the self and depends on the caregiver’s capacity to mirror the child’s mental experiences. In Gender Dysphoria (GD) a prevalence of insecure states of mind was found (Vitelli & Riccardi, 2010). Moreover, the exposure to a repeated caregiver’s failure of mentalizing the child’s sense of body incongruity can be hypothesized (Fonagy, 2006; Lemma, 2013). Although attachment Internal Working Models (IWMs) are found to be relatively stable over time, some studies have showed changes following significant life events. In this exploratory study we aimed to examine if and how gender transition process influences the continuity of the IWMs and RF level. Adult Attachment Interview (AAI) was administrated to 20 adults with GD referred to C.I.D.I.Ge.M. of Turin pre- (T0) and post- sex reassignment surgery (T1). RF was coded according to the RF Scale from AAI transcripts. Data at T0 showed a high percentage of insecure attachment with frequent signs of unresolved loss or trauma. An improvement both in the AAI coherence scale and RF scoring was reported at T1. RF indicators related to the awareness of the nature of mental states and family dynamics, as well as a revision of thoughts and emotions in light of understanding gained since childhood, were found. These findings underline that the gender transition involves effects on subjective and intersubjective mirroring processes associated to the new sense of self body congruity. Results may be useful to better understand the psychological mechanisms involved in the gender transition in order to improve the clinical intervention.