Not recognizing yourself in the sex assigned at birth is not an illness. “But it can imply suffering that interferes with emotional, relational and social well-being” explains the child neuropsychiatrist of Bambino Gesù
Paola is fifteen years old and lives with her father. Three years ago the mother died suddenly in a car accident. When she returned from school that day, Paola no longer found the smile, the attention, the affection she always had. Since then the pain coexists with a void that cannot be filled. In the last two years she has left the house very little, she has left school and abandoned the athletics she had practiced since she was a child. She has three friends left, Federica, Marzia and Graziella who visit her every week. With them she can be herself, she talks, laughs, sometimes cries. He often tells me that he doesn’t have to pretend with them. Outside of this small circle, however, Paola closes off. The looks of others scare her and judgment terrifies her.
For a long time, even visiting, talking about emotions is difficult. The answers are short, the silence frequent. It takes months for trust to allow the words to arrive. They emerge anxietyl’embarrassment in front of othersbut also the passion for music and art. Then, one day, Paola finally finds the courage to say what she has always kept. He tells me he feels like a man, that he feels like Paolo. It’s a pain that comes from afar. Since he was a child he has never felt comfortable in his own body. She has always rejected the idea of being female, preferring games, clothes and the company of males. Already at the age of seven or eight he imagined what it would be like to live as a boy.
The comment of the neuropsychiatrist Stefano Vicari*
With the puberty the body takes a directionhowever, which Paul does not recognize as his own. The menstrual cycle and breast development make him feel trapped in a shell that does not represent him. Withdrawal then becomes the only possible way. School, sport, going out with friends become unbearable experiences. Talking to the father is one of the most difficult steps. Paolo tells me about it during his visit. She puts it off for a long time, afraid of hurting him. When he finally finds the words, he tries to explain himself with an image. He asks his father to imagine a great desire to live, to move, to change. And then to be closed, trapped, under a glass bell.
Safe, but stuck. Inside that bell is the true self. The bell is the body, a body that changes in unwanted ways and that prevents being. The father listens. At first he is embarrassed, confused. Then he chooses to stay, not to close, to try to understand. Over time that embarrassment gives way to an initial, tiring acceptance.
With the support of her friends and father, Paolo begins to feel less alone. To tell who he really is. To take small steps out of its glass bell, towards a life in which body and identity can finally meet.
L’gender incongruity it’s about how a person perceives themselves. Indicates the sensation of not recognizing oneself as the sex assigned at birth and to feel like your own a different gender identity. It is a dimension linked to identity and can be present already in childhood or pre-adolescence. Incongruity, in itself, is not a disease and does not necessarily imply psychological distress. Some boys and girls manage to live with this distance between body and identity in a relatively peaceful way, especially if the surrounding environment is welcoming and respectful.
The Gender dysphoria, on the other hand, is about suffering. We speak of dysphoria when gender incongruity is accompanied by a intense and persistent discomfortwhich interferes with emotional, relational and social well-being. The person may experience their body as foreign or wrong, suffer from pubertal changes, experience strong discomfort when treated according to the sex assigned at birth. They can appear anxiety, depressed mood, social retreat e a deep feeling of being trapped.
In developmental age these experiences can manifest themselves in different ways. Some signals include the rejection of bodily characteristics linked to biological sex, difficulty wearing clothes or participating in activities perceived as inconsistent with one’s identitya strong one identification with another gender and one marked suffering when this identity is not recognized.
Recognizing the difference between incongruity and dysphoria is critical. Not all people with gender incongruity develop dysphoria, but dysphoria always presupposes a previous incongruity. In other words, incongruity is about who a person feels they are, dysphoria is about how bad that distance makes them feel. A safe, non-judgmental environment can make a big difference. Listening, respect and the possibility of expressing oneself freely reduce the risk that the incongruity turns into intense suffering. However, when the discomfort is present and persistent, it is important to offer adequate support, capable of accompanying the boy or girl on a growth path that is as peaceful and aware as possible.
*director of Child Neuropsychiatry at the Bambino Gesù Pediatric Hospital in Rome and professor of Child Neuropsychiatry at the Catholic University of the Sacred Heart
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