The Traumatic Foundation of Gender Dysphoria

We live in a culture that says you can become—and, in fact, are— whatever you think you are, so few people dare question the transgender person’s idea of reality.

Of course, it’s possible that nature may in some rare instances “cross-wire” a male by feminizing his brain before birth so he feels more like a woman. However, there is no way, at this time, to test that theory. In fact, psychoanalysts discovered the primary reason for transgenderism many years ago. But today’s political environment has buried that knowledge. We believe that for many—and probably most—men who feel trapped in an opposite-sex body, the origins of their conflict trace back to early childhood.

Therefore, no psychotherapist should simply accept at face value the man’s experience of himself as female, and recommend that he have mutilating surgery which will only make him into a crude caricature of a woman. Nature has previously settled the issue through his DNA: chemical castration and surgery will never make him truly female.

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When we investigate the childhood of the man who believes he is a woman, we often see what attachment theorists call an “intense but insecure maternal attachment.” Mothers of gender-disturbed children usually report high levels of stress during the child’s earliest years. When the mother is alternately deeply involved in the boy’s life, and then unexpectedly disengaged, her erratic and unpredictable emotional engagement leaves the child feeling profoundly insecure.

The term that psychoanalysts use to describe this profound insecurity is “abandonment-annihilation trauma.” In early infancy, the child’s sense of self is very fragile. Because the boy’s very existence is dependent upon this emotional connection, if the mother abandons him (emotionally or physically), he feels like he is going to die—“be annihilated.” We know this fear is rooted in all mammals as a basic survival instinct.

The infant’s solution to this unbearable anxiety is to resort to the fantasy that “I am Mommy”: “When Mommy is gone, I ‘become’ her and will be safe.” This infantile defense is not a normal, mature identification process, but is an emergency safety maneuver that generates an “as-if” personality.

Mothers of transgender men were often under severe stress during the first two years of their sons’ lives, and could not function normally as emotionally available mothers. Others were narcissistic, in the sense that their relationship to their child was determined not by the child’s emotional needs but, rather, by their own. Such mothers will emotionally connect and disconnect from moment to moment, depending upon their own needs or even whims.

We often see severe maternal clinical depression during the critical attachment period (birth to age 3) when the child is individuating as a separate person, and when his gender identity is being formed. The mother’s behavior was often highly volatile, which could have been due to a life crisis (such as a marital disruption), or from a deeper psychological problem in the mother herself, e.g., borderline personality disorder, narcissism, or a hysterical personality type.

This is the same dynamic that we see in the fetish, where the boy is “taking a piece of Mommy” (e.g., her shoes, her scarf, etc.) and developing an intense (and later sexualized) attachment to an object that is intimately associated with her.

The infantile dynamic of “imitative attachment” is such that “keeping Mommy inside” becomes truly a life-or-death issue—“Either I become Mommy, or I cease to exist.” This explains why gender-disturbed boys are willing to tolerate social rejection for their opposite-sex role-playing—it feels like death to abandon this perception of themselves as a female.

The phenomenon of “imitative attachment” explains why gender-disturbed boys do not display femininity in a natural, biologically-based way, as do girls; rather, they demonstrate a one-dimensional caricature of femininity—an exaggerated interest in girls’ clothes, makeup, purse-collecting, etc. and a mimicry of the feminine manner of speaking.

As one mother explained to me, “My gender-disturbed boy is more ‘feminine’ than his sisters.”

In other instances, the family pattern was different. Psychoanalytic histories show us examples of the mother’s and even the father’s unspoken messages telling their son that he should have been—or is in fact—a girl.

This is why the transgendered man says that when he assumes the clothing of the opposite sex, he feels a profound sense of relief, reassurance, and a return to emotional stability. It feels like “this is who I really am.”

When we look at the three gender variations—transgender, transvestite, and homosexual—we see that the transgendered person has the greatest body image distortion. This is why he feels driven to surgically, chemically, and cosmetically alter his body to accommodate his emotional distortion.

The second category, the transvestite, is someone who knows he is a male and does not feel the need to be a female, but who needs, from time to time, to relieve his internal distress with the illusion of becoming female, and so he cross-dresses. When people respond to him as if he were a woman, he gets a great deal of satisfaction in that he interprets the environment as confirming his internal distortion.

The third category is the homosexual, who knows he is a male, but who has an internal insecurity regarding his masculine identification and seeks to repair that insecurity by romanticizing and eroticizing other men. In so doing, he sexually “incorporates” the other man’s masculinity.

Why is none of this generally known? It used to be common knowledge in the mental health field. However, the body of research that penetrates these psychological anomalies is now essentially buried. Because psychology has abandoned the concept that “normality is ‘that which functions in accordance with its design,’ ” it has also abandoned the conviction that transgenderism is abnormal.

The psychological profession now relies on surface appearance and self-report, and is bowing to the new, cultural conviction that “I can self-create.” Instead, my profession should return to penetrating the real reasons why a psychological phenomenon exists.

Photo credit: Shutterstock


  • Joseph Nicolosi

    Dr. Joseph Nicolosi (1947 – 2017) was the founder of the Thomas Aquinas Psychological Clinic and president of the National Association for Research and Therapy of Homosexuality. His books were recently banned by Amazon, but they remain available at

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