Self-Hatred, Gender Dysphoria & Autism
Psychological issues that cannot be fixed by gender transition
According to the CDC, 1 in 44 children are now born with Autism. This increase in Autism has been consistent for years. The ratio for males to females is now 2:1 steadily heading towards 1:1. A core theme in many autistic, aspergers, adhd or neurodiverse/neurodivergent individuals is self hatred or self-loathing, in both the diagnosed & undiagnosed and across the lifespan. Many children, teens and adults are unaware they have Autism, Aspergers Syndrome, ADD, or other conditions and/or learning differences. Autism at it’s ‘core’ is a social communication difference with sensory processing differences, fine and gross motor skills issues, restricted interests or obsessions and language issues. IQ, EQ, social skills may be at different developmental stages within the same person.
Many individuals have mental health conditions and/or learning issues. Many are misdiagnosed or have missed diagnoses, for many years, or their entire lives. Those who were late diagnosed (after kindergarten) are included. A common theme is growing up feeling 'different', 'not fitting in', not belonging on “this planet”, being bullied, not being accepted, 'feeling like an alien', being placed on the wrong planet, not understanding oneself or others and the subsequent confusion all leading to poor and negative low self-esteem.
A lack of friends, family of origin (FOO) issues, difficulties communicating, being misunderstood & trauma are common. They may have Post Traumatic Stress Disorder, childhood developmental trauma, a history of being bullied (or vice versa due to lack of trust in others) and/or abused. They often feel as though something is inherently wrong with them (shame & guilt), with no understanding of what or why. Their undiagnosed learning disabilities make them feel dumb when they may actually be high average to gifted IQ (with a subtext scatter). They don't relate to their peers. Their strengths have gone unrecognized or ignored. There may be undiagnosed twice exceptional (2e). They often do not know they are 2e.
They often have sensory processing issues, clumsiness, dyspraxia, dyslexia, dyscalculia, dysgraphia, executive function issues, Alexythymia, proprioception & interception issues, anxiety, depression, social communication issues, obsessions or OCD, synaesthesia, aphantasia, face blindness, Tics, face blindness, restricted interests, & language issues (literal inflexible thinking, black & white thinking). They also have a wide number of strengths (this is another post). Unfortunately, too much emphasis is placed on their challenges.
They may also have mental health issues, ranging from mild to severe. Autistic teens are at a higher risk for psychosis, other mental health conditions and personality disorders. They are also are the highest risk group for sexual abuse, especially females. This is not uncommon in my work & seen in the research.
All or any of these issues often lead to self hatred or internalised hatred, of the body, of the self, of the mind. The other aspect of this is that in social camouflaging (masking, assimilation & compensation) enables them to try to fit in, by altering one's non-verbal appearance, repressing emotion, copying and mimicking others. However, in doing this, they sacrifice their own identity and core self as they take on bits of other peoples identities, over time. They do this to fit it socially, hide parts of themselves, be included in a group or act ‘normal’. This can look like Borderline Personality Disorder, although it certainly is possible to have both. This is a florid presentation different to 'pure autism'. It is also known as 'Autism plus' by Professor Christopher Gilberg. Experienced & highly trained clinicians in Autism and neurodevelopmental conditions, who have seen hundreds of Autistic clients understand all the expressions, subtypes and presentations, including who would be the least likely to be diagnosed (that is another post entirely).
Self hatred or internalised hatred has devastating consequences for the individual (and those around them), where there is virtually nothing they like about themselves. They have no core self, no sense of who they are or their own 'identity'. They may hate others who have the skills they wish they had & lash out at them in unhealthy ways. This can often be seen in the hatred displayed towards neurotypical people.
When I discuss ‘identity’, I am not talking about pronouns or sexuality. I am talking about who a person is at their core, what they like or don't like, their strengths, their personality, their unique self. Identity work is critical to self esteem & overcoming self hatred and self worth issues. This is achieved through therapy. Long term psychotherapy is indicated for internalised hatred and rejection of the body, their autism & associated challenges, in addition to a exploration and focus on their strengths, understanding their Autism & making environmental changes. Identity work is a key therapeutic component.
The removal of the term Aspergers has been problematic. Children, teens and adults with Aspergers are now more often missed diagnostically due to the more subtler signs and not meeting the full DSM criteria or being too ‘high-functioning’. It may appear that the Autism appeared when they were teenagers, but the subtle signs were always there in early childhood. Puberty and Autism (diagnosed or undiagnosed) has been described to me by clients as 'hell' and I agree with them. They often have depression, severe anxiety, severe challenges with their changing bodies (which they cannot control), heightened emotions (larger amygdala), sensory issues, along with a higher social skills load, which often is exhausting. Remember, Autistic individuals find change and uncertainty very challenging and very scary. They prefer things, their schedule, their environment, their food to be the same, as examples, keeping in mind that one person on the spectrum is just one person on the spectrum. A schedule, step plan or outlook for their future is calming, as they know what is going to happen to them and their life ahead of time.
We have a large number of undiagnosed Autistic individuals, across the lifespan, (worldwide), desperate for appropriate diagnoses, therapy and support. Often their teenage difficulties mimic Gender Dysphoria and it is crucial they receive comprehensive assessments, diagnoses, treatment, support and long term therapy, first.
I love your writing. Thank you. Your work is one of the reasons my 16 year will get screened for Autism next week.
For me, the self-hatred really started to set in when I realized that Asperger's (and, before that, PCOS,) had closed the doors on the life I wanted. I wanted to get married and have kids, that's it. Nothing exciting or special. When, in 2000 in 10th grade, I realized that kids might not be something my body could do, I figured, "I'll just have to hope to find a husband who's willing to adopt." Fast forward 14 years and I'm realizing that I'm probably autistic, and then I read somewhere that something like 98% of high-functioning women, regardless of desires, never marry. THAT was when the self-hatred set in, when I realized that a genetic condition in which I had NO say and NO control over (and NO treatment for growing up, because 80s baby,) was going to cost me not everything, but everything I ever wanted. I'd give up the higher IQ, every "plus" others might see in my autism, just to not live alone, to not die alone. Nursing homes are often abusive enough environments; what will they be decades from now for an autistic woman with no spouse or children to advocate for her? I tremble at the thought...
I'm old enough (and stubborn enough,) that gender dysphoria wasn't ever an issue for me, though, even as a teen; instead of feeling "less female" because of autism specifically, the Asperger's allowed me to tell myself that *I* was the normal one and aaaaaaall of the other girls were the wrong and defective ones 🙄 (It wasn't until my 30s that I even realized that the things I hated about them were *why* they were married and I wasn't and am not.) The fact that PCOS couldn't fully "transition" my body to male was something that kept me SANE. Had PCOS had even the potential to fully "transition" my body, I don't know if I would've refused suicide's siren song... One condition kept me from looking sufficiently female to attract a husband; the other, "extreme male brain syndrome," and my presentation of Asperger's is VERY classically male, (what role the PCOS had in that being the case, only God knows,) so boys, and later on men, only ever treated me as their kid sister or, more often, one of the guys.
I hate myself because my SELF can't obtain the things she wants or desires in life, my SELF can barely hold a steady job, my SELF can barely function as an adult. (To say my apartment is abject squalor is an understatement; I've had multiple infestations of flies *just this year.*) I can leave puberty and all of the rest in the past; the worst parts of autism have been aging and watching my dreams die. If I could go back to that 15-year-old Muzical, whose "transition" to high school went about as well as a nuclear bomb going off, and tell her one thing, I'd tell her to give up on her hopes and dreams because she is unable to achieve them. The one thing she wanted that WAS achieved, a college degree, by the time it was obtained, it was no longer desired on any level, and it wasn't even useful, let alone helpful.
Sorry for the rambling, but I'm guessing your professional experience means you're used to it 😅