Mental Pain and Psychological Correlates in Individuals With Gender Dysphoria

Background: Previous studies have observed high mental distress in individuals with gender dysphoria (GD). A deeper investigation on constructs underlying mental distress in this specific population is warranted, given the high burden of neglected health needs. Aims: To assess mental pain levels in individuals with GD, compared to a control group, and to evaluate potential psychological correlates. Method: In this case-control study, 180 individuals were enrolled between January 2020 and January 2024 (94 individuals with GD and 86 controls). All participants completed the following questionnaires: Identity and Eating disorders questionnaire, Orbach & Mikulincer Mental Pain scale, Symptom CheckList 90 - Revised, Beck Depression Inventory II. Results: Among participants with GD, 39 were undergoing gender affirming hormone therapy (GAHT) while 55 were not. Individuals with GD showed significantly higher levels of mental pain than those in the control group (Cohen's d = 0.318, p < 0.001). Positive correlations emerged between mental pain and general mental distress (r = .559, p < .001), depression (r = .828, p < .001), or embodiment disturbances (r = .582, p < .001). Individuals with GD undergoing GAHT for at least one year showed lower levels of mental pain than those seeking GAHT, but not exposed to GAHT at the time of evaluation (Cohen's d = 0.571, p < .001). Conclusion: Mental pain is elevated in individuals with GD, with specific correlates related to mental distress, depression, and embodiment disturbances. Preliminary evidence suggests that GAHT may reduce levels of mental pain in individuals with GD.