跨性别者之中有很多自闭谱系人士？│ 文献导读

Original 症状网络症状网络 Symptoms Network

先上结论

跨性别人士自闭特质（ACS）在统计上明显高于顺性别对照，大量研究均能发现这个相关性，但是差异并不大，跨性别人群大概百分之十几具有较高自闭特质，相比顺性别人群的自闭特征大概在个位数。仅仅具有较高的自闭特质并不能诊断自闭症；同时，自闭谱系障碍的患者中性别烦躁的出现率较高。

但是有许多不足之处，体现在：

（1）跨性别者的焦虑与社交焦虑水平明显高于对照组，因此难以在匹配相同的焦虑与社交焦虑的情况下对比。尤其是目前的调研方式大部分是基于self-reported autism spectrum quotient-short (AQ-short)，这个问卷适合测量智商平均或是高于平均的人群，在高焦虑水平的人群难以区分。

（2）借由网络招募与滚雪球招募的受试者的自闭特质明显高于人群，而目前大部分的跨性别者的研究都难以避免这种样本招募方式。

【前沿扩展】已知激素疗法能减轻性别烦躁，其作用的靶点是否与某些自闭症特异性的靶点相关。

【前沿扩展】也有一些网上社群中的说法赞成这样的观点：自闭谱系人群远比一般人更抵抗社会规训大部分普通人中潜在的跨性别者被社会二元化的性别规范抹杀了。

文献汇总

观点01

自闭症谱系疾病的患者共病性别烦躁的比例较一般人群高

Lai, M. C. , Kassee, C. , Besney, R. , Bonato, S. , Hull, L. , & Mandy, W. , et al. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis.Social Science Electronic Publishing.

观点02

跨性别者的抑郁、焦虑水平明显升高

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观点03

跨性别者与自闭症谱系疾病相关

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Parkinson J. Gender dysphoria in Asperger’s syndrome: A caution. Australasian Psychiatry. 2014;22(1):84–85. doi: 10.1177/1039856213497814.

Robinow O. Paraphilia and transgenderism: A connection with Asperger’s disorder? Sexual and Relationship Therapy. 2009;24(2):143–151. doi: 10.1080/14681990902951358.

Tateno M, Tateno Y, Saito T. Comorbid childhood gender identity disorder in a boy with Asperger syndrome. Psychiatry and Clinical Neurosciences. 2008;62(2):238. doi: 10.1111/j.1440-1819.2008.01761.x.

Vanderlaan D, Leef J, Wood H, Hughes S, Zucker K. Autism spectrum disorder risk factors and autistic traits in gender dysphoric children. Journal of Autism and Developmental Disorders. 2015;45:1742–1750. doi: 10.1007/s10803-014-2331-3.

Jones R, Wheelwright S, Farrell K, Martin E, Green R, Di Ceglie D, Baron-Cohen S. Brief report: Female-to-male transsexual people and autistic traits. Journal of Autism and Developmental Disorders. 2012;42(2):301–306. doi: 10.1007/s10803-011-1227-8.

Pasterski V, Gilligan L, Curtis R. Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior. 2014;43(2):387–393. doi: 10.1007/s10508-013-0154-5.

观点04

认可跨性别者与自闭症谱系疾病相关，但是提到缺乏合适的高焦虑水平的顺性别对照组。跨性别者可能遇到与自闭症者类似的困境，例如切换社会角色，以及童年被欺负，因此出现了类似的应对方式与表征，出现类似的高焦虑与低自尊。例如常规行为变化相关的社会困难，切换性别角色，这意味着学习和实践不同的性别特定行为，可能会出现类似于自闭症谱系疾病适应社会时出现的困难。此外，社交焦虑者，填写量表时，具有将某些条目夸大的倾向。

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Shumer D, Reisner S, Edwards-Leeper L, Tishelman A. Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic. LGBT Health. 2015;3(5):387–390. doi: 10.1089/lgbt.2015.0070.

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Lombardi E. Enhancing transgender health care. American Journal of Public Health. 2001;91(6):869–872. doi: 10.2105/AJPH.91.6.869.

Grossman AH, D’, augelli AR. Transgender youth: Invisible and vulnerable. Journal of homosexuality. 2006;51(1):111–128. doi: 10.1300/J082v51n01_06.

Skagerberg E, Di Ceglie D, Carmichael P. Brief report: Autistic features in children and adolescents with gender dysphoria. Journal of Autism and Developmental Disorders. 2015;45(8):2628–2632. doi: 10.1007/s10803-015-2413-x.

White S, Bray B, Ollensick T. Examining shared and unique aspects of social anxiety disorder and autism spectrum disorder using factor analysis. Journal of Autism and Developmental Disorders. 2012;42(5):874–884. doi: 10.1007/s10803-011-1325-7.

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Bouman WP, Davey A, Meyer C, Witcomb GL, Arcelus J. Predictors of psychological well-being among trans individuals. Sexual and Relationship Therapy. 2016;31(3):357–373.

观点04扩展-1

高焦虑水平以及社交焦虑的患者，尽管可以出现自闭分数升高，但是不能解释跨性别者出现的具有自闭症特征性的注意力转移特点以及模式化的认知特征。

Bouman WP, Claes L, Marshall E, Pinner G, Longworth J, Maddox V, Arcelus J. Socio-demographic variables, clinical features and the role of pre-assessment cross-sex hormones in older trans people. Journal of Sexual Medicine. 2016;13(4):711–719. doi: 10.1016/j.jsxm.2016.01.009.

Gómez-Gil E, Zubiaurre-Elorza L, Esteva I, Guillamon A, Godás T, Almaraz MC, Salamero M. Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology. 2012;37(5):662–670. doi: 10.1016/j.psyneuen.2011.08.010.

观点04扩展-2

尽管跨性别男性的自闭得分较高，跨性别女性的社交焦虑明显高于跨性别男性，而且跨性别女性的社交模式有许多自闭症特有的特点，不能用社交焦虑来解释。而跨性别女性较低的自闭特质可能由于既往对自闭症理论过于倾向于男性中心偏差的原因，才会导致跨性别女性的自闭特质出现了出现了假阴性。

Yu C, Zuo X, Blum RW, Tolman DL, Kågesten A, Mmari K, Lian Q. Marching to a different drummer: A cross-cultural comparison of young adolescents who challenge gender norms. Journal of Adolescent Health. 2017;61(4):S48–S54. doi: 10.1016/j.jadohealth.2017.07.005.

Batten A. Inclusion and the autism spectrum. Improving schools. 2005;8(1):93–96. doi: 10.1177/1365480205049341.

Turban JL, van Schalkwyk GI. “Gender Dysphoria” and autism spectrum disorder: Is the link real? Journal of the American Academy of Child & Adolescent Psychiatry. 2018;57(1):8–9. doi: 10.1016/j.jaac.2017.08.017.

观点05

认可跨性别与自闭症谱系疾病相关，但是提到测量工具不足，自闭特质并不能代表自闭症谱系疾病。

Pine DS, Guyer AE, Goldwin M, Towbin KA, Leibenluft E. Autism spectrum disorder scale scores in pediatric mood and anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2008;47(6):652–661. doi: 10.1097/CHI.0b013e31816bffa5.

观点06

认可跨性别与自闭症谱系疾病相关，但是提出网络招募的样本自闭特质会偏高

Kristensen Z, Broome M. Autistic traits in an Internet sample of gender variant UK adults. International Journal of Transgenderism. 2016;16:234–245. doi: 10.1080/15532739.2015.1094436.

观点07

用于量化智力水平平均或高于平均水平的成年人的自闭症特征

Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders. 2001;31(1):5–17. doi: 10.1023/A:1005653411471.

Wheelwright S, Auyeung B, Allison C, Baron-Cohen S. Defining the broader, medium and narrow autism phenotype among parents using the autism spectrum quotient (AQ. Molecular Autism. 2010;1(1):10. doi: 10.1186/2040-2392-1-10.

Woodbury-Smith M, Robinson J, Wheelwright S, Baron-Cohen S. Screening adults for Asperger syndrome using the AQ: A preliminary study of its diagnostic validity in clinical practice. Journal of Autism and Developmental Disorders. 2005;35(3):331–335. doi: 10.1007/s10803-005-3300-7.

Baron-Cohen S. A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE. 2011;6:e20835. doi: 10.1371/journal.pone.0020835.

Hoekstra R, Vinkhuyzen A, Wheelwright S, Bartels M, Boomsma D, Baron-Cohen S, van der Sluis S. The construction and validation of an abridged version of the autism-spectrum quotient (AQ-short) Journal of Autism and Developmental Disorders. 2011;41:589–596. doi: 10.1007/s10803-010-1073-0.

观点08

认可跨性别群体AQ得分较高，但是认为这种升高有其它原因，而非与自闭症谱系疾病相关。

Brugha TS, Spiers N, Bankart J, Cooper S, McManus S, Scott FJ, Tyrer F. Epidemiology of autism in adults across age groups and ability levels. British Journal of Psychiatry. 2016;209(6):498–503. doi: 10.1192/bjp.bp.115.174649.

Kristensen Z, Broome M. Autistic traits in an Internet sample of gender variant UK adults. International Journal of Transgenderism. 2016;16:234–245. doi: 10.1080/15532739.2015.1094436.

观点09

跨性别女性较顺性别女性有较高自闭特质，但是与顺性别男性比差异不大。

跨性别男性有较顺女、顺男、跨女有更高的自闭特质。30%的跨性别男性高于人群两个标准差的自闭特质得分，只有5%的顺性别女性达到这个分数。

其中7%的跨性别男性能够达到自闭症谱系疾病的诊断，而顺性别女性只有1%。跨性别女性与顺性别男性的自闭特质得分以及自闭症谱系疾病发病率接近，但是稍高，有统计学意义。因此有部分的人认为，自闭谱系疾病“完全男性脑（EMB）”的理论适用于跨性别男性，但是不适用与其它群体。

Kristensen Z, Broome M. Autistic traits in an Internet sample of gender variant UK adults. International Journal of Transgenderism. 2016;16:234–245. doi: 10.1080/15532739.2015.1094436.

Pasterski V, Gilligan L, Curtis R. Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior. 2014;43(2):387–393. doi: 10.1007/s10508-013-0154-5.

观点10

全男脑extreme male brain theory（EMB）

“极端男性大脑”理论表明，自闭症谱系障碍（ASD）是男性智力的极端变异。然而，有些自相矛盾的是，许多患有ASD的人不论性别都表现出雌雄同体的身体特征。

Auyeung B, Baron-Cohen S, Ashwin E, Knickmeyer R, Taylor K, Hackett G. Fetal testosterone and autistic traits. British Journal of Psychology. 2009;100(1):1–22. doi: 10.1348/000712608X311731.

Baron-Cohen S. The extreme male brain theory of autism. Trends in Cognitive Sciences. 2002;6(6):248–254. doi: 10.1016/S1364-6613(02)01904-6.

Baron-Cohen S. The essential difference: The truth about the male and female brain. London: Allen Lane; 2003.

Baron-Cohen S, Auyeung B, Nørgaard-Pedersen B, Hougaard DM, Abdallah MW, Melgaard L, Lombardo MV. Elevated fetal steroidogenic activity in autism. Molecular Psychiatry. 2015;20(3):369–376. doi: 10.1038/mp.2014.48.

观点11

网上观点：自闭谱系人群远比一般人更抵抗社会规训

自闭人群中跨性别者比例远高于一般人群的原因并不是某些研究者认为的所谓“自闭者较容易被误诊为跨性别” 。而是自闭谱系人群远比一般人更抵抗社会规训大部分普通人中潜在的跨性别者被社会二元化的性别规范抹杀了。也就是说跨性别者占人类的实际比例应该是跨性别者占自闭人群的比例。