ABSTRACT

Forty-five self-defined female-to-male transsexuals were interviewed as part of a wide ranging sociological field study about female-to-male transsexuals. The data in this study are unusual in that they were obtained outside of any clinical settings. Questions were asked about childhood experiences of physical, sexual and emotional abuse. Sixty percent reported one or more types of severe child abuse. In the course of discussing other issues, participants also reported having experienced many of the commonly cited initial and long-term effects of child abuse, including fear, anxiety and depression, eating disorders, substance abuse, excessive aggression, and suicide ideation and attempts. It was not possible to determine to what extent the sources of these complaints lay in child abuse, in gender dysphoria, in some combination of the two, or elsewhere. While no information was solicited about dissociative responses to child abuse, I have speculated, as have some of the participants themselves, that, in some cases, transsexualism may be an adaptive extreme dissociative survival response to severe child abuse.

INTRODUCTION

Child abuse is a way of life for many people. The U.S. National Center on Child Abuse and Neglect (1981) has estimated that out of every 1,000 U.S. children 3.4 have been physically assaulted, 2.2 have been emotionally abused, and 0.7 have been sexually abused. These figures, based only on the number of officially confirmed child abuse cases, are surely a vast underestimation of the extent of the problem. By contrast, Miller and Miller (1983) found that one-third of college students studied reported moderate, and 5-10% reported severe physical abuse during their childhoods. Russell, in her random sampling study of 930 adult women found that 16% had experienced at least one sexual assault by a family member before the age of 18 years and that 38% had experienced at least one sexual assault either intrafamilially or extrafamilially by the age of 18 years. She found that only 2-6% of sexual abuse cases ever get reported to authorities, few of which are confirmed and make their way into official statistics (Russell, 1986, 1988). Physical and sexual abuse are often accompanied by emotional abuse (Claussen & Crittenden, 1991; Briere & Runtz, 1990; Germain, Brassard & Hart, 1985). Samples taken from psychiatric populations often report much higher incidence rates than those drawn from the general public (McConaghy, 1993).

Children who have been physically abused tend to suffer from an increased number of behavioral problems when compared to children not known to have been abused. Tantrums and aggression are among the most consistently cited phenomena (Ammerman, Cassisi, Hersen, & Van Hasselt, 1986; Hoffman-Plotkin & Twentyman, 1984; Lamphear, 1985; Lewis, Shanock, Pincus, & Glaser, 1980; McLaren & Brown, 1989). Physically abused children often have poor peer relationships, poor social skills, and problems in school (Hoffman-Plotkin & Twentyman, 1984; Lamphear, 1985). Anxiety and depression have also been reported as outcomes of physical abuse of children (Ammerman et al., 1986; Farber & Joseph, 1985). Adults who were physically abused as children often continue to exhibit increased levels of aggressive behaviors (Briere & Runtz, 1990).

During recent years, our understanding of childhood sexual abuse and its adult sequelae has increased tremendously. Browne and Finkelhor’s (1986) comprehensive review of sexual abuse literature allows for some fairly confident assertions about both initial and long-term effects of sexual abuse on those who survive it. Initial effects, which occur within two years of the abuse, are not necessarily short-term. They include fear, anxiety, and depression; aggressive behaviors, and age-inappropriate sexual behaviors. Both clinical and empirical data on these initial effects have suggested similar results (Briere & Runtz, 1988; Browne & Finkelhor, 1986, Conte & Berliner, 1988; Finkelhor & Browne, 1988).

The clinical and empirical literature on the long-term effects of sexual abuse on adult survivors both point to depression and self-destructiveness, including substance abuse, eating disorders and suicide ideation and attempts, as the most frequently reported long-term effects. Sexual functioning also seems to be affected in adults who were sexually abused as children, although empirical confirmation of clinical findings has not been entirely consistent on this point. Sexual problems show themselves in an inability to trust in sexual circumstances, an avoidance of sexual contact altogether, or in sexual compulsivity (Briere & Runtz, 1988; Browne & Finkelhor, 1986; Conte & Berliner, 1988; Courtois & Sprei, 1988; Edwall & Hoffmann, 1988; Finkelhor & Browne, 1988; Fritz, Stoll & Wagner, 1981; Remell, 1990).

Other frequently noted long-term effects of childhood sexual abuse include amnesia for abuse experiences, somatization, depression, and dissociation (Briere & Runtz, 1986; Browne & Finkelhor, 1986; Conte & Berliner, 1988; Courtois & Sprei, 1988; Finkelhor & Browne, 1988; Remell, 1990). These complaints have all been repeatedly and strongly associated with child sexual and physical abuse in the largely psychiatric literature on dissociation and multiple personality disorder where physical, sexual and/or intensive emotional abuse have been reported by 80-90% of persons diagnosed as having dissociative and multiple personality disorders (Braun & Sachs, 1985; Coons, 1986; Coons, Bowman, & Milstein, 1988; Kluft, 1985a, 1985b; Putnam, 1985, 1989; Putnam, Guroff, Silberman, Barban, & Post, 1986; Rivera, 1991; Wilbur, 1985).

Clinical and empirical research have also shown a fairly high degree of agreement regarding the relationship between how children experience sexual abuse and the later effects that abuse has on the survivors. The more severe adult sequelae seem to be associated with abuse that was perpetrated by adult males, particularly by father figures, or that involved force or genital contact (Browne & Finkelhor, 1986; Finkelhor & Browne, 1988).

Child abuse has been frequently reported by female-to-male transsexuals. Pauly (1974a) summarized the information about female-to-male transsexuals found in 80 reports published by 39 authors between 1922 and 1970. Physical abuse was mentioned in 24 reports. Seventy-nine percent reported that the children perceived their fathers as abusive. Twenty-two percent of the 23 articles which included information about validated sexual abuse reported that fathers had sexually abused their daughters. Lothstein (1983) found that approximately half of the 53 female-to-male transsexuals involved in his study reported some form of child abuse and that 23% of them told of incestuous relations. Many of the female-to-male transsexuals who participated in this study also reported suffering from physical, sexual, or emotional abuse during their childhoods, often under the most traumatizing of circumstances. Many of the initial and long-term effects suggested by the literature on abuse were also reported. A few authors have suggested that child abuse experiences may be implicated in the etiology of transsexualism (Money, 1986; Money & Lamacz, 1984; Schwartz, 1988; Zucker & Kuksis, 1990). In this article I present some preliminary data in this regard and make some suggestions for further study.

METHOD

Research Design

Data were gathered through in-depth interviews and observation between September 1988 and September 1992 as part of a sociological filed study for a book on female-to-male transsexuals. Child abuse was not the main focus of this research, therefore, most of the information about possible effects of child abuse were gained indirectly and as a result of questions about other issues. Data were qualitatively analyzed to produce descriptive statistics. Data were also used as the basis for generation of some tentative theoretical
hypotheses.

Subjects

A total of 46 self-defined female-to-male transsexuals were interviewed. They ranged from people who had, at the time of contact, taken no concrete steps toward effecting a transition to those who had completed their transitions eighteen years before. All participants in this study volunteered their time as a result of hearing about this project through public advertisements or through networks within the transsexual community. One person declined to be included in the data set after completing one interview. His reasons for withdrawal are presented later in this report.

Thirty-eight participants lived in the United States, seven lived in Canada, and one person resided in New Zealand at the time of contact. They ranged in age from 22 to 53 years with a mean age of 37 years at the time of first contact. All participants had a minimum of a high school education, with the average being four years of post-secondary education. Participants’ incomes ranged from a low of welfare support to a high of US $75,000/yr. Average income was approximately US $22,600/yr. Thirty-eight participants were Caucasians of European heritage, five people were of mixed heritage two of whom were of Eurasian background, two of Amerindian and European heritage, and one of whom was of Polynesian and European heritage. There was one Black American participant and one Hispanic American participant.

Although the participants in this study did not constitute a random sample of all female-to-male transsexuals, they did represent a relatively large and diverse group. They were also probably more forthcoming than many female-to-male transsexuals because they were interviewed in-depth, outside of any clinical context, and by a sociologist with no ability to influence the course of their lives beyond any personal reactions they may have had to the interview process itself. It therefore seems possible that this research may have uncovered some information not readily available in clinical environments. The sample also included a disproportionate number of individuals who had been active as female-to-male transsexual advocates and were therefore probably more accustomed to speaking with strangers about the more intimate details of their lives. Some of the participants had little or no contact with the therapeutic community in regard to their gender issues. Others had sampled all that gender clinics had to offer and were many years into their new lives. The data presented here, not being based on a random sample, must be taken with caution, but they do provide insights into the lives of female-to-male transsexuals from a different perspective than most publications which have largely been either based on clinical data or auto(biographical).

PROCEDURES

Twenty-seven individuals were interviewed face-to-face and in-depth by the author. In four cases, part of the interview was conducted face-to-face and part was self-administered. Another eighteen people were mailed copies of the interview questions and either answered the questions in writing or by speaking into a tape recorder. Face-to-face interviews were audio tape recorded. Eight of the self-administered interviews were quite brief in comparison to the interviews which were conducted in person. All participants completed at least part I of the interview process; 31 persons also completed part II. Each part of the interview process, when conducted in-person, usually lasted between two and three hours.

Part I consisted of questions about (1) demographic information, (2) gender issues in relationships with family members, (3) gender issues in relationships with peers, (4) gender issues in school experiences, (5) childhood abuse experiences, and (6) sexual and romantic experiences. Part LI covered the following areas: (7) physical health, (8) gender identity development, (9) body image development, (10) transsexual identity development, (11) transition experiences, and (12) philosophical questions about the meanings of sex, gender, and sexuality. (A complete copy of the interview schedule may be obtained from the author.) In-person interviews were loosely structured so as to allow participants more freedom to follow their own thoughts through to their own conclusions. As a result, in those interviews, topics were not always covered in exactly the same way and unique information sometimes arose.

I maintained correspondence, face-to-face, and/or telephone contact with all participants throughout the period of time required to complete individuals’ interviews. I also attended a number of formal and informal gatherings of female-to-male transsexuals during the research period. Field notes were taken after attendance at any such meetings where I was in attendance in an official capacity as a researcher.

Analysis

Interviews were transcribed from audiotape to computer disk. Interview materials and field notes were coded and collated for information about experiences of childhood physical, sexual and/or emotional abuse, evidence of fear, anxiety and depression, expressions of high degrees of anger and hostility during childhood, inhibited or compulsive sexuality, self-destructive behaviours, suicide ideation, and suicide attempts. Descriptive statistics were compiled and possible theoretical implications were noted. No effort was made to arrive at clinical diagnoses.

RESULTS

Childhood Experiences of Abuse

Thirty-eight percent (17) of the participants reported having experienced significant physical abuse in their childhood homes. Table 1 summarizes some of the conditions of the physical abuse experienced by participants.

Type of abuse	n of abused	% of abused
by fathers	12	71 (N = 17)
by mothers	8	47 (N = 17)
frequent	15	88 (N = 17)
early onset	11	65 (N = 17)
Total physical abuse	17	63 (N = 17)

 

I have only considered those situations where the abuse was generally quite severe and ongoing. The abuse that participants suffered took the form of being severely slapped, punched, kicked, burned, horsewhipped, choked, beaten with belts, loops of rubber hose or electrical cable, pushed down stairs, thrown against walls, and locked in basements. Their beatings resulted in welts, bruises, broken bones, bums, and lacerations in addition to the emotional scars they sustained. Most did not receive medical attention, although several felt that they should have. A few required hospitalization. Beatings were administered by both mothers and fathers, although fathers were the abusers 50% more often than were mothers. Many spoke of the daily terror this engendered in them. For example, one person, whose mother used to say “these parents who hug their children make me sick,” recalled:

My mother instituted this thing like if my father was at work and we did anything bad when he got in it was like a regimented thing. He would come in and beat us up. I can remember when [my brother and I] did something and I remember one night we were lying in bed and we heard him come in and both my brother and I were just screaming and crying because we knew for sure that she was telling him and he was going to come in and hit us both. And we were just terrified. I can remember that terror of knowing that there was someone that was going to come in and beat you up. Just give you a really good spanking and hit you on the face and all.

Similarly, another remembered:

We got beaten on a regular basis. Like the mealtimes—it was either before or after.. . . Just to give you an example. . . there was steps to the basement, and at the side there was a mirror, and every time we walked in from that mirror, you could see many parts of the downstairs, and even from the upstairs. We never walked in the house from one place to another without checking in the mirror whether there wasn’t somebody standing there, ready to beat us up.

Sexual abuse experiences were also reported by 31% (14) of the participants in this study, including one person who reported having been date-raped as a teenager. Table 2 summarizes the types of sexual abuse experienced by participants.

Type of abuse	n of abused	% of abused
by older males by father figures by brothers by other older males	9 5 2 5	64 (N = 14) 36 (N = 14) 14 (N = 14) 36 (N = 14)
by mother	1	7 (N = 14)
by date rape	3	21 (N = 14)
by exhibitionist	1	7 (N = 14)
genital contact	11	92 (N = 12)
Total sexually abused	14	52 (N =27)

 

In total 64% (9) of the fourteen people who specifically recounted the facts of at least some of their abuse remembered having been sexually abused by an older male. The mildest form of sexual abuse reported was that of an adult male neighbour exposing his genitals to one six year old. All other instances about which information was provided involved genital contact. These are the kinds of circumstances that previous research has indicated are most likely to produce more severe effects in the lives of those so abused.

Emotional abuse often accompanied the physical and sexual abuse experienced by the female-to-male transsexuals in this study. I have only counted participants as having experienced emotional abuse when the stories they recounted seemed to be well beyond the normal stresses of family life, and indicated recurrent emotional abuse. Terror of abusive parents was one major theme. For instance, one father who was particularly physically and sexually abusive kidnapped his children from their mother and lied to them that their mother was dead. The participant also believed that the father had killed a previous wife and child and therefore was afraid of being murdered, too. Three more participants similarly feared for their lives or the lives of their mothers and siblings. Others told of being profoundly humiliated by their parents. One person, whose father had locked the child in a coal cellar for several days recalled the following incident:

Another incident was a breakfast type of thing. My father insisted that we eat poached eggs. I didn’t like poached eggs and I remember one morning that.., he had made these poached eggs and sat them down in front of me. They were ninny. I didn’t want to eat them. I sat there all day. He wouldn’t let me up from the table. I wet my pants. I ended up defecating in my pants. I still hal to sit there. I ended up failing asleep at the table. He wouldn’t let me go to bed… . and the next morning these things were still sitting in front of me and he said that I would not leave that table for anything until I ate those eggs. Well, needless to say, I ate the eggs, got sick and threw up. But I guess he won that one.

Another person, who was beaten regularly by both parents,
remembered what he referred to as “morn’s favourite game”:

My mom used to have this favorite game, where…, if she was mad at us for whatever reason, she was going to send us to an orphanage—the three of us. And she would go into a big dramatic schpeil about it—how we’d be separated, and we’d never find each other again, and we’d never see each other again, blah, blah, blah… And then she’d put her hand down on the phone, and pretend to call the cab company. “Now you get out on the porch, and you wait for the cab to come,” etc. So, we’d be out on the porch, crying, and making promises to each other that we’d try to find each other no matter what. Then she’d call us, and we’d come back in, and it was time to beg. We’d get down on our hands and knees, and cry and carry on. She may say ”yes,~~ or she may say “no, it’s not good enough,” and send us back out on the porch, and on and on until she was appeased at some point.

In total, 60% (27) of the 45 female-to-male transsexual participants in this study explicitly reported having experienced physical and/or sexual and/or emotional abuse during their childhoods (see Table 3). In most cases, the conditions under which they experienced abuse were those which are likely to be associated with more severe after effects.

 

Type of abuse	n of abused (N = 27)	% of abused	% of total (N = 45)
physical	17	65	38
sexual	14	52	31
emotional	13	50	29
Total (one or more types)	27	100	60

Initial Effects of Childhood Abuse Experiences

Table 4 summarizes the rates participants reported of some of the more commonly found initial effects of child abuse.

Type of Effect	n of abused (N = 27)	% of abused	n of non-abused (N = 18)	% of non-abused
fear/anxiety/depression fear of parent misc. anxieties fear of murder depressed	26 14 3 4 17	96 52 11 15 63	6 0 3 0 5	33 0 17 0 8
aggression fistfights murderous desires	10 3 8	37 11 30	2 2 0	11 11 0
sexual problems	12	44	6	33
Total (one or more effect)	27	100	12	67

It is important to bear in mind when considering these figures that participants were not asked systematic questions about these issues. Instead, this information came out in the course of the retelling of stories about a variety of events. Fear, anxiety and depression have all been shown to be common initial sequelae of child abuse. Fears of parents, including fear that their parents might murder them, each other, or other family members, were common among those who were abused but not mentioned by other participants. Miscellaneous anxieties mentioned by participants included recurrent nightmares, fears of ever being alone in their parents’ home, or being “afraid of people.” Those whom I counted as depressed had specifically stated that they had been “depressed,” “miserable,” or “unhappy” for extended periods of time during their childhood or adolescent years. I excluded those who said that their depression had been related to their gender dysphoria. In sum, childhood or adolescent fear, anxiety or depression was reported by 96% (26) of those who reported abuse but by only 33% (6) of those who did not report abuse. A heightened level of aggressive behaviour has been the most frequently cited initial and long-term effect of physical abuse and has also been noted in relation to sexual and emotional abuse. I have included reports of regularly having been in fist fights with children or with parents as one criterion of childhood aggression. Perhaps a more telling indicator was found in the expression by those who had been abused, but not by any of the others, of strong desires to kill parents, siblings, or others close to the family. Two people actually went so far as to hold guns on the people to whom they objected. In sum, 37% (10) of the abused group, but only 11% (2) of the others, exhibited highly aggressive childhood or adolescent behaviour.

Inappropriate childhood or adolescent sexual behaviour is often used as a clue to the possibility that a young person has been sexually abused. I have counted three participants who reported that they were almost daily masturbators from the ages of four, five, and seven as having exhibited inappropriate childhood sexual behaviour. One of those persons had been physically abused, two reported no abuse. Eight others who were abused reported one or more of the following: masturbating from an early age; having been “sexually precocious” and never having been “innocent” as a child; any hint of sexual contact having brought on nausea as a teen; having been “intensely sexual” as a youth; having worked for many years as a teen and adult prostitute and being “sexually compulsive.” Two of the people who reported no abuse said that, as teens, their own sexual practices were disgusting to them and two reported never having had any sexual activity. In sum, 100% of the abused told of one or more of the initial effects of child abuse, whereas only two-thirds (12) of those participants who did not report abuse reported one or more of the more common initial effects of child abuse.

Long-Term Effects of Childhood Abuse Experiences

Table 5 lists the incidence of some of the more common long-term effects of child abuse as reported by the participants.

Type of effect	n of abused (N = 27)	% of abused	n of non-abused (N = 18)	% of non-abused
depression	20	74	7	39
substance abuse alcohol abuse drug abuse	15 10 8	56 37 30	4 3 3	22 17 17
eating disorders	6	22	0	0
suicide idea or try ideation only attempted	15 7 8	56 26 31	8 6 2	44 33 11
sexual problems	7	26	6	33
Total (one or more effect)	25	93	12	67

Once again, the reader should remember that the interviews used as the basis for these figures were not focused on child abuse or its outcomes. Participants most often commented on these feelings and activities in the course of discussions of others issues.

Depression is among the most frequently observed adult outcomes of child sexual abuse. Depression is also a common concomitant of female-to-male transsexualism. Pauly (1974b) reported that among 45 female-to-male transsexuals 62% said that they were mildly, moderately or severely depressed. Similarly, in this sample of 45 female-to-male transsexuals, 60% reported having suffered from depression at some time in their lives. Among those who reported abuse, 74% reported having been depressed, whereas only 39% of the other participants reported having suffered from depression.

Somatization and self-destructiveness have been observed to occur in adult survivors of childhood abuse. Defining oneself as transsexual includes a preoccupation with and profound distaste for manifestations of one’s birth sex as well as an intense desire for alteration of the physical body. In another sample of genetic females, such a relationship to one’s body might well be considered as either somatization or self-destructiveness. For the purposes of this discussion, I will not consider such body anxiety, or the desire for sex reassignment surgery, as somatization or self-destructiveness because it is precisely this relationship to one’s body which defines a person as transsexual. To transsexual persons, such a relationship to one’s body feels natural and sex reassignment surgery is perceived as palliative rather than destructive.

Eating disorders and substance abuse have been reported among other samples of female-to-male transsexuals, and have also been cited as self-destructive effects of child abuse. Stuart (1983) found that 25% of the 20 female-to-male transsexuals in her sample reported alcohol or drug abuse. In a larger survey covering 13 years and involving 285 female-to-male transsexuals, it was found that 3.2% reported alcohol abuse and 28.8% reported drug abuse (Dixen, Maddever, van Maasdam, & Edwards, 1984). In this sample of 45 female-to-male transsexuals, 29% reported alcohol abuse and 24% spoke of partaking of drugs beyond casual recreational use. Overall, substance abuse was 2.5 times more common among those reporting abuse than among the other participants. Anorexia and obesity were also found among those who reported abuse, whereas none of the other participants made similar reports.

Suicide ideation and attempts are frequently noted as long-term effects of child abuse. Suicide ideation and attempts are also common among female-to-male transsexuals. Pauly (1974b) reported that 17.5% of the persons he studied had attempted suicide. Lothstein (1983) reported almost half in his study as being suicidal. Stuart (1983) reported that 41% of her sample had considered suicide and that 15% had made an attempt. Dixen et al. (1984) reported 19% of the group they had studied had tried to kill themselves and 11% had considered the idea. Fifty-one percent of the female-to-male transsexual participants in this study had either considered or attempted suicide at some time in their lives. It is of interest to note that among those who did not report abuse, thoughts of suicide were three times more common than attempts, whereas those who did report abuse were as likely to have attempted suicide as to have only considered doing so.

Impairment of sexual function has also been cited as one of the possible long-term effects of child abuse. It is difficult to say exactly what constitutes impairment of sexual function among female-to-male transsexuals. Some female-to-male transsexuals have never experienced consensual sex with males, most spend a part of their lives living as lesbian women, most feel a strong aversion to their female sexual body parts, and many require that their lovers either avoid those parts altogether or relate to them as if they were physically male. I have not included such behaviours as signs of sexual impairment among female-to-male transsexuals.

It should come as no surprise to find that people who suffer such a profound alienation from their bodies would have difficulties achieving satisfactory sexual relationships. Twenty-nine percent of participants reported significant impairment of sexual function such as a complete inability to orgasm, complete sexual abstinence, sexual compulsiveness, or expressions of disgust and physical revulsion for the sexuality that they did engage in. As might be expected, participants reporting abuse mentioned similar levels of sexual impairment as those who did not report abuse.

To summarize, depression, substance abuse, and eating disorders were more commonly found among those who reported abuse. Suicide ideation and attempts, and significant sexual problems were found to exist to a similar extent in both groups. In total 93% (25) of those who remembered having survived child abuse, but only 67% of the others, reported thoughts, feelings, and behaviours which have been identified as possible long-term effects of child abuse.

There are other possible initial and long-term outcomes of child abuse, amnesia for abuse and dissociation, about which I am unable to provide any summary data. Clearly, if abuse experiences are still suppressed from memory, they will not be recalled for an interviewer. However, a few people did mention that other family members had told them of abuse episodes that they themselves had no memory of; others said that they were able to retrieve memories of abuse experiences only after they had made their transitions.

It is also worth noting that all three of the participants who were therapists mentioned that they thought that their own abuse experiences might be related to their transsexualism. One specifically talked about the possibility of using dissociation as a psychological defense against abuse, suggesting that transsexualism might originate in a mechanism similar to that commonly theorized as underlying multiple personality disorder. This person spoke of the possibility of having “lost a little girl” through abuse but made the point that, after so many years of being gender dysphoric, resolution to a gender identity as a woman was not desirable:

I think that serious assault of a young child, especially sexual assault, might cause some children to dissociate and split in a way that establishes a sense of self different from one’s biological sex. I have, in my clinical experience, worked with a number of women with multiple personality disorder who were sexually and physically traumatized as children who have male identities and identities or personalities that are of different races and sexual orientations as well. . . . I don’t know whether there was a little girl that, fairly early on, through some abuse, disappeared. I don’t know that. But I do know that even if that happened, and I were to try to identify that and work it through, it just seems like the way I’ve lived my life to this point, for forty-one years, says there’s something to be said for that identity.

Another psychotherapist with advanced training and degrees in his field, who completed one interview and then asked not to be included in the data set, recounted this story to me in response to a query about his earliest memories. He has given me permission to explain his reasons for withdrawal and to summarize some of what he said.

Approximately six years after he began living full-time as a man, he reported having two dramatic abreactions of sexual abuse. He told me that he had reason to believe that the sexual abuse had occurred at approximately age fourteen months. Prior to his abreaction experiences, he had had no previous recollection of sexual abuse. He went on to say that he doubted that he would have become a transsexual were it not for the abuse he experienced. In his opinion, he had dissociated away both the memory of the abuse, and his attachment to the femaleness that the “baby girl” had interpreted as having made her vulnerable to such abuse. He also believed that he was able to reclaim the memories of the abuse only when he was a man and therefore no longer in any danger of being sexually abused as a female. Furthermore, he was of the opinion that such abuse and dissociation experiences were at the core of many cases of transsexualism.

He withdrew from the research project because, in the time since remembering his abuse, he had been engaged in “reclaiming the little girl” whom he felt he had dissociated away so early in life. He told me that he feels that she is still very wary of being used by others for their own ends and that having told me of her existence began to feel vulnerable to the possibility of her words being used / abused in the research process. He said that my recounting of our conversations, one step removed, was not perceived by the “little girl” as a violation.

DISCUSSION

The female-to-male transsexuals who participated in this study told of having experienced many instances of severe physical, sexual, and/or emotional child abuse. They also recounted stories describing many of the commonly found initial and long-term effects of child abuse. The research which uncovered this information was not directly focused on eliciting such information, therefore this report can only be suggestive rather than declarative. It is also important to bear in mind that there was probably an increased likelihood of disclosure of abuse experiences under the conditions of this research because I had no power to effectively label participants as mentally ill or to otherwise interfere with their progress in their new gender status. At the same time, it seems unlikely that participants would have been motivated to fabricate histories of abuse when the most commonly stated reason for participation was to contribute to a realistic picture of the lives of female-to-male transsexuals. Most female-to-male transsexuals, in my experience with them, are quite concerned that their condition not be construed as an outgrowth of psychological instabilities. Those who have not completed their transitions into men are fearful that they might be denied sex reassignment surgery due to attributions of their transsexualism being a treatable psychological symptom. Those who have already made their transitions are wary that neither they, nor their brothers, should retroactively become similarly stigmatized. I found their stories of child abuse credible.

The female-to-male transsexuals in this sample reported an incidence of physical child abuse which approximated that found in other studies (Miller & Miller, 1983; Russell, 1986, 1988). They also reported many of the possible effects of child abuse. Fully 100% of those abused, as compared to only 67% of the others, reported at least one of the possible initial effects of child abuse; 93% percent of those abused, but only 67% of the others, said that they had experienced one or more of the long-term effects of child abuse. It is possible that the ongoing stresses of transsexualism might have produced effects similar to the long-term effects of child abuse. More research is needed to clarify this issue.

Nonetheless, the data presented here did suggest that if so many common sequelae of child abuse were reported by this group, then others may also have been present. Many clinicians have found that severe child abuse can result in various degrees of dissociation. It is my suggestion that in some cases transsexualism may be an extreme adaptive dissociative response to severe child abuse. Under such circumstances, transsexualism might constitute a kind of adaptive “normal dissociation” (Ross, 1989, p. 86-90) enabling individuals to consciously and willfully move between psychic personality elements. In such cases, a male protector/survivor personality, which functions co-consciously (Beahrs, 1983) with the original female personality, might act first as a defense, and later, after many years of reinforcing psychological and socialization experiences, as an escape route from otherwise intolerable psychic pain.

Several authors have, indeed, suggested that transsexualism might be viewed as a result of a kind of personality splitting or dissociation (Meyer, 1982; Money, 1974, 1986; Volkan & Berent, 1976). Money (1986) briefly mentioned that both child abuse and dissociation “could be etiologically important” in transsexualism (p. 210). Schwartz (1988) wrote about a single case where she diagnosed a post-operative male-to-female transsexual as having multiple personality disorder. She suggested that the person’s transsexualism and multiple personality disorder were both related to extensive child abuse experiences.

Unfortunately, several of the theorists who have discussed a possible connection between child abuse and transsexualism appear to have fallen prey to Freud’s error of failing to see, or give sufficient weight to, child abuse when it does exist (Masson, 1984). Green (1974) suggested that some people may use transsexualism as a defense against their own incestuous desires. He suggested that female-to-male transsexuals may use the strategy that they cannot have sexual relations with their own fathers if they themselves are males. He did not seem to entertain the notion that there might have been actual incest from which children needed defense. Meyer (1982) proposed that transsexuals split off their “good” and “bad” personality traits assigning aggressiveness to their male personality segments. In the case of female-to-male transsexuals, that aggressiveness can be used to defend against female vulnerabilities. Meyer seemed to see this as a symbolic action with little relation to real dangers. Lothstein (1983) suggested that female-to-male transsexuals perceive their femaleness as a dangerous condition and that they believe having a penis acts as “a magical totem” which protects its owner against violation (p. 144-5). Unfortunately. Lothstein’s tone seemed to imply that it is unrealistic to perceive femaleness as a dangerous condition and maleness as a position of relative safety.

Young (1992) took up the question in more general terms. She pointed out that when children’s bodily integrity is violated through physical or sexual abuse, they are left with a problem of embodiment. They have to find a way to live with/in a body which has become a site of danger to them as whole and integrated persons. The literature on multiple personality disorder discusses this issue extensively. Most authors conclude that children may cope with such trauma by dissociating themselves from the body/person who is being hurt and by creating other “people” who can better handle abuse. Thus, they live with the body/person who is subjected to abuse but not in that body/person when there is danger present.

While the true prevalence rate of multiple personality disorder is an intensely debated issue, those experts who do not doubt its existence argue that multiple personalities are formed as extreme dissociative responses to trauma such as multiple and severe incidents of child abuse. They claim that it is quite common, in multiple personality disorder, for alter personalities to be of a different gender than that of the original personality. More than 80% of persons who have been diagnosed as having multiple personality disorder are believed to have protector personalities, who are almost always males (Putnam, Guroff, Silberman, Barban, & Post, 1986; Rivera, 1988; Ross, Norton, & Wozney, 1989). It seems like a logical step for youngsters who are being abused to assume that were they to become like their aggressors they would also become as invulnerable as those aggressors seemed to them at the time (McCarthy, 1990). This mechanism has been suggested as being actively used by youngsters who later become female-to-male transsexuals as a defense against abusive males in their lives (Bradley, 1980, 1985; Lothstein, 1983; Pauly, 1974b).

As is the case with other instances of dissociation and child abuse, precipitating abuse experiences might not be available to memory until a state of sufficient psychic safety has been reached. A successful transsexual transition may be one such place of safety. I would therefore suggest that clinicians should be aware of this possibility and that, in order to clarify these issues, further research should be undertaken into child abuse experienced by transsexuals and the coping mechanisms used by them in response to those experiences. Finally, I wish to underscore that I am neither suggesting that child abuse might be the cause of transsexualism, nor am I suggesting that people should necessarily be denied access to sex reassignment surgery if they are found to be highly dissociative. Transsexualism is, no doubt, the result of many and complex biological, psychological, and social forces. If further research does indeed establish that some transsexual people also have multiple personality disorder, or another extreme dissociative condition, then it would seem only humane to ensure that it is an individual with an integrated personality that requests and receives sex reassignment surgery. It is my hope that a better understanding of the relationship between child abuse and transsexualism will aid in the healing and strengthening of those people who are still suffering in the painful aftermath of child abuse.

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Acknowledgements
The author wishes to express thanks to the people who volunteered their time to become involved in this research project and to teach her something of their way of life. She also wishes to thank the Social Sciences and Humanities Research Council of Canada and the University of Victoria for funding which aided in the accomplishment of this research. Finally, her thanks go to Lynn Greenbough, Frances Ricks, and anonymous reviewers for helpful comments on earlier drafts of this paper and to her research assistants: Noreen Begoray, Bev Copes, Sheila Pedersen, and Sandra Winfield.

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