A Psychological Investigation of the Link Between Autism Spectrum Disorder and Gender Dysphoria/Incongruence

The clinical recognition of the high co-occurrence of autism spectrum disorder (ASD) and gender dysphoria/incongruence has received increased attention in recent years from researchers, as well as the lay press. Yet, many aspects of this phenomenon remain obscure. The overarching aim of this thesis was to develop an enhanced understanding of this intersection by answering three main questions. (1) Is there a link between ASD and gender dysphoria/incongruence? (2) What is the role of mentalising in the high co-occurrence of ASD and gender dysphoria/incongruence? (3) How does ASD affect gender-related cognition? To begin address these questions, we conducted a systematic literature review, two meta-analyses, two studies in the general population (original study; N = 101, followed by a replication study; N = 126), and a case-control study in neurotypical and autistic cisgender and transgender adults (N = 347). The findings in this thesis indicate the existence of a link between ASD and gender dysphoria/incongruence that is real and not a methodological artefact. Results of our studies also suggest that mentalising is not the shared underlying mechanism that underpins this link. Yet, our findings indicate that a mentalising difficulty might trigger subclinical gender dysphoric feelings in autistic cisgender people. Lastly, this thesis provides evidence that ASD hinders the explicit (and implicit at least among birth-assigned females) identification of autistic cisgender people with their experienced/reported gender. Autistic transgender people's explicit and implicit identification with their experienced/reported gender seems to be unaffected by ASD. The theoretical and clinical implications of these findings, as well as directions for future research are discussed.