The Embodied Fracture: Gender Discomfort and Dissociation as Undiagnosed Trauma

ByAdam O’Brien PhD

The Wounded Healers Institute (WHI), through the lens of the Addiction as Dissociation Model (ADM), views the psychological distress known as Gender Dysphoria (GD) or Gender Discomfort (GDC) not as a primary condition, but as a severe somatic manifestation of unresolved trauma and chronic dissociation. This perspective is particularly critical for understanding the high co-occurrence rates found in Neurodivergent populations (ASD), where individuals are three to six times more likely to be gender-diverse than neurotypical people.  

The failure of mainstream clinical models lies in their limited, industrialized and nationalized siloed definitions of the key concepts that govern human suffering—namely, addiction, dissociation, and the unconscious—leading to widespread misdiagnosis, misdirected treatment, and the perpetuation of trauma, particularly medical and psychological traumas. This work will reveal what is a far cry from “do no harm”, particularly when those who are supposed to be educated are the ones that are so unaware of how dissociative their definitions are and why they do not see it enough to understand it.

I. The Somatic Roots of Identity Crisis: A Dissociation-Informed Model for Gender Discomfort

A. The Definition Crisis: The Unconscious, Addiction, and Dissociation

The inadequacy of the current clinical response to complex presentations like co-occurring ASD and GD is traceable to a definitional crisis within psychology, medicine, and law:

  1. The Unconscious is the Body: Mainstream psychiatry, operating from a mind-body dualism, treats the physical body and the psychological self as separate entities. The WHI fundamentally rejects this, asserting that the “physical body is the psychological unconscious”. Trauma is stored somatically, manifesting as “tension, blockages, constrictions, flattening sensations and emotions”. For individuals with ASD, who often struggle with interoception and sensory overwhelm, the constant state of being overwhelmed is chronic environmental and relational trauma. Therefore, the distress of GDC (the “marked incongruence” defined by the DSM) is not merely a mental belief, but the somatic dissociation of the body-unconscious rejecting a painful, unsafe reality.  
  2. Dissociation as Undiagnosed Healing: Dissociation is defined by the WHI not just as a pathological symptom, but as an adaptive survival mechanism. It is the mind’s effort to create distance from overwhelming experiences that cannot be escaped. In the context of ASD, the struggle to form a coherent understanding of their ambiguous and often hostile social environment, coupled with deficits in social interaction and communication, leads to persistent feelings of alienation and profound distress. The feeling of being fundamentally “mismatched” with the body and assigned gender can thus be understood as a structural dissociation—the psyche fragmenting to survive the inescapable trauma of existence in a neurotypical world. This dissociative state is an initial, albeit failed, attempt by the body to start the healing process.  
  3. Addiction as Relational Dependence: The WHI’s Addiction as Dissociation Model (ADM) redefines addiction as attachment dependence and a dissociative trauma reenactment loop. The pursuit of gender affirmation, especially when urgent or compulsive, can act as a transferring addiction. The obsessive thinking style associated with ASD can easily fixate on gender topics, turning the pursuit of identity change into a Positive Addiction —a rigid, compulsive focus that promises external resolution for internal chaos. This compulsive engagement is the attempt to form a Trauma Bond with the new identity or the medical process itself, temporarily masking the inner void left by the unresolved childhood and environmental trauma.

B. The Pathological Loop: Misdiagnosis and Unresolved Trauma

When clinicians operate without these accurate definitions, the patient’s trauma is undiagnosed or misdiagnosed, leading to ineffective treatment:

  • Undiagnosed Trauma: The emotional turmoil of GDC is often seen purely as an identity issue, while the Neurodivergent individual’s history of sensory and social distress (which may include physical or emotional abuse) is not screened for as a source of trauma. This oversight violates fundamental dissociation-informed care principles.
  • Misdirected Treatment (The Reenactment Trap): Treating the intense, compulsive distress only with affirmation or medical intervention risks facilitating the Addictive Reenactment Loop. The pursuit of external change becomes the addictive behavior that satisfies the brain’s demand for immediate relief (delay discounting), but it fails to address the fragmented memory and emotional core. The anxiety and depression felt during this process are rational withdrawal symptoms from the instability of the self, yet they are often misattributed to the “mismatch” itself. The memory, which is activated but not fully resolved, is re-consolidated with its original charge, making the underlying trauma stronger and the identity fixation more intense—the definition of a destructive reenactment.

C. The Ethical Imperative: Moving Toward Integrated Care

The high comorbidity rates and the atypical presentation of neurodivergence with GD in ASD populations demand an integrated, dissociation-informed approach. As William White argued in his ethical critique of addiction treatment, treating the client in a one-size-fits-all model without recognizing individual differences (including neurodiversity and gender identity) is malpractice. Perpetuating that addiction is a disease (with no operational definition of addiction in the DSM) and overdiagnosing or overmedicating the population is criminal. Now, when the law is now holding those professionals who were enabling them accountable, what is the truth of who are the criminals? Refusing to accept that psychedelics produce healing states of dissociative consciousness and implicit wisdom, is insane because the science is so clear. Refuting the evidence that science is producing is psychological abuse.

The Wounded Healers Institute advocates for a methodology that integrates the fragmented parts of the self before focusing on external interventions. This requires clinicians and clients to:

  1. Embrace Process-Related Guidance: Recognize that clinical discrepancies between the client’s lived experience and the clinician’s understanding of dissociation are common. Focus on rapport, professional reflexivity, and cultural responsiveness.
  2. Facilitate Somatic Awareness: Utilize the principle that the body is the unconscious to help the client listen to the physical manifestations of their GDC, distinguishing trauma-related fragmentation (dissociation) from authentic identity.  
  3. Prioritize Memory Reconsolidation: Focus on psychological techniques to process the underlying trauma (the emotional distress) that is fueling the identity compulsion, allowing the individual to achieve the “unmet desire to heal” before the addictive pursuit of an external solution becomes cemented.  

II.The Wounded Healers’ Response to the Identity Crisis

Why Your Body is Rejecting Your Identity: The Somatic Truth of Gender Discomfort

Gender Discomfort (GD) is defined by a feeling of profound mismatch—but where does that feeling come from? It originates in the body, the true archive of your psyche. At the Wounded Healers Institute, we assert that the physical body is the psychological unconscious.  

For the Neurodivergent individual, the world is a constant source of sensory and social bombardment, leading to chronic trauma. The body’s response is dissociation—an adaptive survival mechanism that creates distance from the pain and the seeking of attachment for healing. When this defense becomes chronic, the feeling of being “mismatched” with one’s assigned gender is the ultimate somatic cry of the unconscious self, rejecting a reality that has felt profoundly unsafe and incongruent since childhood.  

If the “mismatch” were purely identity, it would not carry such overwhelming emotional turmoil and distress. That intensity is the signature of unresolved trauma—a desperate signal that the self is fragmented. Failing to define the body as the unconscious leads directly to misdiagnosis: treating the identity label as the problem, rather than the underlying trauma that made the body feel uninhabitable in the first place.

The Addictive-Dependent Loop: When Identity Search Becomes a Trauma Reenactment

The high comorbidity between Autism and Gender Discomfort reveals the dark side of a therapeutic pursuit: the risk of the healing process becoming an Addictive Reenactment Loop.

The core of the problem is the inadequate definition of addiction and its relationship to attachment styles and research. It is not a vice; it is a dependence on a behavior or substance to achieve temporary relief from distress, but also produce the state of healing that is needed to heal. When the Autistic individual’s tendency toward obsessive focus encounters the existential distress of GDC, the compulsive fixation on identity change or medical transition risks becoming a Positive Addiction. This is the tragic irony of the Addiction as Dissociation Model (ADM).

  • The compulsion provides immediate relief (a dopamine surge) and a false sense of control and certainty over a chaotic inner world.
  • The rush toward external change (medical intervention) is a Trauma Bond to a specific outcome. It bypasses the agonizing internal work of memory reconsolidation, which is the only true pathway to healing trauma.  

The result? The compulsive action repeats the trauma, solidifying the need for external dependence and trapping the person in the very pain they sought to escape. The solution is not to block the desire, but to validate it as the body’s unmet desire to heal, and redirect that immense energy toward profound internal integration. Intergenerational healing from the previous generations poisoning and abuse, either with intellectually or environmental, becomes all that important for the collective unconscious as to what exactly is going on.

The Path to Integration: Choosing Multiplicity Over Binary Certainty

Healing from trauma-related dissociation—especially GDC in Neurodivergent populations—demands rejecting the binary thinking that plagues our institutions. Our society, exemplified by the rigid logic of “1 + 1 only =’s 2,” is addicted to certainty. Yet, the human reality is multiplicity. The emotional distress that underlies GDC is a call to integrate the fragmented parts of the self. The Wounded Healers Institute’s approach empowers individuals to:

  1. Redefine Withdrawal: Recognize that the deep anxiety and depression experienced during identity exploration are rational withdrawal symptoms from the loss of the old, dependent self or the certainty of the obsession. This reframing replaces shame with compassion.  
  2. Embrace Dissociation-Informed Care: Acknowledge that dissociation is a functional response, not a flaw. The healing journey must start by establishing safety and trust so the individual can afford to drop their defenses and reconnect with the body-unconscious.
  3. Achieve Wholeness: The ultimate goal is not necessarily to find one single, permanent label, but to achieve a profound internal self-connection that makes the self feel safe, loved, and whole. This integrated self, having processed the wound, is the Wounded Healer, transforming their deepest pain into their greatest source of wisdom.

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References

O’Brien, A. (2023a). Addiction as Trauma-Related Dissociation: A Phenomenological Investigation of the Addictive State. International University of Graduate Studies. (Dissertation). Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023b). Memory Reconsolidation in Psychedelics Therapy. In Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023c). Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024a). Healer and Healing: The re-education of the healer and healing professions as an advocation. Re-educational and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024e). Path of the Wounded Healers for Thrivers: Perfectionism, Altruism, and Ambition Addictions; Re-education and training manual for Abusers, Activists, Batterers, Bullies, Enablers, Killers, Narcissists, Offenders, Parents, Perpetrators, and Warriors. Re-Education and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025a). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025b). Applied Recovery: Post-War on Drugs, Post-COVID, and What Recovery Culture and Citizens Require Moving Forward. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025c). Recovering Recovery: How Psychedelic Science Is Ending the War on Drugs. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

*This is for informational and educational purposes only. For medical advice or diagnosis, consult a professional.

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