Notes on Perceived Parenting Styles of Individuals With Gender Dysphoria

Source: Garcia CC, Schwarz K, Costa AB, Bridi Filho CA, Lobato MIR (2021). Perceived Parenting Styles of Individuals With Gender Dysphoria. Frontiers in Psychology, 12:655407. DOI: 10.3389/fpsyg.2021.655407
Publication type: Brief research report
Language: English
Structure covered: Objective, Design/Methods, Instruments, Procedures, Data Analysis, Results, Discussion, Limitations, Conclusion, Ethics/Funding/Declarations

Objective

Map patterns of behavior of parents and/or caregivers as perceived by their adult children who are transgender patients seen through PROTIG (Programa Transdisciplinar de Identidade de Gênero).
Determine whether one parenting style was more prevalent among the sample.

Key Concepts and Theoretical Background

Gender dysphoria (GD) vs. gender incongruence:
- DSM-5 (2013): marked incongruity between experienced/expressed gender and birth-assigned gender; strong desire to eliminate primary/secondary sex characteristics; duration ≥ 6 months; impairment in social/academic/other areas.
- ICD-11 (WHO, 2018) removed “transgender” from mental illness, renaming it gender incongruence.
Prevalence references cited:
- Males at birth: ~0.005–0.014%; females at birth: ~0.02–0.03% (DSM-5 era references).
Foundational parenting theory (selected):
- Baumrind (1966): authoritative parenting with firm rules/limits but non-repressive and participatory is more effective than authoritarian or permissive styles.
- Maccoby & Martin (1983): two core dimensions of parental socialization: demand/control (limits, rules) and responsiveness (emotional support). Indulgent vs. neglectful/extremely lax styles emerged later.
- Darling & Steinberg (1993): parenting style as context influencing child development.
Parental rearing measures:
- Inventory for Assessing Memories of Parental Rearing Behavior (EMBU): early work comparing transgender individuals to controls.
Parental style measurement in this study:
- Parental Style Inventory (PSI) by Gomide (2006): 42 items across seven educational practices; split into two domains: positive (social) and negative (antisocial) behaviors.
PSI scoring framework (formula):
- Positive practices: A = Positive Monitoring, B = Moral Behavior.
- Negative practices: C = Inconsistent Punishment, D = Negligence, E = Relaxed Discipline, F = Negative Monitoring, G = Physical Abuse.
- PSI score: PSI = (A + B) - (C + D + E + F + G)
- Score interpretation: positive PSI indicates relatively more positive parenting practices; negative PSI indicates stronger negative influences.
- Score range: -60 ext{ (complete absence of positive practices)} ext{ to } +24 ext{ (absence of negative practices)}
- Categorization (relative): Great parenting style; Regular above average; Regular below average; Risky parenting style (predominance of negative practices).
PSI constructs (operational definitions used in this study):
- Positive Monitoring (A): knowing children’s whereabouts/activities and how they adapt.
- Moral Behavior (B): imparting values such as justice, compassion, and friendship.
- Inconsistent Punishment (C): irregular or unpredictable punitive responses.
- Negligence (D): ignoring children’s behavior; little or no response when they initiate communication.
- Relaxed Discipline (E): withdrawing from conflict when children do not comply with rules.
- Negative Monitoring (F): excessive control and coercive orders.
- Physical Abuse (G): use of physical force intended to cause pain.
The instrument is designed to capture two broad domains:
- Positive social behaviors (A, B).
- Antisocial/negative behaviors (C–G).

Materials and Methods

Participants

Setting: PROTIG/HCPA (Porto Alegre General Hospital, Brazil).
Design: Cross-sectional, convenience sampling.
Timeframe: October 2017 to July 2018.
Sample size rationale: Calculated using WinPepi v11.65. With a 95% confidence level, a margin of error around two units, and an SD of 10.02 on the referenced IEP scale (per Sampaio & Gomide, 2007), a sample size of 99 was deemed appropriate; 82 participants ultimately participated.
Included individuals: Adults with GD diagnosed per DSM-5 criteria; seen at PROTIG outpatient clinic.
Final sample: 82 participants (32 transgender men [TM], 50 transgender women [TW]); age 18–59 years.
Subsample sizes for analysis: 65 parental protocols concerning fathers; 80 concerning mothers (participants could complete one or both protocols).
Sociodemographics (Table 1, summarized):
- Age distribution: Up to 29 years (38; 46.3%), 30–39 years (29; 35.4%), over 40 years (13; 15.9%), and a small portion did not answer.
- Gender identity of participants: Transgender men (TM) = 32 (39.0%), Transgender women (TW) = 50 (61.0%).
- Education: Most had high school or less; some had begun/completed higher education; a subset did not answer.

Instrument

Parenting Style Inventory (PSI) – Gomide 2006: 42 items; seven educational practices; 6 items per practice.
Two positive practices: A (Positive Monitoring) and B (Moral Behavior).
Five negative practices: C (Inconsistent Punishment), D (Negligence), E (Relaxed Discipline), F (Negative Monitoring), G (Physical Abuse).
Scoring: PSI = (A + B) − (C + D + E + F + G).
Interpretation: Positive PSI indicates dominance of positive practices; negative PSI indicates dominance of negative practices.
Score range: −60 to +24.
Categories (as described): Great parenting style; Regular above average; Regular below average; Risky parenting style.

Procedures

Procedures followed standard ethical research practice: informed consent obtained; anonymity guaranteed; data access restricted to researchers.
Data collection location: On PROTIG/HCPA premises; in-person administration.
Inclusion criteria: GD diagnosis per DSM-5; adults seeking gender-affirming care.

Data Analysis

Reliability: Cronbach’s alpha for PSI calculated to assess internal consistency.
Grouping: Participants divided into three age groups for some analyses: up to 29 years, 30–39 years, over 40 years.
Statistical tests: Analysis of Variance (ANOVA) to compare PSI scores across age groups; post hoc tests (Tukey’s HSD) used for pairwise comparisons where appropriate.
Effect size: Cohen’s d reported for certain between-group contrasts (e.g., maternal vs paternal differences among TW).
Additional notes: Some analyses split data by transgender identity (TM vs TW) and by parent (maternal vs paternal) to examine differential perceptions.

Results

Overall PSI reliability

Cronbach’s alpha for the PSI:
- ext{Cronbach’s } \alpha = 0.77
- Interpreted as reasonable internal consistency (Pestana & Gageiro, 2008).

Descriptive PSI by parent and gender identity (Table 2)

Sample sizes (protocols) by identity and parent:
- Maternal PSI for TW: n = 50; Mean = +1.92; SD ≈ 11.62; Range: −27 to +21.
- Paternal PSI for TW: n = 38; Mean = −5.82; SD ≈ 14.20; Range: −38 to +16.
- Maternal PSI for TM: n = 30; Mean = −2.87; SD ≈ 12.41; Range: −27 to +15.
- Paternal PSI for TM: n = 27; Mean = −4.52; SD ≈ 11.27; Range: −30 to +11.
Interpretation of Table 2 results:
- Transgender women (TW) showed a slightly positive mean perception of their relationship with mothers (A+B dominance) and a more negative mean perception of their relationship with fathers (A+B dominance relatively lower).
- Transgender men (TM) showed negative mean perceptions for both maternal and paternal relationships, indicating a tendency toward more negative parenting experiences across both parents, with slightly less negativity for maternal outcomes than paternal in some indices.
Key between-group contrast (TW maternal vs TW paternal): TW maternal perceptions were significantly more positive than TW paternal perceptions (p = 0.001, t = 3.77, df = 37; Cohen’s d ≈ 0.60).
Additional note: Among TW, maternal perceptions were more positive overall, while paternal perceptions tended to be negative (i.e., riskier parenting style) relative to maternal perceptions.

Detailed average scores by parent and identity (Table 3)

Average and standard deviation for each of the seven PSI practices (A–G) by group:
- Transgender men (TM) — maternal (n = 30):
- A: 7.47 (3.44)
- B: 7.83 (2.20)
- C: 3.57 (2.40)
- D: 4.60 (3.40)
- E: 2.97 (2.63)
- F: 5.03 (2.34)
- G: 2.00 (2.00)
- Transgender men — paternal (n = 27):
- A: 5.56 (3.14)
- B: 6.81 (3.34)
- C: 3.04 (2.44)
- D: 5.30 (3.45)
- E: 2.26 (1.91)
- F: 3.48 (2.24)
- G: 2.81 (3.64)
- Transgender women (TW) — maternal (n = 50):
- A: 9.08 (2.47)
- B: 9.46 (2.34)
- C: 3.48 (2.44)
- D: 3.06 (2.97)
- E: 2.92 (2.11)
- F: 5.00 (2.09)
- G: 2.16 (2.90)
- Transgender women — paternal (n = 38):
- A: 5.61 (3.58)
- B: 7.31 (3.32)
- C: 3.87 (2.93)
- D: 4.76 (3.63)
- E: 2.66 (2.10)
- F: 3.87 (3.07)
- G: 3.58 (3.78)
Notable significance markers (as per Tukey’s post hoc within columns):
- For practice A and B, maternal scores (both TM and TW groups) tended to be higher than paternal scores, with TW maternal often highest overall.
- For practice D (Negligence), TM paternal scores were higher than TW maternal scores, indicating more negative paternal behavior perceived for TM than maternal behavior perceived for TW.
- Other practices (C, E, F, G) showed limited or no significant differences between groups in most contrasts, though some p-values approached significance in specific comparisons.

Mean perceptions of negligence (Table 4)

Overall mean negligence perception (PSI negligence component) across groups:
- Maternal PSI (n = 80): Mean = 0.13; SD ≈ 12.07; Range: −27 to +21.
- Paternal PSI (n = 65): Mean = −5.28; SD ≈ 12.98; Range: −38 to +16.
Interpretation: On average, mothers were perceived as having somewhat positive overall parenting practices (near zero to positive) whereas fathers were perceived more negatively with a negative mean around −5.28.

Summary of group differences reported in the text

Transgender women (TW):
- Positive perception of maternal relationship (mean positive value) and negative perception of paternal relationship.
- Significant differences in several positive practices (A and B) favoring mothers over fathers (p = 0.0001 for A; p = 0.0001 for B in the reported analyses).
- Maternal vs paternal differences were significant, with mothers perceived as exhibiting more positive practices.
Transgender men (TM):
- Negative perceptions for both maternal and paternal parenting styles, interpreted as “risky” parenting styles for both parents, with some nuance in D (negligence) where paternal D exceeded maternal D in perceived negativity.
Between TM and TW: some differences in paternal D (negligence) and in maternal vs paternal scores, reinforcing the idea that gender identity of the child modifies perceived parental behavior.
Overall pattern for the entire sample: both TM and TW tended to view mothers more positively than fathers; TW especially showed a clear maternal advantage in positive practices.

Discussion

The study reaffirms a history of rejection and mistreatment narratives among individuals with GD, framing the motivation for family-based education and support (WPATH and broader mental health supports).
Maternal influence: Across groups, mothers tended to be perceived as more accepting and used more positive parenting practices than fathers, aligning with prior literature suggesting maternal acceptance supports GD individuals’ adjustment.
Fathers’ involvement: Fathers were often perceived as more negative or less supportive, with some evidence of greater neglect (especially in TM) and higher negative monitoring in some cases, which the authors discuss in the context of broader cultural attitudes toward gender nonconformity.
Gender-specific patterns:
- TW: Mothers perceived as providing more positive practices; fathers perceived as less positive or more negative, particularly in A and B (positive monitoring and moral behavior).
- TM: Both parents perceived more negatively overall, with some evidence of higher neglect (D) in paternal perceptions than maternal ones.
Cultural and societal context (Brazil): The authors discuss the prevalence of female-headed households and the social latitude toward mothers in Brazil, yet acknowledge homophobic currents and the particular difficulty fathers have in engaging with GD issues. They compare findings to Western contexts and other studies (e.g., Simon et al., 2011; Lai et al., 2010) noting similarities and potential cultural explanations.
Age and education effects: No significant association between age or education and PSI scores in this sample; no generational shift detected regarding more positive parenting styles post-1990s (despite expectations that younger cohorts might show more tolerant parenting styles).
Maternal role in GD: The data reinforce the idea that the maternal role is central to family dynamics and support for GD individuals, particularly for TW, whose maternal relationships appear more positive on average.

Limitations

Cross-sectional and descriptive in nature; cannot infer causality.
Convenience sample from a single program (PROTIG/HCPA) with regional relevance to Brazil; results may not generalize to other cultures or settings.
No control group of non-GD individuals and no age/education-matched control, limiting comparisons to non-GD populations.
Some data limitations: incomplete sociodemographic information (education data had missing values in places); not all participants completed both maternal and paternal protocols.
Lack of qualitative data: no in-depth interviews to illuminate contextual factors behind parenting behaviors.
The authors note the exploratory nature and encourage replication with larger, more diverse samples and inclusion of parental perceptions as well.

Practical and Ethical Implications

Clinical relevance: Findings suggest a need for mental health professionals to engage families, particularly fathers, in education and supportive interventions to create a more welcoming environment for individuals with GD.
Family-based supports: Emphasize the importance of parental education programs that address gender diversity and GD acceptance to improve family functioning and GD individuals’ social adaptation.
Policy and cultural considerations: Brazilian context discussed; results may reflect broader societal attitudes toward gender nonconformity and highlight the necessity of culturally sensitive family work.

Conclusions

Since 1998, PROTIG/HCPA has provided support and research to assist GD individuals seeking gender-affirming care.
Positive family relationships correlate with better interpersonal relationships, quality of life, and emotional balance, particularly in GD contexts where social barriers are high.
Main conclusion: Fathers, more so than mothers, require encouragement to participate in understanding GD; families should receive mental health support to foster a more welcoming environment for individuals with GD.
Future directions: Expand the sample, include parental self-perceptions, incorporate qualitative interviews, and add a control group to strengthen comparative inferences.

Ethics, Funding, and Declarations

Ethics: Study approved by Comitê de Ética em Pesquisa—HCPA. Written informed consent obtained from all participants.
Data availability: Original data included in the article/supplementary material; inquiries directed to corresponding authors.
Funding: Supported by CNPq, CAPES, the Graduate Program in Behavioral Sciences and Psychiatry at UFRGS, and FIPE (Hospital de Clinicas de Porto Alegre).
Conflicts of interest: Authors declare no potential conflicts of interest.

Quick recap for exam-style recall

PSI framework and calculation: PSI = (A + B) - (C + D + E + F + G) with A = Positive Monitoring, B = Moral Behavior; C–G = various negative practices; score range −60 to +24.
Key findings: TW perceive mothers more positively than fathers; TM perceive both parents more negatively; maternal positivity is a protective pattern, paternal negativity more common in GD contexts.
Implications: Need for family-focused interventions, especially involving fathers, within cultural contexts like Brazil; support from mental health professionals to foster a welcoming environment for GD individuals.
Limitations to remember for critique: cross-sectional, convenience sample, single-site, no control group, lack of parental perspectives, limited qualitative data.

References and Related Concepts (selected cited works)

American Psychiatric Association (2013). DSM-5.
World Health Organization (2018). ICD-11 updates and gender incongruence terminology.
Baumrind, D. (1966). Effects of authoritative parental control on child behavior. Child Development.
Maccoby, E., & Martin, J. (1983). Handbook of Child Psychology: Socialization, Personality, and Social Development.
Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model. Psychological Bulletin.
Gomide, P. (2006). Inventário de estilos parentais. Manual de aplicação e interpretação.
Cohen-Kettenis, P. T., & Arrindel, W. A. (1990). Perceived parental rearing style, parental divorce and transgender. Psychological Medicine.
Lai, M. C., et al. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior.
Simon, L., Zsolt, U., Fogd, D., & Czobor, P. (2011). Dysfunctional core beliefs, perceived parenting behavior and psychopathology in gender identity disorder. Journal of Behavioral Therapy and Experimental Psychiatry.
Weber, L., Prado, P., Viezzer, A., & Brandenburg, O. (2004). Identificação de estilos parentais: O ponto de vista dos pais e dos filhos. Psicologia, Reflexão e Crítica.