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From a dynamic perspective, it is essential to search for links that may exist between the two disorders that affect this child. The attachment theory allows us to develop a hypothesis, based on the history of this boy and the clinical observations of the authors.
The affective deprivation of the first 16 months of life is indicated by the great difficulty with which the boy entered into a relationship with his adoptive parents. He obviously took a long time to accept his highly attentive adopted mother. This included an oppositional phase (so often observed in deprived children).that seemed to be intended to provoke maternal rejection. But why, during this slow relationship-forming process, did he flee from the male figure? Had he been abused by one or more males in his early childhood? If so, this could be the primary reason why he is inclined to adopt a female identity.
It may be, however, that the observed behaviour of the adoptive mother is influencing him to assume a female identity. One notes that his mother—in keeping with a process often observed in children thought to be traumatised and profoundly deprived—shows a tendency to put his needs before her own. She gave him an affectionate nickname that is typically given to females, and he demonstrates—even at the age of 6–7—a constant search for the approval of his adopted mother.
If the child has suffered trauma at the hands of a male figure, this overprotective behaviour by the adoptive mother might encourage the boy to imagine that, if he were a girl, he would receive all the affection he desired and missed during his first 16 months—a crucial period in self-development.