L’expérience vécue des pédopsychiatres amenés à prendre en charge des enfants prépubères avec incongruence de genre : une étude qualitative IPSE

Introduction

Gender dysphoria in children is a relatively recent concept with often criticized diagnostic criteria. Management of these cases remains challenging and typically follows multidisciplinary discussions within specialized teams: there is currently no consensus, and the heterogeneity of approaches is underpinned by numerous ethical and ideological questions. The diversity of clinical presentations, coupled with high comorbidity rates, force the clinician to deal with complex diagnostic and therapeutic challenges. It seems relevant to better understand the role and place of psychiatric follow-up in this specific context.

Objective

To deeply explore and describe the lived experiences of child psychiatrists involved in the care of children under 12 years old, consulting for gender incongruence. This exploratory approach aims to propose concrete recommendations for improving the quality of care for these children and to understand the challenges these child psychiatrists face.

Method

CHOICE is a multicentric and retrospective exploratory study, conducted between 2021 and 2023, based on semi-structured interviews with 12 French-speaking child psychiatrists who encountered prepubescent children with gender incongruence using the IPSE method introduced for qualitative research in medicine. The IPSE method uses a constructivist paradigm and a phenomenological and experiential approach. Recruitment, following the principle of purposive sampling, continued until data saturation was reached. Data analysis, consisting of a descriptive individual phase and a group structuring phase, was carried out using NVIVO software.

Results

The inductive analysis revealed a clinician experience structured around three main axes. The first axis focused on the social experience of child psychiatrists and the interaction between psychiatry and society, where there was a medical injunction within the societal and a societal injunction within the medical. The second axis related to the intimate experience and its impact in clinical practice. Finally, the third axis questioned the ethical experience of child psychiatrists, exploring how to perform their work effectively when there is a significant risk of being influenced by both internal and external factors.

Conclusion

The experiences of child psychiatrists emerge as being deeply influenced by political, social and societal issues that go beyond medical questions and the intersubjective dimension that plays out in their work with patients. Child psychiatrists must find a balance between the answer to immediate expectations and supporting the child's identity development. Societal challenges make this process complex, and the study's findings show that these tensions can hinder the care of the children and families they encounter.