The concept of massive gender trauma, a clinical syndrome arising at the intersection of the misgendering of transgender patients and the anguished experience of the natal body, is introduced. Psychoanalysts have become increasingly aware of the complex interactions between psyche, soma, and culture, and of the psychic risks inherent in misgendering. However, patients’ body dysphoria is often left unaddressed even by analysts who work within gendered experience. Through a detailed account of work with a five-year-old trans girl (female-identified, male-bodied), the developmental implications of the natal body’s not becoming sufficiently mentalized are tracked and explored. Attention to unconscious fantasy and its transformations shows the importance of helping transgender patients whose bodies are a source of suffering to be able to psychically represent their pain as a critical step in the process of a psychologically healthy sexual transition.
Keywords: Gender, misgendering, body dysphoria, unconscious fantasy, transgender