A developmental model of gender identity course based on Hamburg sample of children with gender dysphoria

Abstract

There are few data concerning first signs and developmental trajectories of people with gender variant behaviours and this paper aims to describe them in a clinical sample. Method: This paper presents a chart review of 44 children and adolescents assessed for gender dysphoria in Child and Adolescent Psychiatry and Psychotherapy, at the University Hospital Hamburg, Germany. I used information from these charts to reconstruct the course of cross-gender behaviour and identity in these patients from birth up to the time of assessment and organised it in a model. I looked into the pattern of development being representative of this sample and examined continuity/variability within individuals over time. Results: First signs at behavioural level appeared in most cases since the beginning and were consistently reported during preschool years (84%). A prior period of gender typical behaviour before onset of cross-gender behaviour was rare. Conclusion: A particular finding in this clinic based sample is that gender identity expressed around the age of 3-5 years was not reversed later in life. There was a common pattern of development in majority of cases: first signs in kindergarten age and strongly re-emergence around puberty, which might have implications in referral times of this group in the clinic.