Gender Identity Disorder In Children Research Articles

A narrative review of gender dysphoria in childhood and adolescence: definition, epidemiology, and clinical recognition

A narrative review of gender dysphoria in childhood and adolescence: definition, epidemiology, and clinical recognition

European Academy of Paediatrics statement on the clinical management of children and adolescents with gender dysphoria.

Gender issues have become a polarised and political subject in modern paediatrics and indeed, in broader society. These include the management of infants with disorders of sex development and transgender sports participation, but especially recently regarding the management of gender dysphoria. The European Academy of Paediatrics (EAP) acknowledges that there are deeply held beliefs about this issue based on conscience and social norms. Several European countries, led by the UK, have recently reviewed the management of gender dysphoria in children and young people. Recognising the need for far more research into treatments such as pubertal suppression and cross-sex hormones in children and young people, we review the current ethical and legal dilemmas facing children with gender dysphoria, their families and the clinical teams caring for them. We suggest an approach that maintains the child's right to an open future whilst acknowledging that the individual child is the crucial person affected by decisions made and must receive appropriate support in decision-making and care for any associated mental health or psychological issues. Noting that national approaches to this vary and are in flux, the EAP advocates a child-centred individual rights-based analytical approach.

Detransition and Desistance Among Previously Trans-Identified Young Adults

Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US individuals ages 18–33 years who previously identified as transgender and had stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1 years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that “rapid-onset gender dysphoria” applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to trans-identification. Most participants (N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransition/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants’ own thought processes) than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is both possible and beneficial.

Phenomenological Interview and Gender Dysphoria: A Third Pathway for Diagnosis and Treatment.

Gender dysphoria (GD) is marked by an incongruence between a person's biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called "wait-and-see" approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a "third pathway" for the diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients' personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny's conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender.

Indicators for continuance of childhood gender dysphoria into adulthood: A critical interpretive synthesis of literature (2000–2020)

Introduction: Health professionals are unable to predict whether gender nonconforming distress or manifestations will continue after puberty. They also hold varied ideologies about gender. Information about these indicators lacks integration to benefit decision-making about how to intervene in childhood gender dysphoria. Aims: The aim of this review was to synthesize the literature on early indicators that anticipate the continuity of childhood gender dysphoria following puberty. A secondary aim, because of the ideological debates that underpin clinical decisions in transgender health care, was to critically interpret that literature. Methods: A critical interpretive synthesis was selected to integrate and offer a critical appraisal of literature (n=20). Results: A synthesizing argument was developed from four constructs: the intensity of gender dysphoric feelings, the child’s assertion of their gender identity, the stability of gender identity, and gender is a composite of multiple selves. Conclusions: The framing of experts’ arguments fed into presumed stability of gender identity. No single homogenous indicator can be postulated, but a compartmentalizing process is needed to understand the experiential world of a child’s gender nonconformity so that one concept (dysphoria about gender identity) can be teased apart from other investments of gender, body, and sexuality. Our constructs of the intensity of feelings and gender as a composite of multiple selves were found to challenge DSM-5 criteria. Understanding that multiple transitions may occur can help a child locate a gendered positioning in which they are comfortable. This could enable health practitioners offer affirmative care while remaining cautious about using medical treatments that cannot be reversed. The search for indicators itself, however, can be considered a historical moment, given the developments in the field in the 2 years after this review was conducted.

Features of gender identity disorders in schizophrenia spectrum disorders in comparison with transsexualism

The original study presents the results of a comparative analysis of the clinical, psychopathological, and psychosexual characteristics of gender identity disorders in schizophrenia spectrum disorders and transsexualism. The sample consisted of 120 people with complaints about the inconsistency between gender self-perception and the biological sex, divided into 2 groups: with schizophrenia spectrum disorders and transsexualism. It was found that in the patients with transsexualism, compared to those with schizophrenia spectrum disorders, the age of gender incongruence awareness fell on an earlier age period, and they more often had elements of trans-role behavior in childhood. The respondents with transsexualism more often had experience of living in an associated gender and less often made attempts to adapt in accordance with the gender assigned at birth. The psychosexual development of the patients with transsexualism was generally normative, while the patients with schizophrenia often showed delays in the platonic-erotic stage of libido. It was concluded that in the differential diagnosis of transsexualism and gender identity disorders in schizophrenia spectrum disorders, attention should be paid to such parameters as the presence of signs of gender identity disorders in childhood, age of gender incongruence awareness, experience of life in the associated gender, the presence of dysmorphophobic symptoms not related to sexual characteristics, and the results of a psychological examination of gender identity.

Experiences of Children with Gender Dysphoria/Gender Incongruence and their Parents with the Health Care System in Germany

The aim of the study is to describe experiences within the health care system of children and adolescents with gender dysphoria/gender incongruence (GD/GI) as well as their parents in Germany.The findings are intended to improve health care of children and adolescents with GD/GI and their families and have been incorporated into the development of the new S3 Guidelines "Gender Incongruence and Gender Dysphoria in Childhood and Adolescence: Diagnosis and Treatment". A total of 78 people, 35 children, adolescents, and young adults (6- 21 years) with GD/GI as well as 33mothers and 10 fathers, were interviewed. Seventeen semistructured individual interviews and five focus groups were conducted. Many of the participants reported waiting times of several months or years as well as inadequately trained doctors and therapists. A trans*identity, especially amongst smaller children and their parents, was often dismissed by health care providers, as a temporary phenomenon or an imagination of the child or the parents. Trans*ident children, adolescents and young adults as well as their parents were rarely perceived as experts in their own right. Recommendations for an affirmative care of trans* children and adolescents are formulated.

3.112 Age of Realization of Gender Identity and Mental Health Outcomes Among Transgender and Gender-Diverse Adults: Evaluating The “Rapid-Onset Gender Dysphoria” Hypothesis

The rapid-onset gender dysphoria (ROGD) hypothesis theorizes a distinct form of gender dysphoria in which individuals with no history of childhood gender dysphoria come to understand themselves as transgender and/or gender-diverse (TGD) in adolescence as a result of underlying mental illness, or as a “maladaptive coping mechanism.” This study evaluated the key components of the ROGD hypothesis by: 1) estimating the prevalence of realizing one’s TGD identity after childhood; and 2) determining whether this later realization is associated with poor mental health in adulthood.

An Attempt to Understand the Biology of Gender and Gender Dysphoria: A Christian Approach

The recent rise in the number of transgender individuals has perplexed many. A study of possible biological origins of gender dysphoria presents a complex picture. In some cases, prenatal hormonal imbalance may cause early-onset and persistent gender dysphoria. In contrast, late-onset cases are associated with a high incidence of comorbidities such as trauma, depression, and autism. In such cases, social isolation and an impaired body image may make individuals susceptible to social media suggestions of gender dysphoria. Moreover, affirmative counseling without addressing underlying comorbidities can strengthen this misperception, further moving these individuals along a trajectory toward transition. Care must be taken when considering early transition, given the fact that childhood gender dysphoria frequently desists. One must balance sparing a child from the distressing sexual changes of puberty with beginning transition in someone who might otherwise have desisted. Recent studies of perception suggest that it is a top-down predictive, "best guess" process. Although these "guesses" are continuously modified by sensory experience, they can persist; they might also apply to some cases of gender dysphoria. While some people have managed to detransition back to their natal gender, we should not assume that this is possible with everyone. As Christians, we need to examine each case individually, removing the stigma and supporting them through this distressing condition.

Health Psychology Gender Identity Disorder Clinical Picture - Types - Epidemiology

This paper is a literature review of scientific articles covering a period from 1970 to 2020. It addresses the issue of gender identity disorder in children, adolescents and young adults. The purpose of this paper is to present the issue of gender disorder, through the prism of modern psychological data. Reference is made to the etiology, the clinical picture.

Health Psychology Gender Identity Disorder Clinical Picture - Types - Epidemiology

This paper is a literature review of scientific articles covering a period from 1970 to 2020. It addresses the issue of gender identity disorder in children, adolescents and young adults. The purpose of this paper is to present the issue of gender disorder, through the prism of modern psychological data. Reference is made to the etiology, the clinical picture.

Rise of gender identity disorders among children and adolescents- data from 10 countries

There is growing number of publications pointing to the global trend of a significant increase in people who identify differently to their biological sex. Children and adolescents are a particularly sensitive group here, as their identity is still under development. These trends are also reaching Poland. Parents and state services involved in the upbringing and education may be surprised and unprepared. There is small number of analyzes of these trends, especially in the context of the already available knowledge about gender identity disorders and further practical recommendations. The first part of the article presents epidemiological data illustrating the occurrence of gender identity disorders in the population. The methodological challenge was to define a reliable criterion illustrating the strength and scope of the observed changes in epidemiology among children and adolescents and at the same time enabling international comparisons of data from autonomous and world-wide clinics as the problem is the data availability at all. The article presents data on the explosion of gender identity disorders in children and adolescents based on the criterion of number of referrals to youth clinics from 8 countries: Sweden - an increase of 19,700%, Italy - 7,200%, Great Britain - 2,457%, the Netherlands - 904% and outside Europe: Australia - 12,650%, Canada - 538%, USA - 275%, and New Zealand - 187% (the article gives the exact time range). This data were also subjected to qualitative analysis (gender and age of reports, number of referrals versus diagnoses). The explanations given in the scientific literature were also collected and analyzed in relation to the available knowledge about the genesis of gender dysphoria, which, according to research, is predominantly of environmental origin. Both the scale of the trend and additional qualitative analyzes (change of the clinical picture and the inflow to clinics, especially of teenage girls), indicate that this trend cannot be explained only by an increase in social awareness, but also by the inducing influence of media and culture (additional studies that support these conclusions are mentioned). The article provides an overview of the available knowledge in the field of the epidemiology of gender identity disorders, especially in children and adolescents, and helps to define practical steps, especially in the neglected area of ​​prevention, which is crucial from the point of view of parents.

Re Imogen: the role of the Family Court of Australia in disputes over gender dysphoria treatment.

This article examines Re Imogen (No 6) (2020) 61 Fam LR 344, a decision of the Family Court of Australia, which held that an application to the Family Court is mandatory if a parent or a medical practitioner of a child or adolescent diagnosed with gender dysphoria disputes the diagnosis, the capacity to consent, or the proposed treatment. First, we explain the regulatory framework for the medical treatment of gender dysphoria in children and adolescents, including the development of the welfare jurisdiction under Section67ZC of the Family Law Act 1975 (Cth). We then provide an overview of the Re Imogen decision, and discuss the balancing exercise involved in determining a child's best interests in the medical treatment context. We challenge the Family Court's conclusion that, in relation to a dispute about diagnosis or treatment, a finding that the child or adolescent is Gillick competent to consent to treatment is not determinative, and the Family Court must determine the dispute. We argue that this conclusion represents an unjustified incursion into the right of Gillick competent transgender children and adolescents to make decisions about their own bodies and identities, and that the protective role of parents and the Family Court cannot justify interfering with their bodily autonomy in this context. Finally, we propose an alternative regulatory framework that removes the Family Court from the medical treatment process for gender dysphoria in circumstances of dispute between a parent and their Gillick competent child.

The Third Backdoor: How the DSM Casebooks Pathologized Homosexuality

ABSTRACT This study argues that institutional psychiatry’s pathologizing stance on homosexuality persisted after 1973, when the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. It persisted not only through the well-known diagnoses of “ego-dystonic homosexuality” and “gender identity disorder of childhood,” but also through case studies published in four editions of the DSM Casebooks (1981, 1989, 1994, 2002), the APA publications advertised as a “learning companion to the Diagnostic and Statistical Manual.” These publications contained harmful and false homosexual stereotypes, associating gay men with child abuse, violence, and sexual sadism; associating homosexuality with mental disturbance while failing to similarly mark heterosexuality or bisexuality; associating psychopathology with gay social contexts while failing to similarly mark non-gay social contexts. This study provides evidence that the DSM Casebooks portrayed homosexual women and bisexuals as invisible, and homosexual men as narcissistic, predatory, and dangerous.

Progression of Gender Dysphoria in Children and Adolescents: A Longitudinal Study.

BACKGROUND AND OBJECTIVESThe progression of gender-expansive behavior to gender dysphoria and to gender-affirming hormonal treatment (GAHT) in children and adolescents is poorly understood.METHODSA cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria–related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups.RESULTSOverall, 29% of participants received a GDRD and 25% were prescribed GAHT during the average follow-up of 3.5 years (maximum 9 years). Compared with youth assigned male sex at birth, those assigned female sex at birth were more likely to receive a diagnosis and initiate GAHT with hazard ratio (95% confidence interval) estimates of 1.3 (1.0–1.7), and 2.5 (1.8–3.3), respectively. A progression to diagnosis was more common among those aged ≥15 years at initial presentation compared with those aged 10 to 14 years and those aged 3 to 9 years (37% vs 28% vs 16%, respectively). By using the youngest group as a reference, the adjusted hazard ratios (95% confidence interval) for a GDRD were 2.0 (1.3–3.0) for age 10 to 14 years and 2.7 (1.8–3.9) for age ≥15 years. Racial and ethnic minorities were less likely to receive a diagnosis or be prescribed GAHT.CONCLUSIONSThis study characterized the progression of GD behavior in children and adolescents. Less than one-third of GD youth receive an eventual GDRD, and approximately one-quarter receive GAHT. Female sex at birth, older age of initial GD presentation to medical care, and non-Hispanic white race and ethnicity increased the likelihood of receiving diagnosis and treatment.

Mental health correlates and potential childhood predictors for the wish to be of the opposite sex in young autistic adults.

Autistic people/people with autism spectrum disorder are more likely to experience gender dysphoria. However, the possible longitudinal predictors and underlying mechanisms of this co-occurrence are unclear. To fill this knowledge gap, we assessed 88 people with autism spectrum disorder and 42 typically developing individuals at their average ages of 13.0 (baseline, childhood/adolescence) and 20.2 years old (follow-up, adulthood). At follow-up, their endorsement on the item "I wish I was the opposite sex" was used to evaluate gender dysphoric symptoms. We compared mental health symptoms between adults with and without this item endorsement at the follow-up assessment. We explored parent-reported family and autism characteristics-related predictors in childhood/adolescence to this item endorsement in adulthood. We found that more autistic adults reported the wish to be of the opposite sex than did typically developing individuals. Autistic adults who endorsed this item experienced more mental health challenges, more school bullying and cyberbullying, more suicidal ideation, and worse quality of life. Moreover, parent-reported lower family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. More attention and support should be provided to autistic people regarding gender development and related mental health and quality of life impact, especially during the transition period to young adulthood.

“This is not me”; an overview

IntroductionAPA describes Gender dysphoria (GD) as the conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. Recently DSM-V renamed gender identity disorder as “gender dysphoria”. This change in terminology removes the ‘pathology’ from being transgender, which is not a mental health condition.ObjectivesTo systematically summarise available evidence in this important but less researched field.MethodsA comprehensive review was carried using the PubMed/ Medline database.ResultsFormal epidemiological studies of gender dysphoria in children and adolescents have not been conducted. The true prevalence os gender dysphoria is unknown around the world because of the varying definitions, different cultural norms and lack of data. Individuals who identify as transgender are vulnerable, and have higher rates of psychiatric comorbility compared with the general population. Gender dysphoria, gender identity disorder or transsexualism is a psychological condition that requires care and multiple health professionals.ConclusionsThe natural history of gender identity for children who express gender nonconforming or transgender identities is an area of active research. In addition, there is a lack of guidelines to approach these patients.

A Follow-Up Study of Boys With Gender Identity Disorder.

This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33–12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07–39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.

Body image in children with gender incongruence.

Background:In the DSM-5 diagnosis of childhood Gender Dysphoria, two of the eight criteria focus on body satisfaction of the child. Nevertheless, this subject is understudied. This study aims to describe the body image of children with gender incongruence (GI) in relation to birth assigned sex and the intensity of GI.Method:Self-report and parent-report measures on body satisfaction and gender incongruence were obtained from 207 children (<12 years) who were referred to the Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Centers, location VUmc, between 2010 and 2016. First, a general description of body satisfaction in children who took part in this study is provided. Secondly, body image of birth assigned boys and girls are compared using chi-square tests and univariate ANCOVA’s. Thirdly, the association between intensity of GI and body image is examined using multiple linear regression analyses.Results:Of the 207 children with GI, 50% reported dissatisfaction with their gender-specific characteristics. Overall, children were less dissatisfied with their neutral body characteristics. Birth assigned girls report greater dissatisfaction with their body characteristics than birth assigned boys. Intensity of GI was significantly related to satisfaction with gender specific body characteristics where a greater intensity of GI relates to more body dissatisfaction.Conclusion:Mental health practitioners should be aware of the diversity in body dissatisfaction in this group. Furthermore, evaluation of body image should be an important topic in the counseling of these children. Future research should focus on the relation of body dissatisfaction and the development of gender incongruent feelings in children with GI.

Gender dysphoria in children and adolescents – a disease far from pediatric practice?

Gender dysphoria in children and adolescents – a disease far from pediatric practice?